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Xie X, Yang M, Wei X, Chu H, Zhao W, Shen N. Dual immunostimulatory CD73 antibody-polymeric cytotoxic drug complex for triple negative breast cancer therapy. Acta Biomater 2024:S1742-7061(24)00549-X. [PMID: 39341438 DOI: 10.1016/j.actbio.2024.09.033] [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: 03/31/2024] [Revised: 08/30/2024] [Accepted: 09/18/2024] [Indexed: 10/01/2024]
Abstract
Treatment of triple-negative breast cancer (TNBC) poses significant challenges due to its propensity for metastasis. A key impediment lies in the suppressive immune microenvironment, which fosters tumor progression. This study introduces an approach employing a dual immune-stimulatory CD73 antibody-polymeric cytotoxic drug complex (αCD73-PLG-MMAE). This complex is designed for targeted eradication of TNBC while modulating tumor immunity through mechanisms such as immunogenic cell death (ICD) and interference with the adenosine signaling pathway. By enhancing antitumor immune responses, this strategy offers a highly effective means of treating TNBC and mitigating metastasis. The complex is synthesized by combining αCD73 with poly(L-glutamic acid) (PLG) grafted Fc binding peptides (Fc-III-4C) and Val-Cit-PAB-monomethyl auristatin E (MMAE), exploiting the affinity between αCD73 and Fc-III-4C. αCD73 selectively targets CD73 molecules on both tumor and immune suppressive cells, thereby inhibiting the adenosine pathway. Meanwhile, Val-Cit-PAB-MMAE, activated by cathepsin B, triggers selective release of MMAE, inducing ICD in tumor cells. In a 4T1 tumor model, αCD73-PLG-MMAE significantly enhances drug accumulation in tumors by 4.13-fold compared to IgG-PLG-MMAE, leading to suppression of tumor growth and metastasis. Furthermore, it synergistically augments the antitumor effects of αPD-1, resulting in a tumor inhibition rate of 92% as compared to 21% with αPD-1 alone. This study thus presents a pioneering therapeutic strategy for TNBC, emphasizing the potential of targeted immunomodulation in cancer treatment. STATEMENT OF SIGNIFICANCE: Antibody-drug conjugate (ADC) therapy holds promise for treating triple-negative breast cancer (TNBC). However, the current ADC, sacituzumab govitecan, fails to overcome the crucial role of adenosine in the suppressive immune microenvironment characteristic of this "cold tumor". Here, we present a dual immune-stimulatory complex, αCD73-PLG-MMAE, which targets TNBC specifically and modulates tumor immunity through mechanisms such as immunogenic cell death (ICD) and interference with the adenosine signaling pathway. Thus, it kills tumor cells with cytotoxic drugs, comprehensively regulates immunosuppression, and restores a durable immune response. This study proposes an antibody-polymeric drug complex with immunomodulatory and immunoagonist roles, offering new insights into TNBC treatment.
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Affiliation(s)
- Xiao Xie
- Department of Breast Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin 130061, P. R. China
| | - Ming Yang
- Department of Breast Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin 130061, P. R. China.
| | - Xue Wei
- Department of Breast Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin 130061, P. R. China
| | - Hongyu Chu
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Weidong Zhao
- Key Laboratory of Polymer Ecomaterials, Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences Changchun, Jilin 130022, P. R. China
| | - Na Shen
- Key Laboratory of Polymer Ecomaterials, Jilin Biomedical Polymers Engineering Laboratory, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences Changchun, Jilin 130022, P. R. China.
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Ma Q, Liu YB, She T, Liu XL. The Role of Ki-67 in HR+/HER2- Breast Cancer: A Real-World Study of 956 Patients. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:117-126. [PMID: 38476641 PMCID: PMC10929654 DOI: 10.2147/bctt.s451617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
Objective This study determined the cut-off value of Ki-67 expression and discussed the interaction between Ki-67 and histological grade, further explored the prognostic role of Ki-67 in hormone receptor-positive and human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer;. Materials and Methods We assessed the Ki-67 expression of 956 patients with HR+/HER2 breast cancer diagnosed in the General Hospital of Ningxia Medical University from 2015 to 2019 by immunohistochemistry (IHC), The disease-free survival (DFS) was defined as the time from postoperative to the first local recurrence, distant metastasis or death of the disease. The follow-up by means of inpatient or outpatient medical records and telephone. Results 22.5% was used as the cut-off for low/high Ki-67 expression in HR+/HER2- breast cancer. Compared with the value of 14%, which is commonly used in clinic at present, the consistency of the two values is moderate (Kappa = 0.484, P<0.001). The expression of Ki-67 was increased with the grade. (Median: G1:10%; G2:20%; G3:40%. Mean: G1:13%; G2:23%; G3:39%, P <0.001). Survival analysis was based on all patients for a median of 51 months (24-89 months), 63 cases had recurrence or metastasis during the follow-up, which 21 cases had low expression of Ki-67 and 42 cases had high expression. The patients with Ki-67 ≥ 22.5% had a 2.969 higher risk of early recurrence and metastasis than the patients with Ki-67 < 22.5%. There were 4 cases of local recurrence, 7 cases of regional lymph node metastasis, and 52 cases of distant metastasis in all patients, the common distant metastases were bone, liver, and lung, and rare metastases were adrenal gland, bone marrow, and pericardium. Conclusion In HR+/HER2- breast cancer, patients with Ki-67 > 22.5% have a worse prognosis and are more likely to have early recurrence and metastasis.
