The prognostic significance of preoperative tumor marker (CEA, CA15-3) elevation in breast cancer patients: data from the Korean Breast Cancer Society Registry

Single-atom iron boosts electrochemiluminescence for ultrasensitive carcinoembryonic antigen detection

A simple and ultrasensitive sandwich-type electrochemiluminescence (ECL) immunosensor has been developed using porous three-dimensional gold nanoparticles (Au NPs) iron(Fe)-zinc(Zn) metal-organic frameworks (Au NPs-FeZn-MOFs@luminol) as high-efficiency ECL signal probes with Fe single-atom catalysts (SACs) (Fe-N-C SACs) as potentially advanced coreaction accelerators and dissolved oxygen as a coreaction agent to realize an H2O2-free amplification method for detecting carcinoembryonic antigen (CEA). The cathodic ECL of luminol, which was usually negligible, increased first. Because the Fe-N-C SACs exhibited an outstanding catalytic performance and a unique electronic structure, different reactive oxygen species (ROS) were generated via the oxygen reduction reaction. ROS oxidized the luminol anions to luminol anion radicals, preventing the time-consuming luminol electrochemical oxidation. Furthermore, the luminol anion radicals generated in situ reacted with ROS to produce potent cathodic ECL emissions. The immunosensor exhibited favorable analytical accuracy (detection range: 0.1 pg mL-1 - 80 ng mL-1), and its detection limit for serum samples was 0.031 pg mL-1 (S/N = 3). Consequently, the proposed strategy offers a new approach for early screening of CEA.

The dual-crosslinked prospective values of RAI14 for the diagnosis and chemosurveillance in triple negative breast cancer

OBJECTIVE

The exploration of non-invasive biomarkers for assessing tumor response is critical to optimize treatment decisions. In this study, we aimed at determining the potential role of RAI14 in the early diagnosis and evaluation of chemotherapy efficacy in triple-negative breast cancer (TNBC).

METHODS

We recruited 116 patients newly diagnosed with breast cancer, 30 patients with benign breast disease and 30 healthy controls. In addition, 57 TNBC patients were collected in serum at different time points (C0, C2 and C4) for chemotherapy monitoring. The expression of serum RAI14 and CA15-3 were quantified by Elisa and electrochemiluminescence assay, respectively. Then we compared the performances of markers with the chemotherapy efficacy assessed by imaging.

RESULTS

RAI14 is significantly overexpressed in TNBC and is linked to adverse clinicopathological features such as tumor burden, CA15-3 levels and the ER, PR, and HER2 status of the patients. ROC curve analysis showed that RAI14 improves the diagnostic performance for CA15-3(AUCRAI14 = 0.934 vs. AUCCA15-3 = 0.836), especially embodied in early-stage breast cancer diagnosis and patients with CA15-3 negativity. Furthermore, RAI14 behaves well in reproducing treatment response which was consistent with clinical Imaging assessment.

CONCLUSIONS

Recent studies showed that RAI14 has a complementary effect to CA15-3 and a test combining the two parameters can improve the detection rate of early triple-negative breast cancer. At the same time, RAI14 plays a more important role in chemotherapy monitoring than CA15-3 as the change in its concentration is in line with the tumor volume variation. Taken together, RAI14 is a reliable novel marker in the early diagnosis and chemotherapy monitoring of triple-negative breast cancer.

Non-sentinel lymph node metastases risk factors in patients with breast cancer with one or two sentinel lymph node macro-metastases

Approximately 59 % of patients with breast cancer with one or two sentinel lymph nodes (1-2 SLN) macrometastases do not benefit from axillary lymph node dissection (ALND), which may also incur morbidities. It is necessary to evaluate the association between various clinicopathological characteristics and non-sentinel lymph node metastases (non-SLNM) in patients with breast cancer with 1-2 SLN macrometastases, and determine whether they 1-2 should avoid ALND. Eight electronic literature databases (PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal, Wanfang, and Chinese Biomedical Literature) were searched from their inception to June 30, 2023, and two reviewers independently extracted the data and assessed the risk of bias. Association strength was summarized using odds ratios (OR) and 95 % confidence intervals (CI). Heterogeneity was accounted for using a subgroup analysis. Publication bias was evaluated using funnel plots and Egger's test. There were 25 studies with 8021 participants, and 27 potential risk factors were evaluated. The risk factors for non-SLNM in patients with 1-2 SLN macrometastatic breast cancer include the following: factors of primary tumor: multifocality (OR (95 % CI (2.63 (1.96, 3.54))), tumor size ≥ T2 (2.64 (2.22, 3.14)), tumor localization (upper outer quad) (2.06 (1.23, 3.43)), histopathological grade (G3) (2.45 (1.70, 3.52)), vascular invasion (VI) (2.60 (1.35, 4.98)), lymphovascular invasion (LVI) (2.87 (1.80, 4.56)), perineural invasion (PNI) (3.16 (1.18,8.43)). Factors of lymph nodes: method of SLNs detected (blue dye) (3.85 (1.54, 9.60)), SLN metastasis ratio ≥0.5 (2.79 (2.24, 3.48)), two positive SLNs (3.55, (2.08, 6.07)), zero negative SLN (3.72 (CI 2.50, 4.29)), extranodal extension (ENE) (4.69 (2.16, 10.18)). Molecular typing: Her-2 positive (2.08 (1.26, 3.43)), Her-2 over-expressing subtype (1.83 (1.22, 2.73)). Factors of examination/inspection: axillary lymph nodes (ALNs) positive on imaging (3.18 (1.68, 6.00)), cancer antigen 15-3 (CA15-3) (4.01 (2.33,6.89)), carcinoembryonic antigen (CEA) (2.13 (1.32-3.43)). This review identified the risk factors for non-SLNM in patients with 1-2 SLN macrometastatic breast cancer. However, additional studies are needed to confirm the above findings owing to the limited number and types of studies included.

