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Calanca N, Faldoni FLC, Souza CP, Souza JS, de Souza Alves BE, Soares MBP, Wong DVT, Lima-Junior RCP, Marchi FA, Rainho CA, Rogatto SR. Inflammatory breast cancer microenvironment repertoire based on DNA methylation data deconvolution reveals actionable targets to enhance the treatment efficacy. J Transl Med 2024; 22:735. [PMID: 39103878 DOI: 10.1186/s12967-024-05553-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Although the clinical signs of inflammatory breast cancer (IBC) resemble acute inflammation, the role played by infiltrating immune and stromal cells in this aggressive disease is uncharted. The tumor microenvironment (TME) presents molecular alterations, such as epimutations, prior to morphological abnormalities. These changes affect the distribution and the intricate communication between the TME components related to cancer prognosis and therapy response. Herein, we explored the global DNA methylation profile of IBC and surrounding tissues to estimate the microenvironment cellular composition and identify epigenetically dysregulated markers. METHODS We used the HiTIMED algorithm to deconvolve the bulk DNA methylation data of 24 IBC and six surrounding non-tumoral tissues (SNT) (GSE238092) and determine their cellular composition. The prognostic relevance of cell types infiltrating IBC and their relationship with clinicopathological variables were investigated. CD34 (endothelial cell marker) and CD68 (macrophage marker) immunofluorescence staining was evaluated in an independent set of 17 IBC and 16 non-IBC samples. RESULTS We found lower infiltration of endothelial, stromal, memory B, dendritic, and natural killer cells in IBC than in SNT samples. Higher endothelial cell (EC) and stromal cell content were related to better overall survival. EC proportions positively correlated with memory B and memory CD8+ T infiltration in IBC. Immune and EC markers exhibited distinct DNA methylation profiles between IBC and SNT samples, revealing hypermethylated regions mapped to six genes (CD40, CD34, EMCN, HLA-G, PDPN, and TEK). We identified significantly higher CD34 and CD68 protein expression in IBC compared to non-IBC. CONCLUSIONS Our findings underscored cell subsets that distinguished patients with better survival and dysregulated markers potentially actionable through combinations of immunotherapy and epigenetic drugs.
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Affiliation(s)
- Naiade Calanca
- Department of Clinical Genetics, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, DK, 7100, Denmark
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, 18618-689, Brazil
| | - Flavia Lima Costa Faldoni
- Department of Clinical Genetics, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, DK, 7100, Denmark
| | - Cristiano Pádua Souza
- Medical Oncology Department, Barretos Cancer Hospital, Pio XII Foundation, Barretos, SP, 14784-400, Brazil
| | | | - Bianca Elen de Souza Alves
- Department of Physiology and Pharmacology, Drug Research and Development Center (NPDM), Faculty of Medicine, Federal University of Ceará, Fortaleza, 60430-270, Brazil
| | - Milena Botelho Pereira Soares
- Health Technology Institute, SENAI CIMATEC, Salvador, BA, 41650-010, Brazil
- Gonçalo Moniz Institute, FIOCRUZ, Salvador, BA, 40296-710, Brazil
| | - Deysi Viviana Tenazoa Wong
- Department of Physiology and Pharmacology, Drug Research and Development Center (NPDM), Faculty of Medicine, Federal University of Ceará, Fortaleza, 60430-270, Brazil
| | - Roberto César Pereira Lima-Junior
- Department of Physiology and Pharmacology, Drug Research and Development Center (NPDM), Faculty of Medicine, Federal University of Ceará, Fortaleza, 60430-270, Brazil
| | - Fabio Albuquerque Marchi
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, SP, 05402-000, Brazil
- Center for Translational Research in Oncology, Cancer Institute of the State of São Paulo (ICESP), São Paulo, SP, 01246-000, Brazil
| | - Claudia Aparecida Rainho
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, SP, 18618-689, Brazil
| | - Silvia Regina Rogatto
- Department of Clinical Genetics, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, DK, 7100, Denmark.
- Institute of Regional Health Research, University of Southern Denmark, Odense, 5000, Denmark.
- Botucatu Medical School Hospital, São Paulo State University (UNESP), Botucatu, SP, Brazil.
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Devi GR, Pai P, Lee S, Foster MW, Sannareddy DS, Bertucci F, Ueno N, Van Laere S. Altered ribosomal profile in acquired resistance and reversal associates with pathological response to chemotherapy in inflammatory breast cancer. NPJ Breast Cancer 2024; 10:65. [PMID: 39075068 PMCID: PMC11286775 DOI: 10.1038/s41523-024-00664-0] [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: 10/10/2023] [Accepted: 06/19/2024] [Indexed: 07/31/2024] Open
Abstract
Therapeutic resistance presents a significant hurdle in combating inflammatory breast cancer (IBC), adding to the complexity of its management. To investigate these mechanisms, we conducted a comprehensive analysis using transcriptomic and proteomic profiling in a preclinical model alone with correlates of treatment response in IBC patients. This included SUM149 cell lines derived from treatment-naïve patients, along with acquired drug resistance (rSUM149) and others in a state of resistance reversal (rrSUM149), aiming to uncover drug resistance networks. We identified specific ribosomal proteins associated with acquiring resistance. These correlated with elevated levels of molecular markers such as pERK, CDK1, XIAP, and SOD2. While resistance reversal in rrSUM149 cells largely normalized the expression profile, VIPER analysis revealed persistent alterations in ribosomal process-related proteins (AGO2, Exportin 1, RPL5), suggesting their continued involvement in drug resistance. Moreover, genes linked to ribosomal processes were significantly enriched (P < 0.001) among overexpressed genes in IBC patients (n = 87) who exhibited a pathological complete response (pCR) to neoadjuvant chemotherapy. Given the common hyperactivation of MAPK in IBC tumors, including rSUM149, we evaluated Merestinib, a multikinase inhibitor in clinical trials. It effectively targeted pERK and peIF4E pathways, suppressed downstream targets, induced cell death in drug-resistant rSUM149 cells, and showed synergistic effects with another tyrosine kinase inhibitor (Lapatinib) in parental cells. This underscores its significant impact on protein synthesis signaling, crucial for combating translational dependence in cancer cells. In summary, our study elucidates adaptive changes in IBC cells in response to therapy and treatment pauses, guiding precision medicine approaches for this challenging cancer type.
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Affiliation(s)
- Gayathri R Devi
- Department of Surgery, Division of Surgical Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA.
| | - Pritha Pai
- Department of Surgery, Division of Surgical Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA
| | - Seayoung Lee
- Department of Surgery, Division of Surgical Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Matthew W Foster
- Proteomics and Metabolomics Core Facility, Duke University School of Medicine, Durham, NC, USA
| | - Dorababu S Sannareddy
- Department of Surgery, Division of Surgical Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA
| | - Francois Bertucci
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA
- Predictive Oncology team, Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm, CNRS, Aix-Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Naoto Ueno
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Steven Van Laere
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, Durham, NC, USA.
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium.
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Merrill RM, Gibbons IS. Inequality in Female Breast Cancer Relative Survival Rates between White and Black Women in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02079-w. [PMID: 38961004 DOI: 10.1007/s40615-024-02079-w] [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: 05/04/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND This study assessed the difference in 3-, 5-, and 10-year relative survival rates (RSRs) for female breast cancer between White and Black patients across the levels of year, tumor stage, age, and marital status at diagnosis. Confounding factors and effect modifiers were considered. METHODS Analyses were based on 17 population-based tumor registries in the Surveillance, Epidemiology, and End Results (SEER) Program. Cases were diagnosed in 2000-2017 and followed through 2020. RESULTS Three-, 5-, and 10-year female breast cancer RSRs significantly improved for White and Black patients during the years 2000-2020, more so for Blacks than Whites. Three-, 5-, and 10-year estimated annual percent changes in trends were 0.09%, 0.16%, and 0.29% for Whites and 0.36%, 0.49%, and 0.86% for Blacks, respectively. However, a large difference in RSRs for White and Black patients persists, 4.2% for three-year RSRs, 5.7% for five-year RSRs, and 7.5% for 10-year RSRs, after adjusting for year, tumor stage, age, and marital status at diagnosis. The difference in RSRs between White and Black patients differs by tumor stage at diagnosis. For example, higher five-year RSRs in Whites than Blacks were 2.6% for local, 9.3% for regional, 10.4% for distant, and 6.2% for unknown/unstaged tumors at diagnosis. CONCLUSION Improvement in 3-, 5-, and 10-year female breast cancer RSRs occurred for both White and Black patients, albeit more so for Blacks. Yet the poorer RSRs for Blacks remain large and significant, increasingly so with later staged disease at diagnosis and as we move from 3- to 5- to 10-year RSRs.
