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Bocian A, Kędzierawski P, Kopczyński J, Wabik O, Wawruszak A, Kiełbus M, Miziak P, Stepulak A. Kaiso Protein Expression Correlates with Overall Survival in TNBC Patients. J Clin Med 2023; 12:jcm12010370. [PMID: 36615173 PMCID: PMC9821773 DOI: 10.3390/jcm12010370] [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: 12/20/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
Triple-negative breast cancers (TNBCs) are histologically heterogenic invasive carcinomas of no specific type that lack distinctive histological characteristics. The prognosis for women with TNBC is poor. Regardless of the applied treatments, recurrences and deaths are observed 3-5 years after the diagnosis. Thus, new diagnostic markers and targets for personalized treatment are needed. The subject of our study-the Kaiso transcription factor has been found to correlate with the invasion and progression of breast cancer. The publicly available TCGA breast cancer cohort containing Illumina HiSeq RNAseq and clinical data was explored in the study. Additionally, Kaiso protein expression was assessed in formalin-fixed and paraffin-embedded tissue archive specimens using the tissue microarray technique. In this retrospective study, Kaiso protein expression (nuclear localization) was compared with several clinical factors in the cohort of 103 patients with TNBC with long follow-up time. In univariate and multivariate analysis, high Kaiso protein but not mRNA expression was correlated with better overall survival and disease-free survival, as well as with premenopausal age. The use of radiotherapy was correlated with better disease-free survival (DFS) and overall survival (OS). However, given the heterogeneity of TNBC and context-dependent molecular diversity of Kaiso signaling in cancer progression, these results must be taken with caution and require further studies.
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Affiliation(s)
- Artur Bocian
- Oncological Surgery Clinic, The Holycross Cancer Centre, 25-734 Kielce, Poland
| | - Piotr Kędzierawski
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
- Radiotherapy Department, The Holycross Cancer Centre, 25-734 Kielce, Poland
| | - Janusz Kopczyński
- Pathology Department, The Holycross Cancer Centre, 25-734 Kielce, Poland
| | - Olga Wabik
- Pathology Department, The Holycross Cancer Centre, 25-734 Kielce, Poland
| | - Anna Wawruszak
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, 20-093 Lublin, Poland
- Correspondence: ; Tel.: +48-814-486-350
| | - Michał Kiełbus
- Department of Experimental Hematooncology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Paulina Miziak
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Andrzej Stepulak
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, 20-093 Lublin, Poland
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2
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Xie N, Zhou H, Yu L, Huang S, Tian C, Li K, Jiang Y, Hu ZY, Ouyang Q. Artificial intelligence scale-invariant feature transform algorithm-based system to improve the calculation accuracy of Ki-67 index in invasive breast cancer: a multicenter retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1067. [PMID: 36330383 PMCID: PMC9622502 DOI: 10.21037/atm-22-4254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 09/02/2023]
Abstract
BACKGROUND Ki-67 is a key indicator of the proliferation activity of tumors. However, no standardized criterion has been established for Ki-67 index calculation. Scale-invariant feature transform (SIFT) algorithm can identify the robust invariant features to rotation, translation, scaling and linear intensity changes for matching and registration in computer vision. Thus, this study aimed to develop a SIFT-based computer-aided system for Ki-67 calculation in breast cancer. METHODS Hematoxylin and eosin (HE)-stained and Ki-67-stained slides were scanned and whole slide images (WSIs) were obtained. The regions of breast cancer (BC) tissues and non-BC tissues were labeled by experienced pathologists. All the labeled WSIs were randomly divided into the training set, verification set, and test set according to a fixed ratio of 7:2:1. The algorithm for identification of cancerous regions was developed by a ResNet network. The registration process between paired consecutive HE-stained WSIs and Ki-67-stained WSIs was based on a pyramid model using the feature matching method of SIFT. After registration, we counted the nuclear-stained Ki-67-positive cells in each identified invasive cancerous region using color deconvolution. To assess the accuracy, the AI-assisted result for each slice was compared with the manual diagnosis result of pathologists. If the difference of the two positive rate values is not greater than 10%, it was a consistent result; otherwise, it was an inconsistent result. RESULTS The accuracy of the AI-based algorithm in identifying breast cancer tissues in HE-stained slides was 93%, with an area under the curve (AUC) of 0.98. After registration, we succeeded in identifying Ki-67-positive cells among cancerous cells across the entire WSIs and calculated the Ki-67 index, with an accuracy rate of 91.5%, compared to the gold standard pathological reports. Using this system, it took about 1 hour to complete the evaluation of all the tested 771 pairs of HE- and Ki-67-stained slides. Each Ki-67 result took less than 2 seconds. CONCLUSIONS Using a pyramid model and the SIFT feature matching method, we developed an AI-based automatic cancer identification and Ki-67 index calculation system, which could improve the accuracy of Ki-67 index calculation and make the data repeatable among different hospitals and centers.