A human pilot study on positive electrostatic charge effects in solid tumors of the late-stage metastatic patients

Background

Correlative interactions between electrical charges and cancer cells involve important unknown factors in cancer diagnosis and treatment. We previously reported the intrinsic suppressive effects of pure positive electrostatic charges (PEC) on the proliferation and metabolism of invasive cancer cells without any effect on normal cells in cell lines and animal models. The proposed mechanism was the suppression of pro-caspases 3 and 9 with an increase in Bax/Bcl2 ratio in exposed malignant cells and perturbation induced in the KRAS pathway of malignant cells by electrostatic charges due to the phosphate molecule electrostatic charge as the trigger of the pathway. This study aimed to examine PECs as a complementary treatment for patients with different types of solid metastatic tumors, who showed resistance to chemotherapy and radiotherapy.

Methods

In this study, solid metastatic tumors of the end-stage patients (n = 41) with various types of cancers were locally exposed to PEC for at least one course of 12 days. The patient's signs and symptoms, the changes in their tumor size, and serum markers were followed up from 30 days before positive electrostatic charge treating (PECT) until 6 months after the study.

Results

Entirely, 36 patients completed the related follow-ups. Significant reduction in tumor sizes and cancer-associated enzymes as well as improvement in cancer-related signs and symptoms and patients' lifestyles, without any side effects on other tissues or metabolisms of the body, were observed in more than 80% of the candidates.

Conclusion

PECT induced significant cancer remission in combination with other therapies. Therefore, this non-ionizing radiation would be a beneficial complementary therapy, with no observable side effects of ionizing radiotherapy, such as post-radiation inflammation.

An ultrasensitive electrochemical immunosensor for carcinoembryonic antigen detection based on two-dimensional PtPd/Cu-TCPP(Fe) nanocomposites

Establishing an effective signal amplification strategy is the key to achieving sensitive detection of analytes by electrochemical immunoassay. In this work, a novel sandwich-type electrochemical immunosensor with dual-signal amplification was successfully constructed using PtPd/Cu-TCPP(Fe) as the sensing platform and mesoporous silicon dioxide as the signal amplifier. Firstly, two-dimensional wrinkled Cu-TCPP(Fe) nanomaterials loaded with PtPd nanoparticles have strong affinity for the immobilization of capture antibodies and can generate excellent electrochemical signals. Meanwhile, the mesoporous silicon dioxide with large steric hindrance was used as signal label to further improve the sensitivity of the immunosensor by increasing the difference of the current response signal. Under optimal experimental conditions, the electrochemical immunosensor exhibited a wide linear detection range from 0.1 pg/mL to 1.0 μg/mL, with a detection limit as low as 0.166 fg/mL. The experimental results showed that the constructed immunosensor has a great application prospect in clinical biomarker detection.

Discovering Breast Cancer Biomarkers Candidates through mRNA Expression Analysis Based on The Cancer Genome Atlas Database

Background: Research on the discovery of tumor biomarkers based on big data analysis is actively being conducted. This study aimed to secure foundational data for identifying new biomarkers of breast cancer via breast cancer datasets in The Cancer Genome Atlas (TCGA). Methods: The mRNA profiles of 526 breast cancer and 60 adjacent non-cancerous breast tissues collected from TCGA datasets were analyzed via MultiExperiment Viewer and GraphPad Prism. Diagnostic performance was analyzed by identifying the pathological grades of the selected differentially expressed (DE) mRNAs and the expression patterns of molecular subtypes. Results: Via DE mRNA profile analysis, we selected 14 mRNAs with downregulated expression (HADH, CPN2, ADAM33, TDRD10, SNF1LK2, HBA2, KCNIP2, EPB42, PYGM, CEP68, ING3, EMCN, SYF2, and DTWD1) and six mRNAs with upregulated expression (ZNF8, TOMM40, EVPL, EPN3, AP1M2, and SPINT2) in breast cancer tissues compared to that in non-cancerous tissues (p < 0.001). Conclusions: In total, 20 DE mRNAs had an area under cover of 0.9 or higher, demonstrating excellent diagnostic performance in breast cancer. Therefore, the results of this study will provide foundational data for planning preliminary studies to identify new tumor biomarkers.

Diagnostic and prognostic significance of SLC50A1 expression in patients with primary early breast cancer

There is a lack of validated biomarkers for the diagnosis of early breast cancer (EBC). The current study aimed to determine the diagnostic and prognostic value of solute carrier family 50 member 1 (SLC50A1) in patients with EBC. Therefore, 123 patients with EBC, 30 patients with benign breast disease (BBD) and 26 healthy controls (HCs) were recruited. The serum levels of SLC50A1 in paired sera of 40 postoperative patients were assessed by ELISA. Immunohistochemical staining for SLC50A1 was performed in surgical tissue derived from 83 patients with EBC and 30 patients with BBD. mRNA expression of SLC50A1 and its diagnostic and prognostic value in patients with EBC was evaluated using an RNA-sequencing database. The results showed that serum levels of SLC50A1 in patients with EBC were significantly higher compared with those in patients with BBD and HCs (both P<0.001). Additionally, receiver operating characteristic curve analysis revealed that the serum levels of SLC50A1 distinguished patients with EBC from patients with BBD and HCs with a sensitivity of 76.42% and specificity of 76.79% [area under the curve (AUC)=0.783; P<0.001]. The diagnostic value of SLC50A1 was significantly greater than that of carcinoembryonic (P<0.005) and carbohydrate antigen 15-3 (P<0.029). Furthermore, the number of SLC50A1 positive cells significantly increased in tissue of patients with EBC compared with patients with BBD (P<0.001). A positive association between serum levels of SLC50A1 and its expression in tissue samples was observed in patients with EBC (ρ=0.700; P<0.001). Additionally, bioinformatics analysis verified the diagnostic value of SLC50A1, with an AUC of 0.983 (P<0.001). Multivariate analysis demonstrated that SLC50A1 was an independent prognostic factor in patients with EBC with a hazard ratio of 1.917 (P=0.013). These findings indicated that SLC50A1 may be a potential diagnostic biomarker for primary EBC and that SLC50A1 upregulation may be associated with unfavorable prognosis in patients with EBC.