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Affiliation(s)
- Qin Ma
- Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China
| | - Yao-Bang Liu
- Department of Surgical Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China
| | - Tong She
- Hospital of Zhongwei, Zhongwei, People’s Republic of China
| | - Xin-Lan Liu
- Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, People’s Republic of China
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Xing X, Miao H, Wang H, Sun J, Wu C, Wang Y, Zhou X, Wang H. A Model Combining Conventional Ultrasound Characteristics, Strain Elastography and Clinicopathological Features to Predict Ki-67 Expression in Small Breast Cancer. ULTRASONIC IMAGING 2024; 46:121-129. [PMID: 38197383 DOI: 10.1177/01617346231218933] [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: 01/11/2024]
Abstract
To establish a predictive model incorporating conventional ultrasound, strain elastography and clinicopathological features for Ki-67 expression in small breast cancer (SBC) which defined as maximum diameter less than2 cm. In this retrospective study, 165 SBC patients from our hospital were allocated to a high Ki-67 group (n = 104) and a low Ki-67 group (n = 61). Multivariate regression analysis was performed to identify independent indicators for developing predictive models. The area under the receiver operating characteristic (AUC) curve was also determined to establish the diagnostic performance of different predictive models. The corresponding sensitivities and specificities of different models at the cutoff value were compared. Conventional ultrasound parameters (spiculated margin, absence of posterior shadowing and Adler grade 2-3), strain elastic scores and clinicopathological information (HER2 positive) were significantly correlated with high expression of Ki-67 in SBC (all p < .05). Model 2, which incorporated conventional ultrasound features and strain elastic scores, yielded good diagnostic performance (AUC = 0.774) with better sensitivity than model 1, which only incorporated ultrasound characteristics (78.85%vs. 55.77%, p = .000), with specificities of 77.05% and 62.30% (p = .035), respectively. Model 3, which incorporated conventional ultrasound, strain elastography and clinicopathological features, yielded better performance (AUC = 0.853) than model 1 (AUC = 0.694) and model 2 (AUC = 0.774), and the specificity was higher than model 1 (86.89% vs. 77.05%, p = .001). The predictive model combining conventional ultrasound, strain elastic scores and clinicopathological features could improve the predictive performance of Ki-67 expression in SBC.
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Affiliation(s)
- Xuesha Xing
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huanhuan Miao
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiawei Sun
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chengwei Wu
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yichun Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xianli Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongbo Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Wang Y, Nie F, Liu T, Zhu Y, Jia Y, Li N, Wu R. The value of Demetics ultrasound-assisted diagnosis system in diagnosis of breast lesions and in assessment Ki-67 status of breast cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:112-123. [PMID: 37930047 DOI: 10.1002/jcu.23599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This study aims to explore the diagnostic efficiency of the Demetics for breast lesions and assessment of Ki-67 status. MATERIAL This retrospective study included 291 patients. Three combined methods (method 1: upgraded BI-RADS when Demetics classified the breast lesion as malignant; method 2: downgraded BI-RADS when Demetics classified the breast lesion as benign; method 3: BI-RADS was upgraded or downgraded according to Demetrics' diagnosis) were used to compare the diagnostic efficiency of two radiologists with different seniority before and after using Demetics. The correlation between the visual heatmap by Demetics and the Ki-67 expression level of breast cancer was explored. RESULTS The sensitivity, specificity, and area under curve (AUC) of diagnosis by Demetics, junior radiologist and senior radiologist were 89.5%, 83.1%, 0.863; 76.9%, 82.4%, 0.797 and 81.1%, 89.9%, 0.855, respectively. Method 1 was the best for senior radiologist, which increased AUC from 0.855 to 0.884. For junior radiologist, Method 3 was the best method, improving sensitivity (88.8% vs. 76.9%) and specificity (87.2% vs. 82.4%). Demetics paid more attention to the peripheral area of breast cancer with high expression of Ki-67. CONCLUSION Demetics has shown good diagnostic efficiency in the assisted diagnosis of breast lesions and is expected to further distinguish Ki-67 status of breast cancer.