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Affiliation(s)
- Ning Xie
- Medical Department of Breast Cancer, Hunan Cancer Hospital, Changsha, China
- Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Haoyu Zhou
- College of Information and Intelligence, Hunan Agricultural University, Changsha, China
| | - Li Yu
- Ningbo Lensee Intelligent Technology Co., Ltd., Ningbo, China
| | - Shaobing Huang
- Ningbo Lensee Intelligent Technology Co., Ltd., Ningbo, China
| | - Can Tian
- Medical Department of Breast Cancer, Hunan Cancer Hospital, Changsha, China
- Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Keyu Li
- Department of Respiratory Medicine, The First Hospital of Changsha City, Changsha, China
| | - Yi Jiang
- Department of Pathology, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhe-Yu Hu
- Medical Department of Breast Cancer, Hunan Cancer Hospital, Changsha, China
- Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
| | - Quchang Ouyang
- Medical Department of Breast Cancer, Hunan Cancer Hospital, Changsha, China
- Department of Breast Cancer Medical Oncology, the Affiliated Cancer Hospital of Xiangya Medical School, Central South University, Changsha, China
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3
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Kayali M, Abi Jaoude J, Mohammed M, Khabsa J, Tfayli A, Poortmans P, Zeidan YH. Post-mastectomy Radiation Therapy in Triple-Negative Breast Cancer Patients: Analysis of the BEATRICE Trial. Ann Surg Oncol 2021; 29:460-466. [PMID: 34324113 DOI: 10.1245/s10434-021-10511-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/29/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Post-mastectomy radiation therapy (PMRT) improves locoregional control and overall survival in patients with breast cancer. With the evolution of systemic therapy, the benefit of PMRT in patients with triple-negative disease requires further evaluation. PATIENTS AND METHODS BEATRICE is a phase III randomized clinical trial that examined the efficacy of bevacizumab in patients with triple-negative breast cancer (TNBC). The current study is a retrospective analysis of data on patients enrolled and treated with mastectomy and systemic therapy. The primary endpoint was determining the effect of PMRT on locoregional recurrence rates (LRR). Hazard ratios were estimated using Cox regression, and LRR curves were generated by the Kaplan-Meier method. RESULTS In total, 940 patients were included in our analysis, of whom 359 (38.2%) received PMRT while 581 (61.8%) did not. At median follow-up of 5 years, no significant difference in LRR was noted between the PMRT and no PMRT groups in node-negative patients (HR = 1.09). Patients with N1 disease had 5-year LRR-free survival of 96% for PMRT versus 91% for no PMRT (HR = 0.46). Most N2 patients received PMRT and had 5-year LRR-free survival of 76%. CONCLUSION PMRT benefit in TNBC patients treated with modern systemic therapy is lower than historical reports. Delivery of PMRT in patients with N1 disease enrolled in the BEATRICE trial was not shown to improve local control. As this might be due to patient selection for PMRT, future randomized controlled trials are required to assess the role of PMRT in this patient population.