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Affiliation(s)
- Ray M Merrill
- Department of Public Health, College of Life Sciences, Brigham Young University, 2063 Life Sciences Building, Provo, UT, 84602, USA.
| | - Ian S Gibbons
- Department of Public Health, College of Life Sciences, Brigham Young University, 2063 Life Sciences Building, Provo, UT, 84602, USA
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Boussen H, Berrazaga Y, Sherif Kullab, Manai M, Berrada N, Mejri N, Siala I, Levine PH, Cristofanilli M. Inflammatory breast cancer: Epidemiologic data and therapeutic results. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2024; 384:1-23. [PMID: 38637094 DOI: 10.1016/bs.ircmb.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Since the early description more than a century ago, inflammatory breast cancer (IBC) remains an aggressive disease, with a different geographic repartition, with the highest ones incidence reported in the North of Africa (Tunisia, Algeria, Morocco, and Egypt), and the lowest incidence in Western countries (USA, Europe…). In this study, we reviewed the literature using the Surveillance, Epidemiology, and End Results (SEER) database compared to other published series. We observed that in the high incidence areas (North of Africa) when compared to "classical" breast cancer, IBC was associated to younger age (less than 50 years) with rapid evolution of signs and symptoms (in less than 3 up to 6 months), and more aggressive clinical and histopathological-molecular parameters, due to the predominance of triple-negative and HER2+ subtypes in around 60% of cases. An epidemiologic trend was observed in both high and low incidence areas since the eighties are towards reduction of IBC prevalence. Concerning Tunisia, in comparison with the historical series of the 1980s, the incidence decreased in part by applying more stringent diagnostic criteria but also probably due to a slight improvement of the socio-economic level (SEL). This trend was also observed in the US, due to the efforts of collaborative IBC groups from MD Anderson Cancer Center (MDACC), Duke and IBC patient advocacy groups. Therapeutic results are slightly better due to the standardization of a multidisciplinary approach and the use of combined primary chemotherapy and/or targeted therapies (especially in HER2 positive patients), followed by mastectomy plus radiotherapy. The 5-year overall and disease-free survival is at more than 60%, related to an IBC mortality decrease observed in the cohorts of patients treated in the last decade.
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Affiliation(s)
- Hamouda Boussen
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia; Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States.
| | - Yosra Berrazaga
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia
| | | | - Maroua Manai
- Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States; Laboratory of Transmission, Control and Immunobiology of Infections, LR11IPT02 (LTCII), Pasteur Institute of Tunis, 13, place Pasteur, BP74, 1002 Tunis-Belvédère, University of Tunis El Manar, Tunis, Tunisia; Department of Medicine, Hematology/Oncology division, Weill Cornell Medicine, New York, NY, United States
| | | | - Nesrine Mejri
- Department of Medical Oncology, University Hospital A Mami, Ariana, Tunis, Tunisia
| | | | - Paul H Levine
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Massimo Cristofanilli
- Inflammatory breast cancer international consortium (IBC-IC), New York, NY, United States; Department of Medicine, Hematology/Oncology division, Weill Cornell Medicine, New York, NY, United States
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De Schepper M, Nguyen HL, Richard F, Rosias L, Lerebours F, Vion R, Clatot F, Berghian A, Maetens M, Leduc S, Isnaldi E, Molinelli C, Lambertini M, Grillo F, Zoppoli G, Dirix L, Punie K, Wildiers H, Smeets A, Nevelsteen I, Neven P, Vincent-Salomon A, Larsimont D, Duhem C, Viens P, Bertucci F, Biganzoli E, Vermeulen P, Floris G, Desmedt C. Treatment Response, Tumor Infiltrating Lymphocytes and Clinical Outcomes in Inflammatory Breast Cancer-Treated with Neoadjuvant Systemic Therapy. CANCER RESEARCH COMMUNICATIONS 2024; 4:186-199. [PMID: 38147006 PMCID: PMC10807408 DOI: 10.1158/2767-9764.crc-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/01/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
Inflammatory breast cancer (IBC) is a rare (1%-5%), aggressive form of breast cancer, accounting for approximately 10% of breast cancer mortality. In the localized setting, standard of care is neoadjuvant chemotherapy (NACT) ± anti-HER2 therapy, followed by surgery. Here we investigated associations between clinicopathologic variables, stromal tumor-infiltrating lymphocytes (sTIL), and pathologic complete response (pCR), and the prognostic value of pCR. We included 494 localized patients with IBC treated with NACT from October 1996 to October 2021 in eight European hospitals. Standard clinicopathologic variables were collected and central pathologic review was performed, including sTIL. Associations were assessed using Firth logistic regression models. Cox regressions were used to evaluate the role of pCR and residual cancer burden (RCB) on disease-free survival (DFS), distant recurrence-free survival (DRFS), and overall survival (OS). Distribution according to receptor status was as follows: 26.4% estrogen receptor negative (ER-)/HER2-; 22.0% ER-/HER2+; 37.4% ER+/HER2-, and 14.1% ER+/HER2+. Overall pCR rate was 26.3%, being highest in the HER2+ groups (45.9% for ER-/HER2+ and 42.9% for ER+/HER2+). sTILs were low (median: 5.3%), being highest in the ER-/HER2- group (median: 10%). High tumor grade, ER negativity, HER2 positivity, higher sTILs, and taxane-based NACT were significantly associated with pCR. pCR was associated with improved DFS, DRFS, and OS in multivariable analyses. RCB score in patients not achieving pCR was independently associated with survival. In conclusion, sTILs were low in IBC, but were predictive of pCR. Both pCR and RCB have an independent prognostic role in IBC treated with NACT. SIGNIFICANCE IBC is a rare, but very aggressive type of breast cancer. The prognostic role of pCR after systemic therapy and the predictive value of sTILs for pCR are well established in the general breast cancer population; however, only limited information is available in IBC. We assembled the largest retrospective IBC series so far and demonstrated that sTIL is predictive of pCR. We emphasize that reaching pCR remains of utmost importance in IBC.