Circulating proteins as predictive and prognostic biomarkers in breast cancer

Breast cancer (BC) is the most common cancer and among the leading causes of cancer death in women. It is a heterogeneous group of tumours with numerous morphological and molecular subtypes, making predictions of disease evolution and patient outcomes difficult. Therefore, biomarkers are needed to help clinicians choose the best treatment for each patient. For the last years, studies have increasingly focused on biomarkers obtainable by liquid biopsy. Circulating proteins (from serum or plasma) can be used for inexpensive and minimally invasive determination of disease risk, early diagnosis, treatment adjusting, prognostication and disease progression monitoring. We provide here a review of the main published studies on serum proteins in breast cancer and elaborate on the potential of circulating proteins to be predictive and/or prognostic biomarkers in breast cancer.

Significance of serum carcinoembryonic antigen in metastatic breast cancer patients: A prospective study

BACKGROUND

Carcinoembryonic antigen (CEA) is an important serum tumour marker with a substantial role in diagnosis and monitoring of various solid tumours. About 36%-70% of breast cancers have elevated serum CEA. And the available studies show discrepancy in addressing the prognostic significance of CEA in advanced breast cancer.

AIM

To estimate the serum CEA level in our metastatic breast cancer patients and correlate it with response to treatment and clinical outcome.

METHODS

This was a prospective clinical study conducted on 50 metastatic breast cancer patients treated at breast clinic, with newly diagnosed metastatic breast cancer planned for palliative chemotherapy, targeted therapy, and hormonal treatment. We estimated the proportion of patients with elevated serum CEA level at baseline and after palliative treatment and also studied the association of serum CEA levels with known prognostic factors. The response to treatment was correlated with the serum CEA levels in the context of responders and non-responders.

RESULTS

The median pre-treatment and post-treatment CEA levels were 7.9 (1.8-40.7) ng/mL and 4.39 (1.4-12.15) ng/mL, respectively, in the whole study population (P = 0.032). No statistically significant difference was seen in baseline serum CEA between responders and non-responders. Even in the luminal group, pre-treatment serum CEA was not a predictor of response, but post-treatment CEA was a significant predictor of tumour progression. In patients with liver and lung metastases, post-treatment CEA level difference was not statistically significant in both responders and non-responders though the values were higher in non-responders. Among those with bone metastases, 69.5% had elevated post-treatment serum CEA, and only 37.5% had elevated serum CEA in those with no bone metastases.

CONCLUSION

Elevated post-treatment serum CEA levels are associated with disease progression and poor response to therapy. Persistently elevated post-treatment serum CEA levels are significantly associated with bone metastases. Elevated serum CEA and hormonal status are significant predictors of treatment response.

Prognosticating 2-Year Survival Rate of Breast Cancer Patients Through Plasma miRNA-21 and Other Associating Factors

Background

miRNA-21, one of breast cancer (BC) predictive markers, is now gaining cardinal attention from researchers worldwide to evaluate BC patients' survival rate. However, cancer staging, hormonal status, and other BC markers still have to be discussed. We aim to determine the relationship between miRNA-21 and associating factors such as BC staging, other tumor markers, and hormonal status to predict the 2-year survival rate of BC patients.

Methods

We conducted a prospective cohort study on 49 BC patients (26 early stage, 23 advanced stage). Apart from cancer staging, we also examined CEA, Ca15-3, and hormonal status (ER, PR, Her2) and correlated them with miRNA-21 to predict 2-year survival rate. We did bivariate, multivariate, and survival analyses to determine the link between miRNA-21 and those factors to prognosticate on 2-year survival rate.

Results

There are significances between advanced and loco-regional stage (p < 0.001); high and low miRNA-21 (p = 0.002) and CA 15-3 (p = 0.001), and low survival rate in patients with ER/PR-Her2- status (p=0.0015). Cox proportional hazard showed miRNA-21 (Adjusted HR 1.41; 95% CI = 1.205-1.632), cancer stage (Adjusted HR 9.5; 95% CI = 1.378-20.683), and CA15-3 (Adjusted HR 4.64; 95% CI = 1.548-13.931) affected patients' mortality within 2 years.

Conclusion

Low two-year survival rate depends on miRNA-21, cancer stage, CA15-3, and ER/PR-Her2-. Cancer stage is robustly associated with miRNA-21 in predicting 2-year survival rate.

Diagnostic Value of Dynamic Enhanced Magnetic Resonance Imaging Combined with Serum CA15-3, CYFRA21-1, and TFF1 for Breast Cancer

Objective

To explore the diagnostic value of dynamic enhanced magnetic resonance imaging (MRI) combined with serum CA15-3, CYFRA21-1, and TFF1 for breast cancer.

Methods

By means of a retrospective study, 60 breast cancer patients treated in our hospital from January 2018 to December 2020 were selected as the breast cancer group, 60 patients with benign breast lesions were selected as the benign group, and 60 healthy individuals who received physical examination in our hospital in the same period were selected as the control group. All study subjects received dynamic enhanced MRI scan and serological tests, their serum CA15-3 and CYFRA21-1 levels were measured with the electrochemiluminescence instrument and original auxiliary reagent, and the TFF1 level was measured with enzyme-linked immunosorbent assay (ELISA). The MRI performance variation in breast lesion patients was analyzed, the serum CA15-3, CYFRA21-1, and TFF1 levels of study subjects were compared among the three groups, and the efficacy of single diagnosis by dynamic enhanced MRI, CA15-3, CYFRA21-1, or TFF1 as well as combined diagnosis was explored by ROC curves.

Results

Dynamic enhanced MRI showed that malignant lesion had obscure boundary, irregular margin, and heterogeneity after enhancement, and the time-signal intensity curve presented fast-in fast-out; the benign lesion had a clear boundary and smooth margin, 25 cases showed homogeneity after enhancement, and the time-signal intensity curve presented slow-in slow-out; the CA15-3, CYFRA21-1, and TFF1 levels were significantly different among the breast cancer group, benign group, and control group (33.81 ± 12.46 vs 19.02 ± 6.47 vs 9.55 ± 2.64, 4.08 ± 1.41 vs 1.96 ± 1.19 vs 0.99 ± 0.21, 1.39 ± 0.54 vs 1.04 ± 0.26 vs 0.89 ± 0.12, P < 0.05); 57 breast cancer patients were diagnosed by a combined examination, with a sensitivity of 95.0%, specificity of 83.3%, positive predictive value of 74.0%, negative predictive value of 97.1%, accuracy rate of 87.2%, and AUC (95%CI) = 0.892 (0.840–0.943), indicating a significantly higher diagnostic value of the combined examination than the single examination by CA15-3, CYFRA21-1, TFF1, or MRI.