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Affiliation(s)
- Majd Kayali
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joseph Abi Jaoude
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammed Mohammed
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Arafat Tfayli
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Philip Poortmans
- Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Youssef H Zeidan
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon. .,Baptist Health, Lynn Cancer Institute, Boca Raton, FL, USA.
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4
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Hammond JB, Han GR, Cronin PA, Kosiorek HE, Rebecca AM, Casey WJ, Kruger EA, Teven CM, Pockaj BA. Exploring the Effect of Post-mastectomy complications on 5-year survival. Am J Surg 2020; 220:1422-1427. [PMID: 32921402 DOI: 10.1016/j.amjsurg.2020.09.007] [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: 03/20/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ramifications of postoperative complications on long-term survival after mastectomy are uncertain. METHODS Overall complications (Clavien-Dindo Grades I-IIIB) and wound complications were analyzed using the Kaplan-Meier method for impact on 5-year overall (OS) and disease-free survival (DFS). RESULTS A total of 378 patients underwent mastectomy alone (157, 41%) or mastectomy with reconstruction (221, 59%) for Stage I-III disease with a median follow-up of 5 years. Postoperative complications occurred in 186 patients (49%), requiring non-surgical (I/II = 83, 22%) or surgical (IIIa/IIIb = 103, 27%) management. Wound complications occurred in 140 patients (37%). Reconstruction was associated with a higher rate of complication (P < 0.001). Postoperative complications after mastectomy (with or without reconstruction) did not significantly affect OS or DFS. Wound complications also showed no significant effect on OS or DFS following mastectomy alone, or mastectomy with reconstruction. CONCLUSIONS Postoperative complications after mastectomy, with or without reconstruction, bear no significant impact on 5-year survival.
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Affiliation(s)
| | - Ga-Ram Han
- Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Patricia A Cronin
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Heide E Kosiorek
- Department of Health Sciences Research, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - Alanna M Rebecca
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - William J Casey
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Erwin A Kruger
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Chad M Teven
- Division of Plastic & Reconstructive Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Barbara A Pockaj
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ, USA.
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5
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Montero A, Ciérvide R, García-Aranda M, Rubio C. Postmastectomy radiation therapy in early breast cancer: Utility or futility? Crit Rev Oncol Hematol 2020; 147:102887. [PMID: 32018127 DOI: 10.1016/j.critrevonc.2020.102887] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/08/2020] [Accepted: 01/27/2020] [Indexed: 01/31/2023] Open
Abstract
Postmastectomy radiation therapy (PMRT) has been shown to reduce the risk of locoregional recurrence (LRR), in patients with locally advanced breast cancer who are considered of high-risk because of large tumors (>5 cm) or presence of axillary lymph-node involvement, as well as to reduce breast cancer mortality. However, controversy still remains with respect to indication of PMRT in case of early-stages invasive tumors. This review aims to analyze the impact that PMRT has on final results in women with breast tumors in different scenarios that would otherwise be considered as early breast cancer, such as extensive DCIS, tumors without axillary lymph-node involvement or with minimal microscopic nodal-involvement. The existence of risk factors including young age, premenopausal status, and presence of lymphovascular invasion (LVI), high grade or tumor size >2 cm has been associated with an increased risk of LRR in these patients at early-stages and advises to consider PMRT in selected cases.
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Affiliation(s)
- Angel Montero
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Breast Cancer Unit, Hospital Universitario HM Sanchinarro, Madrid, Spain.