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Affiliation(s)
- Maxim De Schepper
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Ha-Linh Nguyen
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - François Richard
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Louise Rosias
- Department of Gynecological and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Roman Vion
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Anca Berghian
- Anatomical Pathology Unit, Department of Biopathology, Centre Henri Becquerel, Rouen, France
| | - Marion Maetens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Sophia Leduc
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Edoardo Isnaldi
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Chiara Molinelli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Grillo
- Anatomical Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Genoa, Italy
- Department of Internal Medicine and Specialistic Medicine, U.O. Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gabriele Zoppoli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Internal Medicine and Specialistic Medicine, U.O. Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luc Dirix
- Translational Cancer Research Unit, Center for Oncological Research, Faculty of Medicine and Health Sciences, University of Antwerp, GZA hospitals, Antwerp, Belgium
| | - Kevin Punie
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ines Nevelsteen
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Gynecological Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anne Vincent-Salomon
- Department of Pathology, Université Paris Sciences Lettres, Institut Curie, Paris, France
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Brussels, Belgium
| | - Caroline Duhem
- Clinique du sein, Centre Hospitalier du Luxembourg, Luxembourg
| | | | | | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences (DIBIC) “L. Sacco” & DSRC, LITA Vialba campus, University of Milan, Milan, Italy
| | - Peter Vermeulen
- Translational Cancer Research Unit, Center for Oncological Research, Faculty of Medicine and Health Sciences, University of Antwerp, GZA hospitals, Antwerp, Belgium
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
- Laboratory for Translational Cell and Tissue Research, Department of Pathology and Imaging, KU Leuven, Belgium
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
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Obinero CG, Pedroza C, Bhadkamkar M, Blakkolb CL, Kao LS, Greives MR. We are moving the needle: Improving racial disparities in immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 88:161-170. [PMID: 37983979 DOI: 10.1016/j.bjps.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Although racial disparities in receipt of immediate breast reconstruction (IBR) have been previously reported, prior studies may not have fully assessed the impact of recent advocacy efforts as healthcare disparities gain increased national attention. The aim of this study is to assess more recent racial differences and annual trends in receiving IBR. METHODS Using the National Surgery Quality Improvement Program database, black or white women over 18 years who underwent mastectomy from 2012 to 2021 were included. IBR was defined by undergoing mastectomy with breast reconstruction during the same anesthetic event. Propensity score analysis was utilized to balance variables between black and white patients. A multivariate logistic regression was performed to determine the effect of race on the odds of receiving IBR. RESULTS The annual percentage of white patients receiving IBR remained stable at around 50% throughout the study period. The annual percentage of black patients receiving IBR increased from 34% in 2012 to 49% in 2021. Compared with white patients, black patients had lower odds of receiving IBR during the entire study period (odds ratio 0.57, 95% confidence interval 0.49-0.67). When assessing annual trends, black patients were less likely to receive IBR each year from 2012 to 2017. By 2021, both races had similar odds of IBR. CONCLUSIONS Although racial disparities in IBR have been longstanding, this study demonstrates that the racial gap appears to be closing. This may be because of increased awareness of racial disparities and their impact on patient outcomes.
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Affiliation(s)
- Chioma G Obinero
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Mohin Bhadkamkar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Christi L Blakkolb
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Lillian S Kao
- Division of Acute Care Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA
| | - Matthew R Greives
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The University of Texas Health Science Center at McGovern Medical School, Houston, TX, USA.
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7
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Johnson KC, Grimm M, Sukumar J, Schnell PM, Park KU, Stover DG, Jhawar SR, Gatti-Mays M, Wesolowski R, Williams N, Sardesai S, Pariser A, Sudheendra P, Tozbikian G, Ramaswamy B, Doto D, Cherian MA. Survival outcomes seen with neoadjuvant chemotherapy in the management of locally advanced inflammatory breast cancer (IBC) versus matched controls. Breast 2023; 72:103591. [PMID: 37871527 PMCID: PMC10598404 DOI: 10.1016/j.breast.2023.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
Inflammatory breast cancer (IBC) poses an ongoing challenge as rates of disease recurrence and mortality remain high compared to stage-matched controls. However, frontline therapy has evolved through the years, including the widespread use of neoadjuvant chemotherapy (NAC) given the prognostic importance of pathologic complete response (pCR). Due to these sweeping changes, we need new data to assess current recurrence and survival outcomes for locally advanced IBC in the context of matched non-inflammatory controls. We conducted a retrospective analysis of institutional IBC data from 2010 to 2016 with the primary objective of comparing overall survival (OS), relapse-free survival (RFS), and distant relapse-free survival (DRFS). We matched IBC patients to non-inflammatory controls based on age, receptor status, tumor grade, clinical stage, and receipt of prior NAC. Secondary objectives included assessing pCR rates and identifying prognostic factors. Among NAC recipients, we observed similar pCR rates (47.6 % vs. 49.4 %, p = 0.88) between IBC (n = 84) and matched non-IBC (n = 81) cohorts. However, we noted a significant worsening of OS (p = 0.0001), RFS (p = 0.0001), and DRFS (p = 0.001) in the IBC group. Specifically, 5-year OS in the IBC cohort was 58.9 % vs. 86.7 % for matched controls (p = 0.0003). Older age was a weak negative predictor for OS (HR 1.03, p = 0.001) and RFS (HR 1.02, p = 0.01). For DRFS, older age was also a weak negative predictor (HR 1.02, p = 0.02), whereas the use of NAC was a positive predictor (HR 0.47, p = 0.02). Despite no clear difference in pCR, survival outcomes remain poor for IBC compared to matched non-inflammatory controls.
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Affiliation(s)
- Kai Cc Johnson
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Michael Grimm
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Jasmine Sukumar
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Patrick M Schnell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ko Un Park
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Daniel G Stover
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Sachin R Jhawar
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Margaret Gatti-Mays
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Robert Wesolowski
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Nicole Williams
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Sagar Sardesai
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashley Pariser
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Preeti Sudheendra
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Gary Tozbikian
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Bhuvaneswari Ramaswamy
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Dureti Doto
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Mathew A Cherian
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
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8
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Devi GR, Fish LJ, Bennion A, Sawin GE, Weaver SM, Reddy K, Saincher R, Tran AN. Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management. Prev Med Rep 2023; 36:102519. [PMID: 38116289 PMCID: PMC10728446 DOI: 10.1016/j.pmedr.2023.102519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
The purpose of this study, based in the United States, was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. PCP participants in the Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant and advanced practice nurse leadership program alumni were first selected in a convenience sample and for semi-structured interviews (n = 11). Based on these data, an online survey tool was developed and disseminated (n = 78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID-19 impact, and continuing medical education (CME). PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31 % reported ever suspecting IBC in a patient. PCP (n = 49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63 % reported breast cancer referral delays, and 33 % reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53 %), lunch time or other in-service training (33 %), patient and provider-facing websites (32 %). Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.
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Affiliation(s)
- Gayathri R. Devi
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
| | - Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Alexandra Bennion
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Trinity School of Arts and Sciences, Duke University, 2606 DUMC, Durham, NC 27710, USA
| | - Gregory E. Sawin
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Sarah M. Weaver
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
| | - Katherine Reddy
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Trinity School of Arts and Sciences, Duke University, 2606 DUMC, Durham, NC 27710, USA
| | - Rashmi Saincher
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
| | - Anh N. Tran
- Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA
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9
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Kong J, Bandyopadhyay S, Chen W, Al-Mufarrej F, Choi L, Kosir MA. Improved Rate of Negative Margins for Inflammatory Breast Cancer Using Intraoperative Frozen Section Analysis. Cancers (Basel) 2023; 15:4597. [PMID: 37760566 PMCID: PMC10526412 DOI: 10.3390/cancers15184597] [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: 08/21/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer with a poor survival rate. Modified radical mastectomy (MRM) with negative pathologic margins is critical for improved survival. We aim to study the potential benefit of intraoperative frozen section analysis (FSA) to improve disease-free margins. METHODS This prospective, monocentric study included 19 patients who underwent MRM for IBC. For each patient, a 2 mm continuous skin edge was sent for FSA to guide further resection. The rate of tumor-free margins and the concurrence between the FSA and permanent pathological results were analyzed. RESULTS Overall, 15 of the 19 patients achieved negative margins, including four patients who would have had positive margins without FSA. The odds ratio of achieving a negative final margin with FSA was infinity (p = 0.031), and there was a strong agreement between the FSA and permanent pathological results (Kappa-0.83; p < 0.0001). CONCLUSIONS The FSA technique decreased the number of positive margins in IBC patients undergoing MRM, thereby potentially reducing the need for re-operation, allowing immediate wound closure, and preventing delays in the administration of adjuvant radiation therapy. More extensive trials are warranted to establish the use of intraoperative FSA in IBC treatment.
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Affiliation(s)
- Joshua Kong
- Department of Surgery, Wayne State University, 4160 John R, Suite 400, Detroit, MI 48201, USA
| | - Sudeshna Bandyopadhyay
- Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201, USA (W.C.)
- Department of Pathology, Wayne State University, 540 E. Canfield, Ste. 9374, Detroit, MI 48201, USA
| | - Wei Chen
- Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201, USA (W.C.)
| | - Faisal Al-Mufarrej
- Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201, USA (W.C.)