Conclusion

Combining dynamic enhanced MRI with serum CA15-3, CYFRA21-1, and TFF1 has good efficacy in diagnosing breast cancer, which can be applied in clinical diagnosis of breast cancer.

Promotion of tumorigenesis by miR-1260b targeting CAPS8: Potential diagnostic and prognostic marker for breast cancer

MicroRNAs are reported as promising biomarkers for the diagnosis and treatment of breast cancer. miR‐1260b is identified as a tumor‐associated noncoding microRNA in other cancers, although the role of miR‐1260b and its clinical relevance in breast cancer remain unclear. In this study, miR‐1260b as a potential prognostic biomarker was observed by univariate and multivariate Cox regression analyses in 102 breast tumor tissues. The tumorigenic role of miR‐1260b in terms of proliferation, apoptosis, and migration of breast cancer cells was investigated using gain‐ and loss‐of‐function assays in vitro. Additionally, the potential early diagnosis and treatment monitoring marker of miR‐1260b was validated in 129 plasma samples. We found that high miR‐1260b expression was markedly associated with bulky tumor size, advanced stage, and lymph node invasion. Particularly, the high–miR‐1260b‐expression group showed shorter overall survival than the low–miR‐1260b‐expression group. The inhibition of oncogenic miR‐1260b induced apoptosis and decreased migration and invasion of MDA‐MB‐231 cells. CASP8 was revealed as a direct target gene of miR‐1260b, which is closely related to apoptosis. Furthermore, miR‐1260b expression levels in plasma were significantly higher in patients with breast cancer than in healthy controls. The patients who tested positive for miR‐1260b showed 16.3‐ and 18.2‐fold higher risks in the early stage and locally advanced stage, respectively, compared with healthy controls, and the risk was decreased 6.2‐fold after neoadjuvant chemotherapy. Taken together, miR‐1260b may be a potential novel diagnostic, prognostic, and therapeutic target in breast cancer.

Tumor-Derived circRNAs as Circulating Biomarkers for Breast Cancer

Early diagnosis is the key to improving the prognosis of breast cancer (BC) patients; however, there are currently no circulating biomarkers that demonstrate good sensitivity and specificity. This study applied circular RNA (circRNA) microarray analysis, screening, and verification in BC plasma samples to identify three tumor-derived differentially expressed circRNAs: hsa_circ_0000091, hsa_circ_0067772, and hsa_circ_0000512. We constructed a diagnostic model using logistic regression analysis in the training set and established an optimal diagnostic model based on the three circRNAs, which showed sensitivity, specificity, and area under the curve (AUC) values of .971, .902, and .974, respectively. We then verified the diagnostic model in the test set which showed satisfactory stability for BC diagnosis. Additionally, the expression of hsa_circ_0000091 in plasma correlated with axillary lymph node (ALN) metastasis, TNM stage, and prognosis of BC patients. Furthermore, hsa_circ_0000091 combined with ultrasound showed predictive ability for ALN metastasis, with an AUC of .808. These findings suggested that the three identified circRNAs can be used as circulating biomarkers for BC diagnosis, with hsa_circ_0000091 potentially representing a prognostic biomarker for BC and novel approach for predicting ALN metastasis.

Cell-Free DNA Variables including Gene Mutations in CA15-3 Normal Breast Cancer Reflect Prognosis

Background

Cell-free DNA (cfDNA) has attracted considerable attention in precision medicine. However, few data are available regarding to the prognostic value of cfDNA variables in CA15-3 normal breast cancer (BC) patients. Here, we aimed at investigating the prognostic value of cfDNA variables including gene mutations in CA15-3 normal BC patients.

Methods

A total of 68 BC patients with normal CA15-3 levels were enrolled. cfDNA concentration and integrity were assessed based on qPCR. cfDNA gene mutations were conducted by using next gene sequencing (NGS). The association between cfDNA variables and the prognosis of patients was analyzed.

Results

cfDNA concentration was related to tumor stage (P = 0.002), metastases (P = 0.001), and distant metastases (P < 0.001). The elevated copy number variants (CNV) were found in distant metastasis patients compared with patients without distant metastases (P = 0.008). Nineteen mutant genes were validated in enrolled CA15-3 normal BC patients. Thirty-two patients (47.0%) had single nucleotide variants (SNV), and 13 (19.1%) patients had TP53 mutations (TP53^mut). SNV (P = 0.033) was related to tumor stage, and TP53^mut was related to metastases (P = 0.016) and distant metastases (P = 0.006). In multivariate logistic analysis, cfDNA concentration was associated with metastases (OR = 3.404, 95% CI: 1.074-10.788, P = 0.037) and distant metastases (OR = 13.750, 95% CI: 1.473-128.358, P = 0.021). Cases with high cfDNA levels (>15.6 ng/ml), SNV, and TP53^mut showed worse DFS compared with patients with low cfDNA levels (P < 0.001), without SNV (P = 0.002) and with TP53 wildtype (P < 0.001), respectively. In the multivariate Cox proportional hazard model, cfDNA concentration was an independent predictor of poor survival (HR = 5.786, 95% CI: 1.101-30.407, P = 0.038).

Conclusions

Assessment of cfDNA concentration, CNV, SNV, and TP53^mut could be useful in predicting prognosis for CA15-3 normal BC patients. The cfDNA concentration was an independent predictor prognostic factor in CA15-3 normal BC patients.

High Prevalence of Abnormal Carcinoembryonic Antigen in Diabetic Inpatients with Poor Glycemic Control

INTRODUCTION

Higher serum carcinoembryonic antigen (CEA) was found in diabetic patients rather than controls. However, the prevalence of abnormal CEA among diabetic inpatients with a large proportion of poor glycemic control is unclear.

METHODS

A total of 385 diabetic inpatients were included in this study. We collected information from a large clinical database. Patients with malignant tumors were excluded by examination and follow-up.