| | - Raquel Ciérvide
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Breast Cancer Unit, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Mariola García-Aranda
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Breast Cancer Unit, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Carmen Rubio
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Breast Cancer Unit, Hospital Universitario HM Sanchinarro, Madrid, Spain
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6
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Can a subgroup at high risk for LRR be identified from T1-2 breast cancer with negative lymph nodes after mastectomy? A meta-analysis. Biosci Rep 2019; 39:BSR20181853. [PMID: 31484798 PMCID: PMC6753322 DOI: 10.1042/bsr20181853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 04/24/2019] [Accepted: 07/10/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: To identify a subgroup at high risk for loco-regional recurrence (LRR) from T1-2 breast cancer with negative lymph nodes (N0) after mastectomy by using a meta-analysis.Methods and materials: Published studies on the relationship between clinical features and LRR of breast cancer were identified from public databases, including PubMed, EMBASE, and the Cochrane Library. High-risk features for LRR in this patient population were defined based on the pooled results of meta-analysis.Results: For the meta-analysis, a total of 11244 breast cancers with pT1-2N0 after mastectomy from 20 publications were included for analysis. The pooled results indicated that age (hazard ratio (HR) 1.77, P=0.001), lymphovascular invasion (LVI) (HR 2.23, P<0.001), histologic grade (HR 1.66, P<0.001), HER2 status (HR 1.65, P=0.027), menopausal status (HR 1.36, P=0.015), and surgical margins (HR 2.56, P=0.014) were associated with a significantly increased risk of developing LRR in this patient population group, but not for tumor size (HR 1.32, P=0.23), systematic therapy (HR 1.67, P=0.20), and hormonal receptor status (HR 1.04, P=0.73).Conclusion: In the current study, patients with young age, positive LVI, high histologic grade, HER-2 positive, premenopausal, and positive surgical margins have an increased risk of developing LRR. Further prospective trials are needed to clearly define the role of adjuvant postmastectomy radiotherapy in T1-2N0 breast cancer at high risk of developing LRR.
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7
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De Santis MC, La Rocca E, Meneghini E, Bregni G, Di Lorenzo G, Galli G, Di Nicola M, Folli S, Gennaro M, Pruneri G, Paolini B, Daidone MG, De Braud F, Apolone G, Sant M, Di Cosimo S. Axillary nodal involvement by primary tumor features in early breast cancer: an analysis of 2600 patients. Clin Transl Oncol 2019; 22:786-792. [PMID: 31372896 DOI: 10.1007/s12094-019-02188-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Primary tumor characteristics, which are readily available to all clinicians, may aid in selecting the optimal adjuvant therapy for patients with breast cancer (BC). Herein, we investigated the relationship between tumor size, hormone receptor and HER2 status, Ki67 and age with axillary lymph node metastases (ALNM) in early-BC patients. METHODS We analyzed data on consecutive 2600 early-BC cases collected in the registry of Fondazione IRCC Istituto Nazionale dei Tumori, Milano, Italy. Correlation between Ki67 and primary tumor size (T-size) was calculated by Spearman's rank correlation coefficient. Association of ALNM with Ki67 and other tumor characteristics was investigated by logistic regression. Adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated in all cases, and separately analyzed according to age, T-size and BC subtype. RESULTS Large tumor size strongly associated to ALNM, with an adjusted odds ratio (OR) for each 5-mm increase of 1.32 (95% CI 1.24-1.41), except for triple-negative BC (TNBC) cases. In tumors =10 mm, without lymphovascular invasion, representing the strongest predictor of ALNM (OR 6.09, 95% CI 4.93-7.53), Ki67 resulted particularly informative, with a fourfold increased odds of ALNM for values > 30%. CONCLUSIONS These results raise the question whether axillary node status is redundant in cases with exceptionally good features, i.e., small tumors with low Ki67, or in those candidate to adjuvant systemic treatment/radiotherapy anyway including TNBC, and support the incorporation of primary BC tumor characteristics as stratification factors in ongoing trials aiming at de-escalating axillary surgical procedures.
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Affiliation(s)
- M C De Santis
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E La Rocca
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,School of Medicine, Università degli Studi di Milan, Milan, Italy
| | - E Meneghini
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Bregni
- Medical Oncology, Ospedale Policlinico S. Martino IRCCS, Genova, Italy
| | - G Di Lorenzo
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,School of Medicine, Università degli Studi di Milan, Milan, Italy
| | - G Galli
- School of Medicine, Università degli Studi di Milan, Milan, Italy.,Division of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Di Nicola
- Division of Medical Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Folli
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Gennaro
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Pruneri
- School of Medicine, Università degli Studi di Milan, Milan, Italy.,Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - B Paolini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M G Daidone
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G Amadeo 42, 20133, Milan, Italy
| | - F De Braud
- School of Medicine, Università degli Studi di Milan, Milan, Italy.,Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sant
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Di Cosimo
- Biomarker Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G Amadeo 42, 20133, Milan, Italy.