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Affiliation(s)
- Yao Wang
- Lanzhou University Second Hospital Department of Ultrasound, Lanzhou, China
| | - Fang Nie
- Lanzhou University Second Hospital Department of Ultrasound, Lanzhou, China
| | - Ting Liu
- Lanzhou University Second Hospital Department of Ultrasound, Lanzhou, China
| | - Yangyang Zhu
- Lanzhou University Second Hospital Department of Ultrasound, Lanzhou, China
| | - Yingying Jia
- Lanzhou University Second Hospital Department of Ultrasound, Lanzhou, China
| | - Nana Li
- Lanzhou University Second Hospital Department of Ultrasound, Lanzhou, China
| | - Ruichao Wu
- Lanzhou University School of Information Science and Engineering, Lanzhou, China
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Khosravi S, Khayyamfar A, Karimi J, Tutuni M, Negahi A, Akbari ME, Nafissi N. Machine Learning Approach for the Determination of the Best Cut-off Points for Ki67 Proliferation Index in Adjuvant and Neo-adjuvant Therapy Breast Cancer Patients. Clin Breast Cancer 2023:S1526-8209(23)00084-8. [PMID: 37156698 DOI: 10.1016/j.clbc.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND This study aims to evaluate Ki67 cut-off points for differentiating low and high-risk patients based on survival and recurrence and find the best Ki67 cut-off points in breast cancer patients undergoing adjuvant and neoadjuvant therapy using machine learning methods. PATIENTS AND METHODS Patients with breast cancer treated at 2 referral hospitals between December 2000 and March 2021 who had invasive breast cancer entered this study. There were 257 patients in the neoadjuvant group and 2139 in the adjuvant group. A decision tree method was used to predict the likelihood of survival and recurrence. The 2-ensemble technique of RUSboost and bagged tree were imposed on the decision tree method to increase the accuracy of the determination. 80 percent of the data was used to train and validate the model, and 20% was used as a test. RESULTS In adjuvant therapy breast cancer patients with Invasive ductal carcinoma (IDC) and Invasive lobular carcinoma (ILC) the cutoff points for survival were 20 and 10, respectively. For luminal A, luminal B, Her2 neu, and triple-negative adjuvant therapy patients' the cutoff points for survival were 25, 15, 20, and 20, respectively. For neoadjuvant therapy luminal A and luminal B group, survival cutoff points were 25 and 20, respectively. CONCLUSION Despite variability in measurement and cut-off points, the Ki-67 proliferation index is still helpful in the clinic. Further investigation is needed to determine the best cut-off points for different patients. The sensitivity and specificity of Ki-67 cutoff point prediction models in this study could further prove its significance as a prognostic factor.
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Liu J, Wang X, Hu M, Zheng Y, Zhu L, Wang W, Hu J, Zhou Z, Dai Y, Dong F. Development of an ultrasound-based radiomics nomogram to preoperatively predict Ki-67 expression level in patients with breast cancer. Front Oncol 2022; 12:963925. [PMID: 36046035 PMCID: PMC9421073 DOI: 10.3389/fonc.2022.963925] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo develop and validate a radiomics nomogram that could incorporate clinicopathological characteristics and ultrasound (US)-based radiomics signature to non-invasively predict Ki-67 expression level in patients with breast cancer (BC) preoperatively.MethodsA total of 328 breast lesions from 324 patients with BC who were pathologically confirmed in our hospital from June 2019 to October 2020 were included, and they were divided into high Ki-67 expression level group and low Ki-67 expression level group. Routine US and shear wave elastography (SWE) were performed for each lesion, and the ipsilateral axillary lymph nodes (ALNs) were scanned for abnormal changes. The datasets were randomly divided into training and validation cohorts with a ratio of 7:3. Correlation analysis and the least absolute shrinkage and selection operator (LASSO) were used to select the radiomics features obtained from gray-scale US images of BC patients, and each radiomics score (Rad-score) was calculated. Afterwards, multivariate logistic regression analysis was used to establish a radiomics nomogram based on the radiomics signature and clinicopathological characteristics. The prediction performance of the nomogram was assessed by the area under the receiver operating characteristic curve (AUC), the calibration curve, and decision curve analysis (DCA) using the results of immunohistochemistry as the gold standard.ResultsThe radiomics signature, consisted of eight selected radiomics features, achieved a nearly moderate prediction efficacy with AUC of 0.821 (95% CI:0.764-0.880) and 0.713 (95% CI:0.612-0.814) in the training and validation cohorts, respectively. The radiomics nomogram, incorporating maximum diameter of lesions, stiff rim sign, US-reported ALN status, and radiomics signature showed a promising performance for prediction of Ki-67 expression level, with AUC of 0.904 (95% CI:0.860-0.948) and 0.890 (95% CI:0.817-0.964) in the training and validation cohorts, respectively. The calibration curve and DCA indicated promising consistency and clinical applicability.ConclusionThe proposed US-based radiomics nomogram could be used to non-invasively predict Ki-67 expression level in BC patients preoperatively, and to assist clinicians in making reliable clinical decisions.