RESULTS

We found a surprisingly high prevalence (14.3%) of diabetic inpatients with CEA above normal. The proportion of patients with abnormal CEA was significantly different in subgroups with different blood glucose levels, 20.4% in the HbA1c ≥ 9% group, and 8.5% in the HbA1c < 9%, p = 0.000. We found that the CEA levels were correlated with age, body mass index and HbA1c. The regression coefficient of HbA1c was the highest, B = 0.284, p = 0.000. We also found that the CEA levels were higher in diabetic inpatients with BMI < 24 kg/m2 than the overweight or obesity patients. There was a significant difference in the insulin level and C peptide level between the elevated CEA group and the non-elevated CEA group.

CONCLUSION

The elevation of CEA is common in diabetic inpatients, especially those with poor hyperglycemia controlled (HbA1c ≥ 9%). The underlying mechanism may be related to glucose toxicity.

Analysis of the Effect of Trastuzumab Combined with Docetaxel on Serum Tumor Markers in the Treatment of HER-2 Positive Breast Cancer and Factors Influencing Therapeutic Efficacy

Objective

To explore the influence of trastuzumab (TZ) combined with docetaxel (DTX) on serum tumor markers (TMs) in the treatment of human epidermal growth factor receptor 2-positive (HER-2+) breast cancer (BC) and to analyze the factors influencing therapeutic efficacy.

Methods

Ninety-six patients with HER-2+ BC treated in the First Affiliated Hospital of Anhui University Of Science and Technology from January 2019 to December 2020 were selected. According to different treatment plans, the patients were divided into two arms with 48 cases each. The control group (CG) was treated with DTX, and the research group (RG) was given TZ combined with DTX (TZ+DTX). The two arms were compared regarding the following aspects: curative effects, adverse reaction, alterations of TMs and inflammatory factors (IFs), and quality of life. Logistic regression analysis was performed to analyze the factors affecting the efficacy of patients.

Results

After treatment, the TMs carcinoembryonic antigen (CEA), carbohydrate antigen (CA)125 and CA15-3 were significantly lower in RG compared with CG. The levels of IFs C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) were also lower in CG. The overall response rate and the Karnofsky performance status (KPS) score were significantly higher in RG. No evident difference was observed in the total incidence of adverse reactions between the two arms. The high expression of CEA, CA125 and CA15-3 as well as DTX monotherapy increased the risk of adverse prognosis.

Conclusion

TZ+DTX can effectively improve the clinical efficacy of HER-2+ BC patients and reduce their levels of serum TMs and IFs.

Enzyme-free sandwich-type electrochemical immunosensor for CEA detection based on the cooperation of an Ag/g-C3N4-modified electrode and Au@SiO2/Cu2O with core-shell structure

Effective signal amplification is a prerequisite for electrochemical immunosensors to achieve ultra-sensitive detection. In this work, we prepared a sandwich-type electrochemical immunosensor for the quantitative detection of carcinoembryonic antigen (CEA). As a base platform, Ag NPs modified aminated two-dimensional nitrogen carbide nanosheets (Ag/g-C₃N₄) have good biocompatibility and conductivity. In addition, with the layered structure of Au@SiO₂/Cu₂O as the signal label, the response current value of H₂O₂ was monitored by the Amperometric i-t Curve (i-t), so as to realize the accurate measurement of CEA. The presence of SiO₂ nanoframes not only reduces the agglomeration of Au NPs and Cu₂O but also provides good biocompatibility to facilitate the connection of secondary antibodies. Finally, we also verified the signal amplification mechanism of the immunosensor through XPS and other means, and calculated the kinetic parameters of the signal tag, which proved the good peroxidase-like activity of Au@SiO₂/Cu₂O. Under the best test conditions, the prepared immunosensor has a detection range from 0.01 pg/mL to 80 ng/mL, and the detection limit is as low as 0.0038 pg/mL. The results show that the immunosensor has good analytical performance and it can provide a new method for the clinical diagnosis of CEA.

The Role of Tumor Markers: Carcinoembryonic Antigen and Cancer Antigen 15-3 in Patients With Breast Cancer

Introduction 

Breast cancer is a major cause of mortality among females, worldwide. The present study was intended to evaluate the significance in the management of carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) in patients with breast cancer.

Methodology

A cohort study was conducted at the Jinnah Postgraduate Medical Center, Karachi, Pakistan from June 2020 to May 2021. All diagnosed cases of breast cancer who underwent surgical excision of tumor were eligible to partake. Patients who had metastatic breast cancer or had a recurrence were excluded. The patient’s sociodemographic and clinical data were documented in a predefined pro forma. It included information about the age, sex, weight, as well as serum CEA and CA15-3. The CA15-3 and CEA levels for each patient were assessed by taking a 5ml blood sample and sending it to the laboratory for further workup. preoperatively on the second, seventh, and 28th postoperative days.

Results

A mean ± SD age of 52.6 ± 8.89 years was reported. Family history of breast cancer was positive in one-fourth of the patients. Nodal metastasis was negative in 114 (46.72%) patients. Three-fourth of patients had Stage II-IV with only a minority diagnosed with Stage I. The mean levels for CA15-3 in women with Stage I cancer was significantly lower on the seventh day and 28th postoperative day, compared to preoperative levels (p = 0.05). Similar associations were seen for stages II and III. Higher CEA levels were significantly associated with stage III breast cancer preoperatively (5.88 ng/ml, p = 0.05) compared to postoperative values.

Conclusion

The current study revealed that preoperative values of serum CEA and CA15-3 significantly reduced postoperatively. Moreover, patients with advanced cancers had significantly higher levels of both tumor markers than those with less advanced diseases. The current study highlighted the importance of regular assessment of serum CEA and CA15-3 in breast cancer patients. Both these biomarkers are substantially elevated in breast cancer patients, preoperatively. Determining the levels of serum CEA and CA15-3 pre- and postoperatively may determine the prognosis and aid in forming the most optimal patient care regime with respect to the stage and subtype of cancer.