- Division of Plastic Surgery, Department of Surgery, Wayne State University, 4160 John R, Suite 400, Detroit, MI 48201, USA
| | - Lydia Choi
- Department of Surgery, Wayne State University, 4160 John R, Suite 400, Detroit, MI 48201, USA
- Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201, USA (W.C.)
| | - Mary A. Kosir
- Department of Surgery, Wayne State University, 4160 John R, Suite 400, Detroit, MI 48201, USA
- Karmanos Cancer Institute, 4100 John R, Detroit, MI 48201, USA (W.C.)
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10
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Carbajal-Ochoa WH, Johnson D, Alvarez A, Bernal AM, Anampa JD. Racial disparities in treatment and outcomes between non-Hispanic Black and non-Hispanic White women with nonmetastatic inflammatory breast cancer. Breast Cancer Res Treat 2023:10.1007/s10549-023-07018-7. [PMID: 37442877 DOI: 10.1007/s10549-023-07018-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The incidence rate of inflammatory breast cancer (IBC) is higher among non-Hispanic Black (NHB) than non-Hispanic White (NHW) women. We examined the differences in treatment and outcomes between NHB and NHW women with IBC, accounting for demographic, clinicopathological, and socioeconomic factors. METHODS We collected data from the Surveillance, Epidemiology, and End Results database for NHB and NHW women with IBC diagnosed between 2010-2016. We analyzed the odds of receiving chemotherapy, radiation, and surgery between NHB and NHW women. We evaluated overall survival (OS) with Kaplan-Meier methods and Cox proportional hazards methods. Competing risk analysis was used to compare the risk of breast cancer death between NHB and NHW women. We also evaluated the magnitude of survival disparities within the strata of demographic, socioeconomic, and treatment factors. RESULTS Among 1,652 NHW and 371 NHB women with IBC, the odds of receiving chemotherapy, surgery, and radiation were similar for NHB and NHW. After 39-month follow-up, the median OS was 40 and 81 months for NHB and NHW, respectively (p < 0.0001). The risk of breast cancer death was higher for NHB than NHW women (5-year risk of breast cancer death, 51% vs. 35%, p < 0.0001). CONCLUSION After adjustment for demographic, clinicopathological, and socioeconomic factors; NHB women with IBC had similar odds of receiving surgery, chemotherapy, and radiation therapy, but were more likely to die of the disease compared to their NHW counterparts. Our findings suggest the presence of masked tumor biology, treatment, or socioeconomic factors associated with race that can lead to worse IBC outcomes.
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Affiliation(s)
- Walter H Carbajal-Ochoa
- Department of Medical Oncology, Catalan Institute of Oncology/Josep Trueta Hospital, Girona, Spain
| | - Devin Johnson
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alvaro Alvarez
- Department of Medicine, Hematology/Oncology, Carole and Ray Neag Comprehensive Cancer Center, UCONN Health, Farmington, CT, USA
| | - Ana M Bernal
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Rd, Bronx, NY, 10461, USA
| | - Jesus D Anampa
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Rd, Bronx, NY, 10461, USA.
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11
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Franco A, Di Leone A, Fabi A, Belli P, Carbognin L, Gambaro E, Marazzi F, Mason EJ, Mulè A, Orlandi A, Palazzo A, Paris I, Rossi A, Scardina L, Terribile DA, Tiberi G, Giannarelli D, Scambia G, Masetti R, Franceschini G. Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting. Cancers (Basel) 2023; 15:cancers15092450. [PMID: 37173916 PMCID: PMC10177504 DOI: 10.3390/cancers15092450] [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: 03/23/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The diffusion of screening programs has resulted in a decrease of cT4 breast cancer diagnosis. The standard care for cT4 was neoadjuvant chemotherapy (NA), surgery, and locoregional or adjuvant systemic therapies. NA allows two outcomes: 1. improve survival rates, and 2. de-escalation of surgery. This de-escalation has allowed the introduction of conservative breast surgery (CBS). We evaluate the possibility of submitting cT4 patients to CBS instead of radical breast surgery (RBS) by assessing the risk of locoregional disease-free survival, (LR-DFS) distant disease-free survival (DDFS), and overall survival (OS). METHODS This monocentric, retrospective study evaluated cT4 patients submitted to NA and surgery between January 2014 and July 2021. The study population included patients undergoing CBS or RBS without immediate reconstruction. Survival curves were obtained using the Kaplan-Meyer method and compared using a Log Rank test. RESULTS At a follow-up of 43.7 months, LR-DFS was 70% and 75.9%, respectively, in CBS and RBS (p = 0.420). DDFS was 67.8% and 29.7%, respectively, (p = 0.122). OS was 69.8% and 59.8%, respectively, (p = 0.311). CONCLUSIONS In patients with major or complete response to NA, CBS can be considered a safe alternative to RBS in the treatment of cT4a-d stage. In patients with poor response to NA, RBS remained the best surgical choice.
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Affiliation(s)
- Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alessandra Fabi
- Precision Medicine Senology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Paolo Belli
- Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Luisa Carbognin
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Elisabetta Gambaro
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Fabio Marazzi
- Cancer Radiation Therapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Elena Jane Mason
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Antonino Mulè
- Anatomic Pathology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Armando Orlandi
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Antonella Palazzo
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Ida Paris
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Alessandro Rossi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma "Foro Italico", 00135 Roma, Italy
| | - Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Daniela Andreina Terribile
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Giordana Tiberi
- Cancer Gynaecology, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Diana Giannarelli
- Epidemiology and Biostatistics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Giovanni Scambia
- Gynecological Oncology Unit, Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Roma, Italy
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12
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Rickard AG, Sannareddy DS, Bennion A, Patel P, Sauer SJ, Rouse DC, Bouchal S, Liu H, Dewhirst MW, Palmer GM, Devi GR. A Novel Preclinical Murine Model to Monitor Inflammatory Breast Cancer Tumor Growth and Lymphovascular Invasion. Cancers (Basel) 2023; 15:cancers15082261. [PMID: 37190189 DOI: 10.3390/cancers15082261] [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: 02/06/2023] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Inflammatory breast cancer (IBC), an understudied and lethal breast cancer, is often misdiagnosed due to its unique presentation of diffuse tumor cell clusters in the skin and dermal lymphatics. Here, we describe a window chamber technique in combination with a novel transgenic mouse model that has red fluorescent lymphatics (ProxTom RFP Nu/Nu) to simulate IBC clinicopathological hallmarks. Various breast cancer cells stably transfected to express green or red fluorescent reporters were transplanted into mice bearing dorsal skinfold window chambers. Intravital fluorescence microscopy and the in vivo imaging system (IVIS) were used to serially quantify local tumor growth, motility, length density of lymph and blood vessels, and degree of tumor cell lymphatic invasion over 0-140 h. This short-term, longitudinal imaging time frame in studying transient or dynamic events of diffuse and collectively migrating tumor cells in the local environment and quantitative analysis of the tumor area, motility, and vessel characteristics can be expanded to investigate other cancer cell types exhibiting lymphovascular invasion, a key step in metastatic dissemination. It was found that these models were able to effectively track tumor cluster migration and dissemination, which is a hallmark of IBC clinically, and was recapitulated in these mouse models.