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Affiliation(s)
- Jinjin Liu
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuchao Wang
- Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Mengshang Hu
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Zheng
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lin Zhu
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Wang
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jisu Hu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Zhiyong Zhou
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- *Correspondence: Zhiyong Zhou, ; Yakang Dai, ; Fenglin Dong,
| | - Yakang Dai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- *Correspondence: Zhiyong Zhou, ; Yakang Dai, ; Fenglin Dong,
| | - Fenglin Dong
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Zhiyong Zhou, ; Yakang Dai, ; Fenglin Dong,
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Amezcua‑Gálvez J, Lopez‑Garcia C, Villarreal‑Garza C, Lopez‑Rivera V, Canavati‑Marcos M, Santuario‑Facio S, Dono A, Monroig‑Bosque P, Ortiz‑López R, Leal‑Lopez A, Gómez‑macías G. Concordance between Ki‑67 index in invasive breast cancer and molecular signatures: EndoPredict and MammaPrint. Mol Clin Oncol 2022; 17:132. [PMID: 35949891 PMCID: PMC9353786 DOI: 10.3892/mco.2022.2565] [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: 10/31/2021] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
Identifying patients with hormone receptor-positive (HR+) early invasive breast cancer (EIBC) who benefit from adjuvant chemotherapy has improved with molecular signature tests. However, due to high cost and limited availability, alternative tests are used. The present study sought to evaluate the performance of the proliferation marker Ki-67 to identify these patients and explore its association with molecular signatures and risk stratification markers. From the San José TecSalud Hospital in Monterrey México, patients with HR+ EIBC as tested with EndoPredict or MammaPrint and Ki-67 index were identified. They were categorized into two groups: Group 1 (June 2016-August 2018) was evaluated using EndoPredict and Group 2 (June 2016-August 2018) with MammaPrint. A ≥20% Ki67 index cutoff was utilized to identify highly proliferative EIBC and an area under the receiver-operating characteristic curve and κ concordance were utilized to evaluate the performance of Ki-67 index compared to molecular signature tests. In the EndoPredict group, 54/96 patients were considered high-risk based on their EPclin score, while 57/96 patients had Ki-67 index ≥20%. However, there was no significant overall concordance between them (59.37%, κ=0.168, P=0.09), while the given risk of distant recurrence given in percentage by EPclin had a positive association with the Ki67 index (P=0.04). In the MammaPrint group, 21/70 patients were considered high-risk and 36/70 patients presented with a Ki-67 index ≥20% with a significant overall concordance (67.14%, κ=0.35, P<0.001). In addition, high Ki-67 index was associated with the Nottingham histological grade in both groups. In conclusion, there was a concordance between Ki-67 and MammaPrint risk stratification of HR+ EIBC and no concordance with the EndoPredict molecular signature, but a positive association with the given percentage of recurrence and the median Ki-67 index as the cutoff at our center. Cost-effectiveness analyses of these tests in developing countries are required; until then, the use of Ki-67 appears reasonable to aid clinical decisions, together with the other established clinicopathological variables.