TNBC: Potential Targeting of Multiple Receptors for a Therapeutic Breakthrough, Nanomedicine, and Immunotherapy

Triple-negative breast cancer (TNBC) is a heterogeneous, recurring cancer associated with a high rate of metastasis, poor prognosis, and lack of therapeutic targets. Although target-based therapeutic options are approved for other cancers, only limited therapeutic options are available for TNBC. Cell signaling and receptor-specific targets are reportedly effective in patients with TNBC under specific clinical conditions. However, most of these cancers are unresponsive, and there is a requirement for more effective treatment modalities. Further, there is a lack of effective biomarkers that can distinguish TNBC from other BC subtypes. ER, PR, and HER2 help identify TNBC and are widely used to identify patients who are most likely to respond to diverse therapeutic strategies. In this review, we discuss the possible treatment options for TNBC based on its inherent subtype receptors and pathways, such as p53 signaling, AKT signaling, cell cycle regulation, DNA damage, and programmed cell death, which play essential roles at multiple stages of TNBC development. We focus on poly-ADP ribose polymerase 1, androgen receptor, vascular endothelial growth factor receptor, and epidermal growth factor receptor as well as the application of nanomedicine and immunotherapy in TNBC and discuss their potential applications in drug development for TNBC.

Microfluidic chip for rapid and selective isolation of tumor-derived extracellular vesicles for early diagnosis and metastatic risk evaluation of breast cancer

The epithelial-to-mesenchymal transition (EMT) index in cancer is a complementary approach for estimating metastatic risk. Considering the demand for evaluating metastatic risk based on liquid biopsies, tumor-derived extracellular vesicles (EVs) can be exploited to generate the EMT index. For the generation of EVs-based EMT index, it is essential to selectively isolate each epithelial cell and mesenchymal cell-derived EVs. This study proposes a novel microfluidic chip for selectively separating two types of EVs in an efficient and timely manner. The microfluidic chip is fully integrated with a micromixer for the creation of efficient collision between EVs and specific antibody-coated microbeads (7 and 15 μm in diameter) and a hydrodynamic particle separator for the stratification of EVs bound microbeads according to the sizes of microbeads. Using this chip, over 90% of EVs expressing the epithelial marker (epithelial cell adhesion molecule, EpCAM) and the mesenchymal marker (CD49f) can be selectively isolated within 6.7 min per 100 μL of sample volume. The clinical relevance of EMT is investigated using plasma samples from 20 breast cancer patients and 10 age-matched controls. The EMT index produced from the microfluidic chip is in a good agreement with the conventional tissue-based EMT index and is significantly high in patients with aggressive breast cancer subtypes, compared with healthy controls. In addition, the patients with high scores on the EMT index (≥5) shows recurrence within 5 years after adjuvant treatment. Predicting EMT-index-based metastatic risk using our microfluidic chip can be beneficial for cancer diagnosis and prognosis.

Preoperative Routine Laboratory Markers for Predicting Postoperative Recurrence and Death in Patients with Breast Cancer

Simple, convenient, and reliable preoperative prognostic indicators are needed to estimate the future risk of recurrences and guide the treatment decisions associated with breast cancer. We evaluated preoperative hematological markers related to recurrence and mortality and investigated independent risk factors for recurrence and mortality in patients after breast cancer surgery. We reviewed electronic medical records of patients with invasive breast cancer diagnosed at our tertiary institution between November 2005 and December 2010 and followed them until 2015. We compared two groups of patients classified according to recurrence or death and identified risk factors for postoperative outcomes. Data from 1783 patients were analyzed ultimately. Cancer antigen (CA) 15-3 and red cell distribution width (RDW) had the highest area under the curve values among several preoperative hematological markers for disease-free survival and overall survival (0.590 and 0.637, respectively). Patients with both preoperative CA 15-3 levels over 11.4 and RDW over 13.5 had a 1.7-fold higher risk of recurrence (hazard ratio (HR): 1.655; 95% confidence interval (CI): 1.154–2.374; p = 0.007) and mortality (HR: 1.723; 95% CI: 1.098–2.704; p = 0.019). In conclusion, relatively high preoperative RDW (>13.5) and CA 15-3 levels (>11.4) had the highest predictive power for mortality and recurrence, respectively. When RDW and CA 15-3 exceeded the cut-off value, the risk of recurrence and death also increased approximately 1.7 times.

Prognostic Models for Nonmetastatic Triple-Negative Breast Cancer Based on the Pretreatment Serum Tumor Markers with Machine Learning

Purpose

Triple-negative breast cancer (TNBC) is a heterogeneous and aggressive disease with poorer prognosis than other subtypes. We aimed to investigate the prognostic efficacy of multiple tumor markers and constructed a prognostic model for stage I-III TNBC patients. Patients and Methods. We included stage I-III TNBC patients whose serum tumor markers levels were measured prior to the treatment. The optimal cut-off value of each tumor marker was determined by X-tile. Then, we adopted two survival models (lasso Cox model and random survival forest model) to build the prognostic model and AUC values of the time-dependent receiver operating characteristic (ROC) were calculated. The Kaplan-Meier method was used to plot the survival curves and the log-rank test was used to test whether there was a significant difference between the predicted high-risk and low-risk groups. We used univariable and multivariable Cox analysis to identify independent prognostic factors and did subgroup analysis further for the lasso Cox model.

Results

We included 258 stage I-III TNBC patients. CEA, CA125, and CA211 showed independent prognostic value for DFS when using the optimal cut-off values; their HRs and 95% CI were as follows: 1.787 (1.056–3.226), 2.684 (1.200–3.931), and 2.513 (1.567–4.877). AUC values of lasso Cox model and random survival forest model were 0.740 and 0.663 for DFS at 60 months, respectively. Both the lasso Cox model and random survival forest model demonstrated excellent prognostic value. According to tumor marker risk scores (TMRS) computed by the lasso Cox model, the high TMRS group had worse DFS (HR = 3.138, 95% CI: 1.711–5.033, p < 0.0001) and OS (3.983, 1.637–7.214, p=0.0011) than low TMRS group. Furthermore, subgroup analysis of N₀-N₁ patients in the lasso Cox model indicated that TMRS still had a significant prognostic effect on DFS (2.278, 1.189–4.346) and OS (2.982, 1.110–7.519).

Conclusions

Our study indicated that pretreatment levels of serum CEA, CA125, and CA211 had independent prognostic significance for TNBC patients. Both lasso Cox model and random survival forest model that we constructed based on tumor markers could strongly predict the survival risk. Higher TMRS was associated with worse DFS and OS both in stage I-III and N₀-N₁ TNBC patients.