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Affiliation(s)
- Ashlyn G Rickard
- Program of Medical Physics, Duke University, Durham, NC 27705, USA
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Dorababu S Sannareddy
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Alexandra Bennion
- Trinity College of Arts and Sciences, Duke University, Durham, NC 27705, USA
| | - Pranalee Patel
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
- Trinity College of Arts and Sciences, Duke University, Durham, NC 27705, USA
| | - Scott J Sauer
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
| | - Douglas C Rouse
- Division of Laboratory Animal Resources, Duke University School of Medicine, Durham, NC 27710, USA
| | - Samantha Bouchal
- Trinity College of Arts and Sciences, Duke University, Durham, NC 27705, USA
| | - Harrison Liu
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Mark W Dewhirst
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Inflammatory Breast Cancer Consortium, Duke Cancer Institute, Durham, NC 27710, USA
| | - Gregory M Palmer
- Program of Medical Physics, Duke University, Durham, NC 27705, USA
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Inflammatory Breast Cancer Consortium, Duke Cancer Institute, Durham, NC 27710, USA
| | - Gayathri R Devi
- Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Inflammatory Breast Cancer Consortium, Duke Cancer Institute, Durham, NC 27710, USA
- Program in Cancer Risk, Detection, and Interception, Duke Cancer Institute, Durham, NC 27710, USA
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13
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Akyol M, Tuğral A, Arıbaş Z, Bakar Y. Assessment of the cardiorespiratory fitness and the quality of life of patients with breast cancer undergoing chemotherapy: a prospective study. Breast Cancer 2023:10.1007/s12282-023-01453-6. [PMID: 36952220 DOI: 10.1007/s12282-023-01453-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Diminished cardiorespiratory fitness is a well-known side effect of chemotherapy as well as a risk factor for potential cardiovascular diseases among cancer patients. This study aimed to assess the potential effects of systemic adjuvant (ACT) or neoadjuvant (NACT) chemotherapy on cardiorespiratory fitness and quality of life (QoL) among breast cancer (BC) patients. METHODS Demographic data, cardiorespiratory fitness, health-related QoL domains were assessed with simple data form, six-minute walk test (6MWT), European Organization for Research and Treatment of Cancer quality of life module (EORTC-C30), and Functional Assessment of Cancer Therapy (FACT-B+), respectively. Time1 (T1, prior to chemotherapy), Time2 (T2; interim assessment), and Time3 (T3, final assessment) were set as assessment points. RESULTS A total of 42 patients (32 ACT vs 10 ACT) completed all assessments. There were no significant differences of main effect of time and time*group interaction on total walked distance (TWD) after controlling for age and BMI (F(2,28) = 1.309, p = 0.286; F(2,28) = 1.444, p = 0.253). EORTC symptoms subscale was found to be correlated with EORTC and FACT-B+ physical function (PF) subscales (r = - 861, p < 0.001; r = - 0.877, p < 0.001) in T3. The EORTC PF subscale was found to be correlated with the TWD in the baseline (r = 0.411, p = 0.024). CONCLUSIONS This study showed that the effect of chemotherapy on diminished PF and remarkably increased symptom burden among BC patients. Yet, the type of chemotherapy had no effect on TWD regarding cardiorespiratory fitness. Monitoring potential functional decline regarding cardiorespiratory fitness can be performed via simple field tests such as 6MWT.
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Affiliation(s)
- Murat Akyol
- Department of Medical Oncology, Faculty of Medicine, Izmir Bakırçay University, Izmir, Turkey
| | - Alper Tuğral
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey.
| | - Zeynep Arıbaş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey
| | - Yeşim Bakar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakırçay University, Izmir, Turkey
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14
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Kuhar CG, Borštnar S, Gazić B, Matos E. Complete response in the axilla and the non-triple negative subtype are favourable prognostic factors for survival outcomes in inflammatory breast cancer. Breast 2023:S0960-9776(23)00011-5. [PMID: 36740512 DOI: 10.1016/j.breast.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
AIM To assess real-world outcomes and prognostic factors of non-metastatic inflammatory breast cancer according to immunohistochemistry (IHC)-based subtype and treatment regimen. METHODS An institutional retrospective analysis of patients treated with neoadjuvant systemic treatment (NAST) for stage III inflammatory breast cancer diagnosed between 2001 and 2018 was performed. The survival outcomes in relation to patient characteristics, tumour characteristics, treatment modality and response to NAST were analyzed. RESULTS 225 patients fulfilled the inclusion criteria, 90% of patients were node-positive. IHC-based subtypes: 39.1% were HR+/HER2-, 19.1% HR+/HER2+, 23.1% HR-/HER2+ and 18.7% HR-/HER2-. Treatment was multimodal: NAST (100%), surgery (94.2%) and radiotherapy (94.2%). 53.3% of patients received adjuvant endocrine therapy, 34.3% (neo)adjuvant trastuzumab. Tri-modality therapy was applied in 89.3% of patients. Following NAST, a pathologic complete remission (pCR) in the breast was found in 16.9%, in the axilla in 29.7% and in both the breast and axilla in 10.3% of patients. The axillary pCR rate was significantly higher in HR- subtypes. Median overall survival (OS) was 8.9, 7.2, 5.8 and 2.3 years (p < 0.001) for HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2- subtype, respectively. On multivariate analysis, IHC-based subtype, age and axillary pCR were found as independent prognostic factors for RFS and OS. pCR rate and median OS improved over time, 5.8% vs 14.7% and 4.7 vs 10.0 years (2001-2009 vs. 2010-2018), respectively. CONCLUSIONS Axillary pCR and the non-triple-negative IHC-based subtype are favourable prognostic factors for RFS and OS in inflammatory breast cancer. Introduction of taxanes and antiHER2 drugs contributed to improved pCR rate and OS.
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Affiliation(s)
- Cvetka Grašič Kuhar
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
| | - Simona Borštnar
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia
| | - Barbara Gazić
- Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia; Institute of Oncology Ljubljana, Department of Pathology, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Erika Matos
- Institute of Oncology Ljubljana, Department of Medical Oncology, Zaloška 2, 1000, Ljubljana, Slovenia; Faculty of Medicine Ljubljana, Vrazov Trg 2, 1000, Ljubljana, Slovenia.
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15
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Stevens LE, Peluffo G, Qiu X, Temko D, Fassl A, Li Z, Trinh A, Seehawer M, Jovanović B, Alečković M, Wilde CM, Geck RC, Shu S, Kingston NL, Harper NW, Almendro V, Pyke AL, Egri SB, Papanastasiou M, Clement K, Zhou N, Walker S, Salas J, Park SY, Frank DA, Meissner A, Jaffe JD, Sicinski P, Toker A, Michor F, Long HW, Overmoyer BA, Polyak K. JAK-STAT Signaling in Inflammatory Breast Cancer Enables Chemotherapy-Resistant Cell States. Cancer Res 2023; 83:264-284. [PMID: 36409824 PMCID: PMC9845989 DOI: 10.1158/0008-5472.can-22-0423] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/23/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
Inflammatory breast cancer (IBC) is a difficult-to-treat disease with poor clinical outcomes due to high risk of metastasis and resistance to treatment. In breast cancer, CD44+CD24- cells possess stem cell-like features and contribute to disease progression, and we previously described a CD44+CD24-pSTAT3+ breast cancer cell subpopulation that is dependent on JAK2/STAT3 signaling. Here we report that CD44+CD24- cells are the most frequent cell type in IBC and are commonly pSTAT3+. Combination of JAK2/STAT3 inhibition with paclitaxel decreased IBC xenograft growth more than either agent alone. IBC cell lines resistant to paclitaxel and doxorubicin were developed and characterized to mimic therapeutic resistance in patients. Multi-omic profiling of parental and resistant cells revealed enrichment of genes associated with lineage identity and inflammation in chemotherapy-resistant derivatives. Integrated pSTAT3 chromatin immunoprecipitation sequencing and RNA sequencing (RNA-seq) analyses showed pSTAT3 regulates genes related to inflammation and epithelial-to-mesenchymal transition (EMT) in resistant cells, as well as PDE4A, a cAMP-specific phosphodiesterase. Metabolomic characterization identified elevated cAMP signaling and CREB as a candidate therapeutic target in IBC. Investigation of cellular dynamics and heterogeneity at the single cell level during chemotherapy and acquired resistance by CyTOF and single cell RNA-seq identified mechanisms of resistance including a shift from luminal to basal/mesenchymal cell states through selection for rare preexisting subpopulations or an acquired change. Finally, combination treatment with paclitaxel and JAK2/STAT3 inhibition prevented the emergence of the mesenchymal chemo-resistant subpopulation. These results provide mechanistic rational for combination of chemotherapy with inhibition of JAK2/STAT3 signaling as a more effective therapeutic strategy in IBC. SIGNIFICANCE Chemotherapy resistance in inflammatory breast cancer is driven by the JAK2/STAT3 pathway, in part via cAMP/PKA signaling and a cell state switch, which can be overcome using paclitaxel combined with JAK2 inhibitors.