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Affiliation(s)
- Jesús Amezcua‑Gálvez
- Department of Pathology, Tecnologico de Monterrey, Hospital San José, Av. Morones Prieto Poniente 3000 Poniente, Los Doctores, Monterrey, NL 64710, México
| | - Carlos Lopez‑Garcia
- Department of Pathology, Tecnologico de Monterrey, Hospital San José, Av. Morones Prieto Poniente 3000 Poniente, Los Doctores, Monterrey, NL 64710, México
| | - Cynthia Villarreal‑Garza
- Breast Cancer Center, Tecnologico de Monterrey, Hospital Zambrano Hellion, Real San Agustín, San Pedro Garza García, NL 66278, México
| | - Victor Lopez‑Rivera
- Department of Neurology, UTHealth McGovern Medical School, The University of Texas Health Science Center at Houston, TX 77030, USA
| | - Mauricio Canavati‑Marcos
- Breast Cancer Center, Tecnologico de Monterrey, Hospital Zambrano Hellion, Real San Agustín, San Pedro Garza García, NL 66278, México
| | - Sandra Santuario‑Facio
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Av Morones Prieto, 3000 Poniente, Los Doctores, Monterrey, Nuevo León, 64710, México
| | - Antonio Dono
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, TX 77030, USA
| | - Paloma Monroig‑Bosque
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Rocío Ortiz‑López
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Av Morones Prieto, 3000 Poniente, Los Doctores, Monterrey, Nuevo León, 64710, México
| | - Andrea Leal‑Lopez
- Breast Cancer Center, Tecnologico de Monterrey, Hospital Zambrano Hellion, Real San Agustín, San Pedro Garza García, NL 66278, México
| | - Gabriela Gómez‑macías
- Department of Pathology, Tecnologico de Monterrey, Hospital San José, Av. Morones Prieto Poniente 3000 Poniente, Los Doctores, Monterrey, NL 64710, México
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Han G, Schell MJ, Reisenbichler ES, Guo B, Rimm DL. Determination of the number of observers needed to evaluate a subjective test and its application in two PD-L1 studies. Stat Med 2021; 41:1361-1375. [PMID: 34897773 DOI: 10.1002/sim.9282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/29/2021] [Accepted: 11/21/2021] [Indexed: 11/10/2022]
Abstract
In pathological studies, subjective assays, especially companion diagnostic tests, can dramatically affect treatment of cancer. Binary diagnostic test results (ie, positive vs negative) may vary between pathologists or observers who read the tumor slides. Some tests have clearly defined criteria resulting in highly concordant outcomes, even with minimal training. Other tests are more challenging. Observers may achieve poor concordance even with training. While there are many statistically rigorous methods for measuring concordance between observers, we are unaware of a method that can identify how many observers are needed to determine whether a test can reach an acceptable concordance, if at all. Here we introduce a statistical approach to the assessment of test performance when the test is read by multiple observers, as would occur in the real world. By plotting the number of observers against the estimated overall agreement proportion, we can obtain a curve that plateaus to the average observer concordance. Diagnostic tests that are well-defined and easily judged show high concordance and plateau with few interobserver comparisons. More challenging tests do not plateau until many interobserver comparisons are made, and typically reach a lower plateau or even 0. We further propose a statistical test of whether the overall agreement proportion will drop to 0 with a large number of pathologists. The proposed analytical framework can be used to evaluate the difficulty in the interpretation of pathological test criteria and platforms, and to determine how pathology-based subjective tests will perform in the real world. The method could also be used outside of pathology, where concordance of a diagnosis or decision point relies on the subjective application of multiple criteria. We apply this method in two recent PD-L1 studies to test whether the curve of overall agreement proportion will converge to 0 and determine the minimal sufficient number of observers required to estimate the concordance plateau of their reads.
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Affiliation(s)
- Gang Han
- Department of Epidemiology and Biostatistics, Texas A&M University School of Public Health, College Station, Texas, USA
| | - Michael J Schell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Emily S Reisenbichler
- Department of Pathology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Bohong Guo
- Department of Epidemiology and Biostatistics, Texas A&M University School of Public Health, College Station, Texas, USA
| | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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Baselice S, Castaldo R, Giannatiempo R, Casaretta G, Franzese M, Salvatore M, Mirabelli P. Impact of Breast Tumor Onset on Blood Count, Carcinoembryonic Antigen, Cancer Antigen 15-3 and Lymphoid Subpopulations Supported by Automatic Classification Approach: A Pilot Study. Cancer Control 2021; 28:10732748211048612. [PMID: 34620015 PMCID: PMC8504274 DOI: 10.1177/10732748211048612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Recent observations showed that systemic immune changes are detectable in case of breast cancer (BC). In this preliminary study, we investigated routinely measured peripheral blood (PB) parameters for malignant BC cases in comparison to benign breast conditions. Complete blood count, circulating lymphoid subpopulation, and serological carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) levels were considered. Methods A total of 127 female patients affected by malignant (n = 77, mean age = 63 years, min = 36, max = 90) BC at diagnosis (naïve patients) or benign breast conditions (n = 50, mean age = 33 years, min = 18, max = 60) were included in this study. For each patient, complete blood count and lymphoid subpopulations (T-helper, T-cytotoxic, B-, NK-, and NKT-cells) analysis on PB samples were performed. Hormonal receptor status, Ki-67 expression, and serological CEA and CA15-3 levels were assessed in the case of patients with malignant BC via statistical analysis. Results Women with malignant BC disclosed increased circulating T-helper lymphocytes and CD4/CD8 ratio in PB when compared to those affected by benign breast conditions (2.345 vs 1.894, P < .05 Wilcoxon rank-sum test). In the case of malignant BC patients, additive logistic regression method was able to identify malignant BC cases with increased CA15-3 levels (CA15-3 >25 UI/mL) via the hematocrit and neutrophils/lymphocytes ratio values. Moreover, in the case of women with aggressive malignant BC featured by high levels of Ki-67 proliferation marker, an increasing number of correlations were found among blood count parameters and lymphocytes subpopulations by performing a Spearman’s correlation analysis. Conclusions This preliminary study confirms the ability of malignant BC to determine systemic modifications. The stratification of malignant BC cases according to the Ki-67 proliferation marker highlighted increasing detectable alterations in the periphery of women with aggressive BC. The advent of novel and more sensitive biomarkers, as well as deep immunophenotyping technologies, will provide additional insights for describing the relationship between tumor onset and peripheral alterations.