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8
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Barrientos R, Samtani S, Frelinghuysen M, Sotomayor C, Gormaz JG, Burotto M. Clinical decision making in postmastectomy radiotherapy in node negative breast cancer. Ecancermedicalscience 2018; 12:874. [PMID: 30483354 PMCID: PMC6214678 DOI: 10.3332/ecancer.2018.874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 11/29/2022] Open
Abstract
For decades, postmastectomy radiotherapy (PMRT) has been recommended for node positive [N(+)] breast cancer patients; nevertheless, the beneficial effect of PMRT for treatment of node negative [N(−)] disease remains under discussion. Nowadays, the biology of breast cancer and the risk factors (RFs) for locoregional failure (LRF) must be included in the decision on whether or not to carry out PMRT. For these reasons, the present review aims to evaluate the rationale use of PMRT in N(−) patients and discuss which subgroups may further benefit from the treatment in present times where the decision must be personalised, according to the RFs of locoregional recurrence (LRR). To perform the analysis, we ponder that LRR of over 10% should be considered unacceptable due to the fact that LRRs generate great morbidity in patients. For this purpose, we consider that routine RT in these patients is not recommended, although there are subgroups of patients with high LRR, in which PMRT could be beneficial.
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Affiliation(s)
- Rodrigo Barrientos
- Department of Radiation Oncology, Instituto de Radiomedicina IRAM, Santiago, Chile
| | - Suraj Samtani
- Department of Medical Oncology, Clinica Alemana Santiago, Vitacura, Chile
| | | | - Camilo Sotomayor
- Radiation Oncology Unit, Hospital Clinico Regional de Concepción, Concepción, Chile
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9
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Li X, Dai D, Chen B, Tang H, Xie X, Wei W. Determination of the prognostic value of preoperative CA15-3 and CEA in predicting the prognosis of young patients with breast cancer. Oncol Lett 2018; 16:4679-4688. [PMID: 30214602 DOI: 10.3892/ol.2018.9160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/07/2017] [Indexed: 01/29/2023] Open
Abstract
To the best of our knowledge, no previous study has investigated the association of carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) with the prognosis for young patients (≤40 years) with breast cancer. In the present study, preoperative CEA and CA15-3 serum levels were evaluated in the prediction of the prognosis for young patients with breast cancer. In total, 699 patients were recruited, for which the CEA and CA15-3 serum levels had been measured prior to surgery via a blood sample. The optimal cut-off high and low values were determined using receiver operating characteristic curve analysis and Youden's index. The value of CEA and CA15-3 in predicting overall survival (OS) and disease-free survival (DFS) were measured using univariate and multivariate Cox's regression analyses. The cut-off values were 3.38 ng/ml and 12.32 U/ml for CEA and CA15-3, respectively. It was identified that CEA, but not CA15-3, was a predictor for the prognosis of the young patients with breast cancer. Multivariate analysis confirmed that CEA, but not CA15-3, was an independent prognostic marker for all young patients with breast cancer. In total, 623 young patients exhibited decreased levels of CEA; in these patients, CA15-3 with a cut-off value of 12.48 U/ml was an independent prognostic factor for OS and DFS. Preoperative serum CEA may thus serve as an independent predictor of poor prognosis for young patients with breast cancer. However, for low-risk patients with decreased CEA levels, serum CA15-3 may supplement the prediction of overall prognosis.