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Affiliation(s)
- Laura E Stevens
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Guillermo Peluffo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Xintao Qiu
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Daniel Temko
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts
| | - Anne Fassl
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
| | - Zheqi Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Anne Trinh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marco Seehawer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bojana Jovanović
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Maša Alečković
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Callahan M Wilde
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Renee C Geck
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Shaokun Shu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Natalie L Kingston
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicholas W Harper
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vanessa Almendro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alanna L Pyke
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shawn B Egri
- The Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | | | - Kendell Clement
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts.,The Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Ningxuan Zhou
- Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah Walker
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline Salas
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - David A Frank
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alexander Meissner
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts.,The Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Jacob D Jaffe
- The Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Piotr Sicinski
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
| | - Alex Toker
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,The Ludwig Center at Harvard, Harvard Medical School, Boston, Massachusetts
| | - Franziska Michor
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts.,The Eli and Edythe L. Broad Institute, Cambridge, Massachusetts.,The Ludwig Center at Harvard, Harvard Medical School, Boston, Massachusetts.,Center for Cancer Evolution, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Henry W Long
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Beth A Overmoyer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kornelia Polyak
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Center for Functional Cancer Epigenetics, Dana-Farber Cancer Institute, Boston, Massachusetts.,The Eli and Edythe L. Broad Institute, Cambridge, Massachusetts.,The Ludwig Center at Harvard, Harvard Medical School, Boston, Massachusetts.,Center for Cancer Evolution, Dana-Farber Cancer Institute, Boston, Massachusetts
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16
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Devi G, Fish L, Bennion A, Sawin G, Weaver S, Tran A. Assessing Knowledge and Barriers at the Primary Care Provider Level that Contribute to Disparities in Inflammatory Breast Cancer Diagnosis and Treatment. RESEARCH SQUARE 2022:rs.3.rs-2302308. [PMID: 36523410 PMCID: PMC9753779 DOI: 10.21203/rs.3.rs-2302308/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Purpose The purpose of this study was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but most lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. Methods PCP participants within Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant, and nurse leadership program alumni were first selected in a convenience sample (n=11) for semi-structured interviews (n=11). Based on these data, an online survey tool was developed and disseminated (n=78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID impact, and continued medical education (CME). Results PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31% reported ever suspecting IBC in a patient. PCP (n=49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63% reported breast cancer referral delays, and 33% reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53%), lunch time or other in-service training (33%), patient and provider-facing websites (32%). Conclusions Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.
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Affiliation(s)
| | | | | | | | | | - Anh Tran
- Duke University School of Medicine
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17
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Campana LG, Mansoor W, Hill J, Macutkiewicz C, Curran F, Donnelly D, Hornung B, Charleston P, Bristow R, Lord GM, Valpione S. T-Cell Infiltration and Clonality May Identify Distinct Survival Groups in Colorectal Cancer: Development and Validation of a Prognostic Model Based on The Cancer Genome Atlas (TCGA) and Clinical Proteomic Tumor Analysis Consortium (CPTAC). Cancers (Basel) 2022; 14:cancers14235883. [PMID: 36497365 PMCID: PMC9740634 DOI: 10.3390/cancers14235883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Predicting the survival outcomes of patients with colorectal cancer (CRC) remains challenging. We investigated the prognostic significance of the transcriptome and tumour-infiltrating lymphocyte T-cell receptor (TIL/Tc-TCR) repertoire and analysed TIL/Tc-TCR sequences of The Cancer Genome Atlas (TCGA) and the Clinical Proteomic Tumor Analysis Consortium (CPTAC) CRC cohorts. Using a multivariate Cox regression, we tested whether TIL/Tc-TCR repertoire, patient and tumour characteristics (stage, sidedness, total non-synonymous mutations, microsatellite instability (MSI) and transcriptional signatures) correlated with patient overall survival (OS) and designed a prognostic nomogram. A multivariate analysis (C-index = 0.75) showed that only patient age, disease stage, TIL/Tc degree of infiltration and clonality were independent prognostic factors for OS. The cut-offs for patients’ allocation to TIL/Tc abundance subgroups were determined using a strategy of maximally selected rank statistics with the OptimalCutpoints R package. These were “high”, “low” and “very high” (90 th percentile) TIL/Tc infiltration-stratified OS (median not reached, 67 and 44.3 months; p < 0.001); the results were validated in the CPTAC cohort. TIL/Tc clonality was prognostic (median OS in “high” vs. “low” clonality not reached and 67.3 months; p = 0.041) and independent of TIL/Tc infiltration. Whilst tumour sidedness was not prognostic, the “very highly” infiltrated tumours were prevalent among right-sided CRCs (p = 0.039) and showed distinct immunological features, with lower Th1 signature (p = 0.004), higher PD-L1 expression (p < 0.001) and likely enrichment in highly suppressory IL1R1+ Tregs (FoxP3 and IL1R1 overexpression, p < 0.001). TIL/Tc abundance and clonality are independent prognosticators in CRC and, combined with clinical variables, refine risk stratification. We identified a subset of CRCs with “very high” TIL/Tc infiltration, poor prognosis and distinct genetic and immunologic features, which may benefit from alternative therapeutic approaches. These results need validation in prospective patient cohorts.
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Affiliation(s)
- Luca G. Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9NT, UK
| | - James Hill
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Christian Macutkiewicz
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Finlay Curran
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - David Donnelly
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Ben Hornung
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Peter Charleston
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Robert Bristow
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9NT, UK
- CRUK Manchester Major Centre and Manchester Cancer Research Centre, Manchester M20 4BX, UK
| | - Graham M. Lord
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
- Correspondence: (G.M.L.); (S.V.); Tel.: +44-161-306-0533 (G.M.L.); +44-161-446-3000 (S.V.)
| | - Sara Valpione
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
- CRUK Manchester Institute, University of Manchester, Manchester SK10 4TG, UK
- Correspondence: (G.M.L.); (S.V.); Tel.: +44-161-306-0533 (G.M.L.); +44-161-446-3000 (S.V.)
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18
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Jackson T, Carmichael C, Lovett K, Scott M, Shakya S, Sotak M. Approach to the patient with a palpable breast mass. JAAPA 2022; 35:22-28. [PMID: 36069843 DOI: 10.1097/01.jaa.0000873772.13779.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Breast mass is a common finding in patients presenting to primary care, women's health, or urgent care clinics. There are multiple etiologies that can cause a palpable breast mass both benign and malignant. PAs must know how to approach a patient with a palpable breast mass as well as what appropriate diagnostic evaluation is needed.
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Affiliation(s)
- Toni Jackson
- Toni Jackson is an assistant professor in the PA program at Wake Forest School of Medicine in Winston-Salem, N.C. At the time this article was written, Caroline Carmichael, Katie Lovett, Morgan Scott, Sabrina Shakya , and Megan Sotak were students in the PA program at Wake Forest School of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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19
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Tuğral A, Bakar Y, Akyol M. THE CHARACTERISTICS OF PAIN TOLERANCE IN PATIENTS WHO UNDERWENT UNILATERAL BREAST CANCER SURGERY: THE EFFECT OF HANDEDNESS AND SURGICAL SITE TO ASSESS THE POTENTIAL MUSCULOSKELETAL SYMPTOMS AND FUNCTION. Clin Breast Cancer 2022; 22:e729-e735. [DOI: 10.1016/j.clbc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/03/2022]
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20
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Al Abo M, Gearhart-Serna L, Van Laere S, Freedman JA, Patierno SR, Hwang ESS, Krishnamurthy S, Williams KP, Devi GR. Adaptive stress response genes associated with breast cancer subtypes and survival outcomes reveal race-related differences. NPJ Breast Cancer 2022; 8:73. [PMID: 35697736 PMCID: PMC9192737 DOI: 10.1038/s41523-022-00431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
Aggressive breast cancer variants, like triple negative and inflammatory breast cancer, contribute to disparities in survival and clinical outcomes among African American (AA) patients compared to White (W) patients. We previously identified the dominant role of anti-apoptotic protein XIAP in regulating tumor cell adaptive stress response (ASR) that promotes a hyperproliferative, drug resistant phenotype. Using The Cancer Genome Atlas (TCGA), we identified 46–88 ASR genes that are differentially expressed (2-fold-change and adjusted p-value < 0.05) depending on PAM50 breast cancer subtype. On average, 20% of all 226 ASR genes exhibited race-related differential expression. These genes were functionally relevant in cell cycle, DNA damage response, signal transduction, and regulation of cell death-related processes. Moreover, 23% of the differentially expressed ASR genes were associated with AA and/or W breast cancer patient survival. These identified genes represent potential therapeutic targets to improve breast cancer outcomes and mitigate associated health disparities.