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Salgado R, Peg V, Rüschoff J, Vincent-Salomon A, Castellano I, Perner S, Van de Vijver K, Quinn CM, Varga Z. Gene expression signatures for tailoring adjuvant chemotherapy of luminal breast cancer: the pathologists' perspective. Ann Oncol 2021; 32:1316-1321. [PMID: 34461263 DOI: 10.1016/j.annonc.2021.08.1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/04/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- R Salgado
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium; Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - V Peg
- Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Pathology, Vall D'Hebron University Hospital, Barcelona, Spain; Spanish Biomedical Research Network Centre in Oncology (CIBERONC), Madrid, Spain
| | - J Rüschoff
- Targos Molecular Pathology GmbH and Institute of Pathology Nordhessen, Kassel, Germany
| | - A Vincent-Salomon
- Department of Pathology and Department of Diagnostic and Theranostic Medicine, Institut Curie, PSL Research University, Paris, France
| | - I Castellano
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Perner
- Institute of Pathology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | - K Van de Vijver
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - C M Quinn
- Department of Pathology, St. Vincent's University Hospital, Dublin and University College Dublin, Dublin, Ireland
| | - Z Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
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11
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Al-Keilani MS, Elstaty RI, Alqudah MA, Alkhateeb AM. Immunohistochemical expression of substance P in breast cancer and its association with prognostic parameters and Ki-67 index. PLoS One 2021; 16:e0252616. [PMID: 34086748 PMCID: PMC8177477 DOI: 10.1371/journal.pone.0252616] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/19/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The neuropeptide substance P is a potential biomarker and therapeutic target in cancer. The main objectives of this study were to investigate the expression level of substance P in different breast cancer molecular subtypes and identify its association with clinicopathological parameters of patients and with Ki-67 index. METHODS A retrospective analysis was performed for a total of 164 paraffin-embedded breast cancer tissue samples [42 Her2/neu-enriched, 40 luminal A, 42 luminal B (triple-positive) and 40 triple negative subtypes]. The tissue microarray slides containing specimens were used to determine the expression of substance p and Ki-67 by immunohistochemical staining. RESULTS The mean age of the cohort was 51.35 years. Twenty two percent of cases had low substance P expression levels (TS ≤ 5), while 78% had high expression levels (TS > 5). A significant association was found between SP expression level and breast cancer molecular subtype (p = 0.002), TNM stage (p = 0.034), pN stage (p = 0.013), axillary lymph node metastasis (p = 0.004), ER and PR statuses (p<0.001) and history of DCIS (p = 0.009). The average percentage of Ki-67 expression was 27.05%. When analyzed as a continuous variable, significant differences were observed between the mean Ki-67 scores and molecular subtype (p = 0.001), grade (p = 0.003), pN stage (p = 0.007), axillary lymph node metastasis (p = 0.001), and ER and PR statuses (p <0.001). CONCLUSION SP is overexpressed in most of the analyzed tissues and has a negative prognostic value in the breast cancer patients. Besides substance P is a potential therapeutic target in breast cancer.