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Affiliation(s)
- Xuan Li
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Danian Dai
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Bo Chen
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Weidong Wei
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
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10
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Affiliation(s)
- J Frank Wilson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adam D Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
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11
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Jiang Y, Liu Y, Hu H. Studies on DNA Damage Repair and Precision Radiotherapy for Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1026:105-123. [PMID: 29282681 DOI: 10.1007/978-981-10-6020-5_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Radiotherapy acts as an important component of breast cancer management, which significantly decreases local recurrence in patients treated with conservative surgery or with radical mastectomy. On the foundation of technological innovation of radiotherapy setting, precision radiotherapy of cancer has been widely applied in recent years. DNA damage and its repair mechanism are the vital factors which lead to the formation of tumor. Moreover, the status of DNA damage repair in cancer cells has been shown to influence patient response to the therapy, including radiotherapy. Some genes can affect the radiosensitivity of tumor cell by regulating the DNA damage repair pathway. This chapter will describe the potential application of DNA damage repair in precision radiotherapy of breast cancer.
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Affiliation(s)
- Yanhui Jiang
- Department of Radiotherapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yimin Liu
- Department of Radiotherapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Hai Hu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
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12
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Possible benefits from post-mastectomy radiotherapy in node-negative breast cancer patients: a multicenter analysis in Korea (KROG 14-22). Oncotarget 2017; 8:59800-59809. [PMID: 28938683 PMCID: PMC5601779 DOI: 10.18632/oncotarget.16241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/20/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This study was performed to identify a subset of patients who may benefit from post-mastectomy radiotherapy (PMRT) among node-negative breast cancer patients. MATERIALS AND METHODS We retrospectively reviewed 1,828 patients with pT1-2N0 breast cancer, treated with mastectomy without PMRT from 2005 to 2010 at 10 institutions. Univariate and multivariate analyses for locoregional recurrence (LRR) and any first recurrence (AFR) were performed according to clinicopathologic factors and biologic subtypes. RESULTS During a median follow-up period of 5.9 years (range: 0.7-10.4 years), 98 patients developed AFR (39 isolated LRR, 13 LRR with synchronous distant metastasis, and 46 isolated distant metastasis), and 52 patients developed LRR. The 7-year LRR and AFR rates were 3.8% and 6.7%, respectively. Multivariate analysis revealed that age of ≤ 40 years (p<0.001) and T2 stage (p=0.013) were independent risk factors for LRR. The 7-year LRR rates were 2.5% with no risk factors, 4.5% with one risk factor, and 12.4% with two risk factors. Multivariate analysis for AFR revealed that age of ≤ 40 years (p<0.001), T2 stage (p<0.001), and triple-negative biological subtype (p=0.045) were independent risk factors for AFR. The 7-year AFR rates were 3.9% with no risk factors, 8.4% with one risk factor, and 15.7% with two to three risk factors. CONCLUSIONS Mastectomy without PMRT is a sufficient local treatment for pT1-2N0M0 breast cancer. Nevertheless, PMRT might be considered for patients with two or three risk factors, among those of young age, with T2 tumors, and with the triple-negative biological subtype based on LRR and AFR.
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Li P, Ye H, Liu J, Jin H, Lin Y, Yan S, Yu Y, Gao L, Xu F, Zhang Z. Evaluation of a newly developed quantitative determination kit for tumor marker CA15-3 with chemiluminescent assay. J Clin Lab Anal 2017; 32. [PMID: 28233344 PMCID: PMC5811926 DOI: 10.1002/jcla.22158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/06/2017] [Indexed: 12/05/2022] Open
Abstract
Background Tumor marker carbohydrate antigen 15‐3 (CA15‐3) is used as a biomarker to aid to diagnose and monitor the prognosis of breast cancer patients. A new quantitative determination kit for CA15‐3 with chemiluminescent assay was developed by Xiamen InnoDx Biotech Co., Ltd, China. Therefore, we conducted the report to evaluate the performance of the kit. Methods According to the “Guiding principles on performance analysis of diagnostic reagents in vitro”, the calibration curve, limit of detection, reportable range, accuracy, precision, anti‐interference capability, cross‐reaction and comparison by measuring EDTA plasma and serum were carried out. In addition, the kit was performed in parallel to electrochemiluminescence immunoassay kit (Roche) to analyze the correlation between the two kits. Results Regression equation of calibration curve of the kit was Y=0.7914X+4.1032 (R2=.990). Limit of detection was 0.0347 U/mL. The reportable range was 0.5‐2400 U/mL. Recovery ratio was 100.0%‐104.8%. Coefficient of variations (CVs) of within‐run and between‐run were 4.8%‐7.6% and 5.8%‐7.4% respectively. No remarkable interferences (all Bias% were less than ±10%) were detected when samples contained hemoglobin ≤183.8 μmol/L, bilirubin ≤340 μmol/L, triglyceride ≤18.1 mmol/L, or rheumatoid factor ≤400 U/mL. No cross‐reaction was present in the kit. Moreover, compared with the results from electrochemiluminescence immunoassay kit (Roche) in 345 serum samples, there was a satisfied correlation coefficient of 0.977 (P<.01), and the kit was simultaneously fit for the detection of EDTA plasma and serum samples. Conclusion The new kit validated satisfactorily, and it can be used for detecting CA15‐3 in clinical practice.