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Affiliation(s)
- Muthana Al Abo
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | | | - Steven Van Laere
- Center for Oncological Research (CORE), Faculty of Medicine and Health Sciences-University of Antwerp, Campus Drie Eiken‑Universiteitsplein 1, 2610, Wilrijk‑Antwerp, Belgium
| | - Jennifer A Freedman
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA.,Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Steven R Patierno
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA.,Department of Medicine, Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Eun-Sil Shelley Hwang
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA.,Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA
| | | | - Kevin P Williams
- Department of Pharmaceutical Sciences and BRITE, North Carolina Central University, Durham, NC, 27707, USA
| | - Gayathri R Devi
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, 27710, USA. .,Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA.
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21
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Giaquinto AN, Miller KD, Tossas KY, Winn RA, Jemal A, Siegel RL. Cancer statistics for African American/Black People 2022. CA Cancer J Clin 2022; 72:202-229. [PMID: 35143040 DOI: 10.3322/caac.21718] [Citation(s) in RCA: 218] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 12/19/2022] Open
Abstract
African American/Black individuals have a disproportionate cancer burden, including the highest mortality and the lowest survival of any racial/ethnic group for most cancers. Every 3 years, the American Cancer Society estimates the number of new cancer cases and deaths for Black people in the United States and compiles the most recent data on cancer incidence (herein through 2018), mortality (through 2019), survival, screening, and risk factors using population-based data from the National Cancer Institute and the Centers for Disease Control and Prevention. In 2022, there will be approximately 224,080 new cancer cases and 73,680 cancer deaths among Black people in the United States. During the most recent 5-year period, Black men had a 6% higher incidence rate but 19% higher mortality than White men overall, including an approximately 2-fold higher risk of death from myeloma, stomach cancer, and prostate cancer. The overall cancer mortality disparity is narrowing between Black and White men because of a steeper drop in Black men for lung and prostate cancers. However, the decline in prostate cancer mortality in Black men slowed from 5% annually during 2010 through 2014 to 1.3% during 2015 through 2019, likely reflecting the 5% annual increase in advanced-stage diagnoses since 2012. Black women have an 8% lower incidence rate than White women but a 12% higher mortality; further, mortality rates are 2-fold higher for endometrial cancer and 41% higher for breast cancer despite similar or lower incidence rates. The wide breast cancer disparity reflects both later stage diagnosis (57% localized stage vs 67% in White women) and lower 5-year survival overall (82% vs 92%, respectively) and for every stage of disease (eg, 20% vs 30%, respectively, for distant stage). Breast cancer surpassed lung cancer as the leading cause of cancer death among Black women in 2019. Targeted interventions are needed to reduce stark cancer inequalities in the Black community.
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Affiliation(s)
- Angela N Giaquinto
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Kimberly D Miller
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Katherine Y Tossas
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robert A Winn
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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22
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Zayas‐Santiago A, Martínez‐Montemayor MM, Colón‐Vázquez J, Ortiz‐Soto G, Cirino‐Simonet JG, Inyushin M. Accumulation of amyloid beta (Aβ) and amyloid precursor protein (APP) in tumors formed by a mouse xenograft model of inflammatory breast cancer. FEBS Open Bio 2022; 12:95-105. [PMID: 34592066 PMCID: PMC8727955 DOI: 10.1002/2211-5463.13308] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/16/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023] Open
Abstract
Accumulation of amyloid in breast cancer is a well-known phenomenon, but only immunoglobulin light-chain amyloidosis (AL) or transthyretin (TTR) amyloid had been detected in human breast tumor samples previously. We recently reported that another amyloidogenic peptide, amyloid beta (Aβ), is present in an aggregated form in animal and human high-grade gliomas and suggested that it originates systemically from the blood, possibly generated by platelets. To study whether breast cancers are also associated with these Aβ peptides and in what form, we used a nude mouse model inoculated with triple-negative inflammatory breast cancer cell (SUM-149) xenografts, which develop noticeable tumors. Immunostaining with two types of specific antibodies for Aβ identified the clear presence of Aβ peptides associated with (a) carcinoma cells and (b) extracellular aggregated amyloid (also revealed by Congo red and thioflavin S staining). Aβ peptides, in both cells and in aggregated amyloid, were distributed in clear gradients, with maximum levels near blood vessels. We detected significant presence of amyloid precursor protein (APP) in the walls of blood vessels of tumor samples, as well as in carcinoma cells. Finally, we used ELISA to confirm the presence of elevated levels of mouse-generated Aβ40 in tumors. We conclude that Aβ in inflammatory breast cancer tumors, at least in a mouse model, is always present and is concentrated near blood vessels. We also discuss here the possible pathways of Aβ accumulation in tumors and whether this phenomenon could represent the specific signature of high-grade cancers.
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Affiliation(s)
| | | | | | | | | | - Mikhail Inyushin
- Department of PhysiologyUniversidad Central del CaribeBayamónPRUSA
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23
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Villodre ES, Hu X, Larson R, Finetti P, Gomez K, Balema W, Stecklein SR, Santiago‐Sanchez G, Krishnamurthy S, Song J, Su X, Ueno NT, Tripathy D, Van Laere S, Bertucci F, Vivas‐Mejía P, Woodward WA, Debeb BG. Lipocalin 2 promotes inflammatory breast cancer tumorigenesis and skin invasion. Mol Oncol 2021; 15:2752-2765. [PMID: 34342930 PMCID: PMC8486564 DOI: 10.1002/1878-0261.13074] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 12/28/2022] Open
Abstract
Inflammatory breast cancer (IBC) is an aggressive form of primary breast cancer characterized by rapid onset and high risk of metastasis and poor clinical outcomes. The biological basis for the aggressiveness of IBC is still not well understood and no IBC-specific targeted therapies exist. In this study, we report that lipocalin 2 (LCN2), a small secreted glycoprotein belonging to the lipocalin superfamily, is expressed at significantly higher levels in IBC vs non-IBC tumors, independently of molecular subtype. LCN2 levels were also significantly higher in IBC cell lines and in their culture media than in non-IBC cell lines. High expression was associated with poor-prognosis features and shorter overall survival in IBC patients. Depletion of LCN2 in IBC cell lines reduced colony formation, migration, and cancer stem cell populations in vitro and inhibited tumor growth, skin invasion, and brain metastasis in mouse models of IBC. Analysis of our proteomics data showed reduced expression of proteins involved in cell cycle and DNA repair in LCN2-silenced IBC cells. Our findings support that LCN2 promotes IBC tumor aggressiveness and offer a new potential therapeutic target for IBC.