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Affiliation(s)
- Maha S. Al-Keilani
- Department of Clinical Pharmacy, College of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Rana I. Elstaty
- Department of Biotechnology and Genetic Engineering, College of Science and Art, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad A. Alqudah
- Department of Pathology and Microbiology, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Asem M. Alkhateeb
- Department of Biotechnology and Genetic Engineering, College of Science and Art, Jordan University of Science and Technology, Irbid, Jordan
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12
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Erices-Leclercq M, Lubig S, Förster F, Förster R, Baldus S, Rudlowski C, Schröder L. Prognostic relevance of Ki67 expression in primary male breast cancer: determination of cut-off points by different evaluation methods and statistical examinations. J Cancer Res Clin Oncol 2021; 148:441-447. [PMID: 33991247 DOI: 10.1007/s00432-021-03623-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE 1% of all breast cancer cases occur in men. There are significant differences regarding clinical behaviour and genetic profiles between female (FBC) and male breast cancer (MBC). Parameters for decision-making on treatment and prognosis are derived from FBC. Ki67 has a high value as a prognostic and predictive factor in FBC, but accurate Ki67 cut-off points for MBC are missing. In this study, we aimed to evaluate adequate examination methods and reliable cut-off points for Ki67 to assess the highest prognostic value for patient's overall survival (OS). METHODS In this multicentric retrospective study, histological specimens were obtained from 104 male patients who were diagnosed and treated for primary invasive breast cancer. We applied three methods of Ki67 analysis: Tumor average scoring (TA), tumor border scoring (TB) and hot-spot scoring (HS). Calculated Ki67 cut-off points for each method were assessed as a threshold for patients' overall survival (OS). RESULTS Ki67 cut-off points were 13.5 for the TA group, 22.5 for the HS group and 17.5 for the TB group. Only Ki67 TA cut-off calculations demonstrated statistical significance (p = 0.04). Ki67 expression analysis of TA showed that more than 90% of patients with low Ki67 levels (< 13.5) were alive after 5-year follow-up. CONCLUSION Our findings demonstrate that determination of Ki67 expression in TA is the most reliable to define a cut-off point with high prognostic value. A Ki67 cut-off point of 13.5 shows highest statistical power to define luminal A subgroup and OS.
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Affiliation(s)
- Melanie Erices-Leclercq
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany
| | - Sabine Lubig
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany
| | - Frank Förster
- Department of Economical Sciences, University of Applied Sciences, Zwickau, Germany.,Outpatient Department of Gynecological Oncology and Palliative Care, Poliklinik GmbH, Chemnitz, Germany
| | - Robert Förster
- Institute for Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Stefan Baldus
- Institute for Pathology, Cytology and Molecular Pathology, Bergisch Gladbach, Germany
| | - Christian Rudlowski
- Department of Breast Cancer, Lutherian Hospital, Ferrenbergstr.24, 51465, Bergisch Gladbach, Germany. .,Medical Faculty, University Hospital Bonn, Bonn, Germany.
| | - Lars Schröder
- Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Cologne, Germany
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13
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Thomas S, Kabir M, Butcher BE, Chou S, Mahajan H, Farshid G, Balleine R, Pathmanathan N. Interobserver concordance in visual assessment of Ki67 immunohistochemistry in surgical excision specimens from patients with lymph node-negative breast cancer. Breast Cancer Res Treat 2021; 188:729-737. [PMID: 33751322 DOI: 10.1007/s10549-021-06188-6] [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: 12/21/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to determine the interobserver concordance of two methods for proliferation assessment in breast cancer using Ki67 immunohistochemistry. METHODS Ki67 was independently assessed in randomly selected tumour samples from patients with lymph node-negative breast cancer using two different methods: either cell counting or visual estimation of hot spot areas. For hot spot cell counting, positive and negative cell numbers were recorded for total cell counts of 300-500, 500-800 and 800-1000 cells. Visual estimation involved allocation of a score from 1 to 5 using a visual scale to estimate percentage positivity. Interobserver agreement for hot spot counting was calculated using a two-way fixed effects intraclass correlation model, and by using Cohen's kappa measure for visual assessment. Prognostic concordance between the two methods was also calculated using Cohen's kappa. RESULTS Samples from 96 patients were included in this analysis. Interobserver agreement for hot spot cell counting was excellent (> 0.75) across all three cell count ranges, with correlation coefficients of 0.88 (95% CI 0.84-0.92), 0.87 (95% CI 0.82-0.91) and 0.89 (95% CI 0.85-0.92), respectively. Interobserver agreement with visual estimation was greatest for hot spots compared with areas of intermediate or low proliferation, with kappa scores of 0.49, 0.42 and 0.40, respectively. Both assessment methods demonstrated excellent prognostic agreement. CONCLUSIONS Interobserver and prognostic concordance in Ki67 immunohistochemistry assessments was high using either hot spot cell counting or visual estimation, further supporting the utility and reproducibility of these cost-efficient methods to assess proliferation.
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Affiliation(s)
- Susanna Thomas
- Westmead Breast Cancer Institute, Westmead, NSW, 2145, Australia
- Western Sydney Local Health District, Westmead, NSW, 2145, Australia
- Australian Clinical Labs, Bella Vista, NSW, 2153, Australia
| | - Masrura Kabir
- Westmead Breast Cancer Institute, Westmead, NSW, 2145, Australia
- Western Sydney Local Health District, Westmead, NSW, 2145, Australia
| | - Belinda E Butcher
- WriteSource Medical Pty Ltd, Lane Cove, NSW, 2066, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Shaun Chou
- Institute of Clinical Pathology and Medical Research, Pathology West, NSW Health Pathology, Sydney, NSW, 2145, Australia
| | - Hema Mahajan
- Institute of Clinical Pathology and Medical Research, Pathology West, NSW Health Pathology, Sydney, NSW, 2145, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, 2145, Australia
| | - Gelareh Farshid
- SA Pathology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
- School of Medical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Rosemary Balleine
- Institute of Clinical Pathology and Medical Research, Pathology West, NSW Health Pathology, Sydney, NSW, 2145, Australia
- Faculty of Medicine and Health, Children's Medical Research Institute, University of Sydney, Westmead, NSW, 2145, Australia
| | - Nirmala Pathmanathan
- Westmead Breast Cancer Institute, Westmead, NSW, 2145, Australia.