Development and validation of nomograms for predicting axillary non-SLN metastases in breast cancer patients with 1-2 positive sentinel lymph node macro-metastases: a retrospective analysis of two independent cohorts

BACKGROUND

It is reported that appropriately 50% of early breast cancer patients with 1-2 positive sentinel lymph node (SLN) micro-metastases could not benefit from axillary lymph node dissection (ALND) or breast-conserving surgery with whole breast irradiation. However, whether patients with 1-2 positive SLN macro-metastases could benefit from ALND remains unknown. The aim of our study was to develop and validate nomograms for assessing axillary non-SLN metastases in patients with 1-2 positive SLN macro-metastases, using their pathological features alone or in combination with STMs.

METHODS

We retrospectively reviewed pathological features and STMs of 1150 early breast cancer patients from two independent cohorts. Best subset regression was used for feature selection and signature building. The risk score of axillary non-SLN metastases was calculated for each patient as a linear combination of selected predictors that were weighted by their respective coefficients.

RESULTS

The pathology-based nomogram possessed a strong discrimination ability for axillary non-SLN metastases, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.727 (95% CI: 0.682-0.771) in the primary cohort and 0.722 (95% CI: 0.653-0.792) in the validation cohort. The addition of CA 15-3 and CEA can significantly improve the performance of pathology-based nomogram in the primary cohort (AUC: 0.773 (0.732-0.815) vs. 0.727 (0.682-0.771), P < 0.001) and validation cohort (AUC: (0.777 (0.713-0.840) vs. 0.722 (0.653-0.792), P < 0.001). Decision curve analysis demonstrated that the nomograms were clinically useful.

CONCLUSION

The nomograms based on pathological features can be used to identify axillary non-SLN metastases in breast cancer patients with 1-2 positive SLN. In addition, the combination of STMs and pathological features can identify patients with patients with axillary non-SLN metastases more accurately than pathological characteristics alone.

An ionic liquid-molecularly imprinted composite based on graphene oxide for the specific recognition and extraction of cancer antigen 153

Molecularly imprinted polymers with graphene oxide (GO) as a carrier (GMIPs) were synthesized to selectively recognize and capture cancer antigen 153 (CA153). The results show that the MIP has good selectivity and adsorption for CA153, and has strong anti-interference ability. Molecularly imprinted solid phase extraction (MISPE) combined with ultra performance liquid chromatography (UPLC) for the specific adsorption of CA153 was also established, and showed great potential for the analysis of CA153 in clinics in the future.

Economical and easily detectable markers of digestive tumors: platelet parameters

Aim: This study aimed to evaluate the clinical values of platelet parameters in patients with digestive tumors. Patients & methods: A total of 974 people were classified into three groups: malignant group, patients with digestive malignant tumors; benign group, patients with benign tumors; and normal group: healthy individuals. Results: Compared with the benign and normal groups, the malignant group showed significantly increased platelet count (PLT) and plateletcrit (PCT) and significantly reduced mean platelet volume (MPV) and platelet-large cell rate (P-LCR, p < 0.001). Elevated PLT and PCT and reduced MPV and P-LCR indicated poor overall survival in patients with digestive tumors. Conclusion: PLT, PCT, MPV and P-LCR were proven to be predictive biomarkers for patients with digestive malignant tumors. Elevated PLT and PCT or decreased MPV and P-LCR indicated poor overall survival.

Serum CXCL5 level is associated with tumor progression in penile cancer

Chemokine (C-X-C motif) ligand 5 is an important regulator of tumor progression in many cancers, and could serve as potential serum cancer biomarker. Our initial analysis identified CXCL5 as a cancer-related gene highly expressed in PC. Patients with PC exhibited markedly higher preoperative serum CXCL5 levels compared with that in healthy individuals (P<0.001). The area under the curve (AUC) was 0.880 with the sensitivity of 84.0%, and specificity of 80.4% to distinguish PC. Serum CXCL5 levels were also significantly decreased following tumor resection in patients with PC (P=0.001). Preoperative serum CXCL5 level was significantly associated with clinicopathological characteristics including T stage (P=0.001), nodal status (P<0.001), and pelvic lymph node metastasis (P=0.018). Cox regression analysis showed that serum CXCL5 level could serve as an independent prognostic factor for disease-free survival with a HR of 6.363 (95% CI: 2.185–18.531, P=0.001). CXCL5 and its receptor CXCR2 exhibited correlated expression pattern in PC tissues. Differential CXCL5 expression was observed in normal penile tissues, PC cell lines, and their culture supernatants. Furthermore, knockdown of CXCL5 or CXCR2 expression markedly suppressed malignant phenotypes (cell proliferation, clonogenesis, apoptosis escape, migration, and invasion), attenuated STAT3 and AKT signaling, and reduced MMP2/9 secretion in PC cell lines. In conclusion, our findings revealed that serum CXCL5 level might serve as a potential diagnostic and prognostic cancer biomarker for penile cancer. Autocrine CXCL5/CXCR2 signaling might activate multiple downstream oncogenic signaling pathways (STAT3, AKT, MMP2/9) to promote malignant progression of PC, which may warrant further investigation in the future.

High serum CCL20 is associated with tumor progression in penile cancer

Serum cancer biomarker has been proven to be very valuable in cancer diagnosis, disease monitoring and prognosis assessment, despite there is still a lack of serum biomarker for penile cancer (PC). Our initial analysis on public GEO dataset identified CCL20 as a top C-C motif ligand (CCL) gene enriched in PC. The patients with PC exhibited markedly higher preoperative serum CCL20 level than healthy control. The area under the curve (AUC) was 0.855 with the sensitivity of 72.4%, and specificity of 93.5% to distinguish PC. Preoperative serum CCL20 level was significantly associated with clinicopathological characteristics including T stage (P=0.005), nodal status (P=0.008), and pelvic lymph node metastasis (P=0.007). PC Patients with high serum CCL20 level had shorter disease-free survival compared to those with low level (P<0.001). Cox regression analysis showed that serum CCL20 level could serve as an independent prognostic factor for disease-free survival with a HR of 3.980 (95% CI: 1.209-13.098, P=0.023). Furthermore, CCL20 expression was observed in PC tissues and cell lines. Knockdown of CCL20 expression markedly suppressed malignant phenotypes (cell proliferation, clonogenesis, apoptosis escape, migration and invasion), attenuated STAT3 and AKT signaling and reduced MMP2/9 secretion in PC cell lines. Consistently, CCL20 and its receptor CCR6 exhibited correlated expression pattern in PC tissues. In conclusion, serum CCL20 level might serve as a potential diagnostic and prognostic cancer biomarker for PC. CCL20 might activate multiple downstream oncogenic signaling pathways (STAT3, AKT, MMP2/9) to promote malignant progression of PC, which may warrant further investigation in the future.