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Affiliation(s)
- Emilly S. Villodre
- Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Xiaoding Hu
- Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Richard Larson
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Pascal Finetti
- Laboratory of Predictive OncologyAix‐Marseille UniversityInsermCNRSInstitut Paoli‐CalmettesCRCMMarseilleFrance
| | - Kristen Gomez
- Department of Biological SciencesThe University of Texas at BrownsvilleTXUSA
| | - Wintana Balema
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Shane R. Stecklein
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Ginette Santiago‐Sanchez
- Department Biochemistry and Cancer CenterUniversity of Puerto Rico Medical Sciences CampusSan Juan, Puerto Rico
| | - Savitri Krishnamurthy
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Juhee Song
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Xiaoping Su
- Department of Bioinformatics and Computational BiologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Naoto T. Ueno
- Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Debu Tripathy
- Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Steven Van Laere
- Center for Oncological Research (CORE)Integrated Personalized and Precision Oncology Network (IPPON)University of AntwerpBelgium
| | - François Bertucci
- Laboratory of Predictive OncologyAix‐Marseille UniversityInsermCNRSInstitut Paoli‐CalmettesCRCMMarseilleFrance
| | - Pablo Vivas‐Mejía
- Department Biochemistry and Cancer CenterUniversity of Puerto Rico Medical Sciences CampusSan Juan, Puerto Rico
| | - Wendy A. Woodward
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Bisrat G. Debeb
- Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
- MD Anderson Morgan Welch Inflammatory Breast Cancer Clinic and Research ProgramThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
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24
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Hirko KA, Regan MM, Remolano MC, Schlossman J, Harrison B, Yeh E, Jacene H, Nakhlis F, Block C, Rosenbluth JM, Garrido-Castro AC, Overmoyer BA. Dermal Lymphatic Invasion, Survival, and Time to Recurrence or Progression in Inflammatory Breast Cancer. Am J Clin Oncol 2021; 44:449-455. [PMID: 34149037 DOI: 10.1097/coc.0000000000000843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Dermal lymphatic invasion (DLI) with tumor emboli is a common pathologic characteristic of inflammatory breast cancer (IBC), although its presence is not required for diagnosis. We examined whether documented DLI on skin biopsy was associated with survival and time to recurrence or progression in IBC. MATERIALS AND METHODS A total of 340 women enrolled in the IBC Registry at Dana-Farber Cancer Institute between 1997 and 2019 were included in this study. Kaplan-Meier curves and multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for associations of DLI and overall survival, time to locoregional recurrence/progression, and distant metastasis by stage at presentation. RESULTS DLI was detected in 215 (63.2%) of IBC cases overall. At disease presentation, IBC with DLI had a higher prevalence of de novo metastases (37.7% vs. 26.4%), breast skin ulceration (6.1% vs. 2.4%), and lymphovascular invasion within the breast parenchyma (52.9% vs. 25.5%) and a lower prevalence of palpable breast mass (48.2% vs. 70.6%) than IBC without DLI. Over a median follow-up of 2.0 years, 147 deaths occurred. DLI was not associated with survival or recurrence in multivariable models (all P ≥0.10). For example, among women with stage III disease, hazard ratios (95% confidence intervals) for DLI presence was 1.29 (0.77-2.15) for overall survival, 1.29 (0.56-3.00) for locoregional recurrence, and 1.71 (0.97-3.02) for distant metastasis. CONCLUSION Although the extent of tumor emboli in dermal lymphatics may be associated with biological features of IBC, DLI was not an independent prognostic marker of clinical outcomes in this study.
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Affiliation(s)
- Kelly A Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
| | | | - Marie C Remolano
- Department of Medical Oncology, Breast Oncology Center, Dana-Farber Cancer Institute
| | - Julia Schlossman
- Department of Medical Oncology, Breast Oncology Center, Dana-Farber Cancer Institute
| | - Beth Harrison
- Department of Surgery, Division of Breast Surgery, Brigham and Women's Hospital
| | - Eren Yeh
- Departments of Imaging/Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | - Heather Jacene
- Departments of Imaging/Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | - Faina Nakhlis
- Department of Medical Oncology, Breast Oncology Center, Dana-Farber Cancer Institute
- Department of Surgery, Division of Breast Surgery, Brigham and Women's Hospital
| | - Caroline Block
- Department of Medical Oncology, Breast Oncology Center, Dana-Farber Cancer Institute
| | - Jennifer M Rosenbluth
- Department of Medical Oncology, Breast Oncology Center, Dana-Farber Cancer Institute
| | - Ana C Garrido-Castro
- Department of Medical Oncology, Breast Oncology Center, Dana-Farber Cancer Institute
| | - Beth A Overmoyer
- Department of Medical Oncology, Breast Oncology Center, Dana-Farber Cancer Institute
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Elmore LC, Kuerer HM, Barcenas CH, Smith BD, Miggins MV, Lucci A, Caudle AS, Meric-Bernstam F, Hunt KK, Teshome M. Clinical Course of Breast Cancer Patients with Local-Regional Progression During Neoadjuvant Systemic Therapy. Ann Surg Oncol 2021; 28:5477-5485. [PMID: 34247335 DOI: 10.1245/s10434-021-10444-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neoadjuvant systemic therapy (NST) is standard for locally advanced breast cancer and is now frequently considered for those with early-stage and node-positive disease. We aimed to evaluate the treatment course and outcomes in patients with disease progression during NST. METHODS Patients diagnosed with unilateral stage I-III breast cancer between 2005 and 2015 with documented local-regional progression while receiving NST, by clinical examination and/or imaging after two or more cycles of chemotherapy, were identified from a prospective database, stratified by receipt of surgery and outcomes analyzed. RESULTS Of 6362 patients treated with NST during the study period, 124 (1.9%) developed disease progression. At a median live follow-up of 71 months, 23.4% were alive without disease and 70.2% had died from breast cancer. Median overall survival (OS) time for patients with progression was 26 months and median distant disease-free survival (DFS) was 14 months. Triple-negative breast cancer was associated with a higher likelihood of death (p < 0.001) and development of distant metastasis (p = 0.002). Among patients who had surgery (104, 89.3%), 40 (38.5%) developed local-regional recurrence, 67 (64.4%) developed distant metastasis, and 69 (66.3%) died from breast cancer. Median OS and median distant DFS in this subgroup was 31 and 16 months, respectively. CONCLUSIONS High rates of local-regional and distant failure were seen following disease progression while receiving NST. This suggests aggressive tumor biology and the need to study novel systemic therapies. Poor survival outcomes despite surgical management highlight the importance of careful patient selection when considering operative intervention after progression while receiving NST.
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Affiliation(s)
- Leisha C Elmore
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Makesha V Miggins
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Li X, Chen W, Feng J, Zhao B. Incidence of death from kidney diseases among cancer patients: a US population-based analysis. Int Urol Nephrol 2021; 53:2627-2633. [PMID: 33686534 DOI: 10.1007/s11255-021-02801-1] [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: 10/14/2020] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of our study was to retrospectively analyze the characteristic of death from kidney diseases among cancer patients and to screen the risk factors associated with nephrotic death using data from the surveillance, epidemiology, and end results (SEER) database. METHODS The information on cancer patients dying of kidney diseases was retrieved from the SEER database. Standardized mortality ratios (SMRs) were calculated using the US general population as reference. Univariate and multivariate Cox regression analyses were conducted to screen potential risk factors of death from kidney diseases. RESULTS Data of 7,167,808 patients diagnosed with malignant tumors between 2000 and 2016 were collected. Of these, 25,903 patients died of kidney diseases. Compared to the general population, cancer patients were at an elevated risk of nephrotic death with an SMR of 3.17, and this risk continues to increase in recent years. The majority of deaths from kidney diseases occur in patients > 45-year-old diagnosed with cancer of prostate, colorectum, and breast. Additionally, cancer patients with diagnosis in recent years, older age at diagnosis, black race, higher grade, and poorer disease stage were more likely to die of kidney diseases are at higher risk of nephrotic death compared to other cancer survivors. CONCLUSION The risk of death from kidney diseases is increasing among cancer survivors recently. Nephrologists should be actively involved in certain facets of cancer treatment, and provide effective nephrology care, especially for elderly patients with black race, higher grade, and poorer disease stage.
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Affiliation(s)
- Xiaoli Li
- Department of Nephrology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No.15 Jiefang Road, Fancheng District, Xiangyang, Hubei, China
| | - Wenhui Chen
- Department of Nephrology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No.15 Jiefang Road, Fancheng District, Xiangyang, Hubei, China
| | - Jinfang Feng
- Department of Nephrology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No.15 Jiefang Road, Fancheng District, Xiangyang, Hubei, China
| | - Bo Zhao
- Geriatrics Department, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No.15 Jiefang Road, Fancheng District, Xiangyang, Hubei, China.
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