- Western Sydney Local Health District, Westmead, NSW, 2145, Australia.
- Westmead Clinical School, University of Sydney, Sydney, NSW, 2145, Australia.
- Douglass Hanly Moir Pathology, Macquarie Park, NSW, 2113, Australia.
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14
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Fischer Maranta A, Ruhstaller T. Response to: Intrinsic subtype distribution should vary according to institutions. Breast 2020; 54:350. [PMID: 33221060 PMCID: PMC7770432 DOI: 10.1016/j.breast.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Angela Fischer Maranta
- Department of Oncology, St. Gallen Cantonal Hospital, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
| | - Thomas Ruhstaller
- Breast Center, St. Gallen Cantonal Hospital, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Petersplatz 1, 4001 Basel, Switzerland
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15
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Vlajnic T, Bubendorf L. Molecular pathology of prostate cancer: a practical approach. Pathology 2020; 53:36-43. [PMID: 33234230 DOI: 10.1016/j.pathol.2020.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
While localised prostate cancer can be cured by local treatment, 'high-risk' prostate cancer often progresses to castration resistant disease and remains incurable with a dismal prognosis. In recent years, technical advances and development of novel methodologies have largely contributed to a better understanding of underlying molecular mechanisms that promote tumour growth and progression. Consecutively, novel therapeutic strategies for treatment of prostate cancer have emerged during the last decade, calling for the identification of predictive biomarkers. The concept of personalised medicine is to tailor treatment according to the specific tumour profile of an individual patient. Moreover, acquired molecular changes during tumour evolution and in response to therapy selection pressure require adapted predictive marker testing at different time points during the disease. In this setting, the pathologist plays a critical role in patient management and treatment selection. In this review, we provide a comprehensive overview of the current knowledge of molecular aspects of prostate cancer and their potential utility in the context of different therapeutic approaches. Furthermore, we discuss methods for molecular marker testing in routine clinical practice, with a focus on castration resistant prostate cancer.
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Affiliation(s)
- Tatjana Vlajnic
- Institute of Pathology, University Hospital Basel, Basel, Switzerland.
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
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16
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Horimoto Y, Tanabe M. Intrinsic subtype distribution should vary according to institutions. Breast 2020; 54:349. [PMID: 33199215 PMCID: PMC7770455 DOI: 10.1016/j.breast.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/03/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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17
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Puppe J, Seifert T, Eichler C, Pilch H, Mallmann P, Malter W. Genomic Signatures in Luminal Breast Cancer. Breast Care (Basel) 2020; 15:355-365. [PMID: 32982645 DOI: 10.1159/000509846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/01/2020] [Indexed: 01/22/2023] Open
Abstract
Background Breast cancer is a very heterogeneous disease and luminal breast carcinomas represent the hormone receptor-positive tumors among all breast cancer subtypes. In this context, multigene signatures were developed to gain further prognostic and predictive information beyond clinical parameters and traditional immunohistochemical markers. Summary For early breast cancer patients these molecular tools can guide clinicians to decide on the extension of endocrine therapy to avoid over- and undertreatment by adjuvant chemotherapy. Beside the predictive and prognostic value, a few genomic tests are also able to provide intrinsic subtype classification. In this review, we compare the most frequently used and commercially available molecular tests (OncotypeDX®, MammaPrint®, Prosigna®, EndoPredict®, and Breast Cancer Index<sup>SM</sup>). Moreover, we discuss the clinical utility of molecular profiling for advanced breast cancer of the luminal subtype. Key Messages Multigene assays can help to de-escalate systemic therapy in early-stage breast cancer. Only the Oncotype DX® and MammaPrint®<sup></sup>test are validated by entirely prospective and randomized phase 3 trials. More clinical evidence is needed to support the use of genomic tests in node-positive disease. Recent developments in high-throughput sequencing technology will provide further insights to understand the heterogeneity of luminal breast cancers in early-stage and metastatic disease.
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Affiliation(s)
- Julian Puppe
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tabea Seifert
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henryk Pilch
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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