Upregulated N6-Methyladenosine RNA in Peripheral Blood: Potential Diagnostic Biomarker for Breast Cancer

Purpose

An effective biomarker for the diagnosis of breast cancer (BC) and benign breast diseases (BBD) is crucial for improving the prognosis. We investigated whether N6-methyladenosine (m⁶A) can be a diagnostic biomarker of BC.

Materials and Methods

We detected the contents of peripheral blood m⁶A in 62 patients with BC, 41 patients with BBD, and 41 normal controls (NCs) using the colorimetric method. The relative expression of the m⁶A regulated genes methyltransferase-like 14 (METTL14) and fat mass and obesity-associated (FTO) was analyzed using quantitative real-time polymerase chain reaction.

Results

m⁶A in peripheral blood RNA was significantly higher in patients with BC than that in patients with BBD (p < 0.001) or the NCs (p < 0.001). m⁶A was closely associated with the disease stage (from stage 0 to stage I-IV, p=0.003). The receiver operating characteristic curve of m⁶A contained an area under the curve (AUC) value of 0.887 in BC, which was greater than that of carcinoembryonic antigen (CEA) or carbohydrate antigen 153 (CA153). The combination of m⁶A, CEA, and CA153 improved the AUC to 0.914. The upregulated and downregulated mRNA expression of METTL14 and FTO, respectively, might contribute to the increase of m⁶A in patients with BC. m⁶A combined with METTL14 and FTO improved the AUC to 0.929 with a specificity of 97.4% in the peripheral blood of patients with BC.

Conclusion

The peripheral blood RNA of m⁶A might be a valuable biomarker for the diagnosis of BC.

Serum CXCL13 Level is Associated with Tumor Progression and Unfavorable Prognosis in Penile Cancer

Background

Chemokine (C-X-C motif) ligands (CXCLs) are important regulators of tumor progression in many cancers and could serve as potential cancer biomarkers. However, the expression patterns as well as functions of CXCLs remain unclear in penile cancer (PC). The aim of this study was to evaluate the usefulness of serum CXCL13 as a potential cancer biomarker for PC.

Patients and Methods

This retrospective study enrolled 76 patients diagnosed with PC between 2016 and 2018. Serum CXCL13 level was detected by enzyme-linked immunosorbent assay. Univariable and multivariable Cox regression analyses were conducted to identify the prognostic factors that influence disease-free survival. Human penile cancer cell lines Penl1, Penl2, 149RCa and LM156 were used as in vitro models. The expression of CXCL13 protein in PC cell lines was analyzed by Western blotting.

Results

Our initial analysis on GSE57955 dataset identified CXCL13 as a top CXCL gene enriched in PC. Higher preoperative serum CXCL13 level was detected in PC cohorts than in healthy male controls (P<0.001). The area under the curve was 0.911 with the sensitivity of 84.2% and specificity of 87.0% to distinguish PC. Preoperative serum CXCL13 level was associated with pathological grade (P=0.048), T stage (P=0.009), nodal status (P<0.001) and pelvic lymph node metastasis (P=0.005) in PC. Serum CXCL13 level could serve as an independent prognostic factor for disease-free survival with a HR of 3.818 (95%CI: 1.126–12.946). Furthermore, autocrine expression of CXCL13 was detected in PC tissues and cell lines. Knockdown of CXCL13 expression suppressed malignant phenotypes (cell proliferation, clonogenesis, apoptosis escape, migration and invasion), attenuated STAT3 and ERK1/2 signaling and reduced MMP2/9 secretion in PC cell lines.

Conclusion

Serum CXCL13 could serve as a novel diagnostic and prognostic biomarker for PC. CXCL13 signaling might activate oncogenic signaling pathways to promote malignant progression of PC.

The E3 Ubiquitin Ligase Cbl-b Predicts Favorable Prognosis in Breast Cancer

Background: Casitas B-lineage lymphoma proto-oncogene-b (Cbl-b) is an E3 ubiquitin-protein ligase and a signal-transducing adaptor protein involved in the development and progression of cancer. Despite the known functions of Cbl-b, its role in breast cancer remains unclear. The aim of this study is to explore the prognostic value of Cbl-b in breast cancer. Methods: Cbl-b expression was analyzed by immunohistochemistry in 292 breast cancer patients from the First Hospital of China Medical University between 1999 and 2008. Kaplan-Meier curve and Cox proportional hazards regression were used to analyze the independent prognostic factors for overall survival (OS) and disease-free survival (DFS). Nomogram was constructed based on these prognostic factors. Results: Cbl-b expression was detected in 54.1% (158/292) breast cancer tissue samples. Cbl-b expression was correlated with DFS (p = 0.033), but was not significantly associated with the known clinic-pathological factors in this study. Log-rank analysis indicated that Cbl-b expression was correlated with better OS (p = 0.013) and DFS (p = 0.016). Multivariate analysis showed that Cbl-b expression was an independent prognostic factor in breast cancer. The nomogram we built for predicting OS was integrated with Cbl-b expression, age, tumor size, lymph node metastasis and histological grade. Except tumor size, all the above factors and date of diagnosis were used to construct the DFS nomogram. The C-indexes of the nomograms were 0.735 and 0.678, respectively. Our new clinical model was superior to the TNM staging for prediction of OS. Conclusion: Cbl-b expression independently predicts favorable prognosis in breast cancer. Cbl-b expression, combined with other variables could be more precise clinical predictive models for predicting OS and DFS in patients with breast cancer.