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Affiliation(s)
- Peihua Li
- Center for Clinical Laboratory, Xiamen University Affiliated Zhongshan Hospital, Xiamen, China
| | - Huiming Ye
- Department of Clinical laboratory, Xiamen's Maternal and Child Health Hospital, Xiamen, China
| | - Jiangwu Liu
- Xiamen InnoDx Biotech Co., Ltd, Xiamen, China
| | - Hongwei Jin
- Center for Clinical Laboratory, Xiamen University Affiliated Zhongshan Hospital, Xiamen, China
| | - Yongzhi Lin
- Center for Clinical Laboratory, Xiamen University Affiliated Zhongshan Hospital, Xiamen, China
| | - Shuidi Yan
- Center for Clinical Laboratory, Xiamen University Affiliated Zhongshan Hospital, Xiamen, China
| | - Yang Yu
- Center for Clinical Laboratory, Xiamen University Affiliated Zhongshan Hospital, Xiamen, China
| | - Lei Gao
- Xiamen InnoDx Biotech Co., Ltd, Xiamen, China
| | - Feihai Xu
- Xiamen InnoDx Biotech Co., Ltd, Xiamen, China
| | - Zhongying Zhang
- Center for Clinical Laboratory, Xiamen University Affiliated Zhongshan Hospital, Xiamen, China
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Laurberg T, Alsner J, Tramm T, Jensen V, Lyngholm CD, Christiansen PM, Overgaard J. Impact of age, intrinsic subtype and local treatment on long-term local-regional recurrence and breast cancer mortality among low-risk breast cancer patients. Acta Oncol 2017; 56:59-67. [PMID: 27846764 DOI: 10.1080/0284186x.2016.1246803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To evaluate the long-term prognostic impact of age, local treatment and intrinsic subtypes on the risk of local-regional recurrence (LRR) and breast cancer mortality among low-risk patients. MATERIAL AND METHODS Cohort study with prospectively collected data, balanced five-year age groups, including 514 Danish lymph node negative breast cancer patients diagnosed between 1989 and 1998, treated with mastectomy (N = 320) or breast-conserving therapy (BCT) (N = 194) and without systemic treatment. Intrinsic subtype approximation was performed by combining information on estrogen-, progesterone-, HER2 receptor and Ki67. RESULTS The majority of the tumors had a luminal subtype: 70% Luminal-A (LumA), 16% Luminal-B (LumB), and 10% Luminal-HER2 + (Lum-HER2+). The distribution of intrinsic subtypes between younger (≤45 years) and older (>45 years) patients was similar. Intrinsic subtypes had no prognostic impact on the 20-year LRR risk, regardless of age. A distinct 20-year mortality pattern was observed among the younger patients: 11% of patients with LumB tumor died of breast cancer within the first five years after primary surgery, 23% of patients with Lum-HER2+ tumor died within a 5-10-year period, whereas patients with LumA tumor died with a constant low rate throughout the 20-year period. After 20 years of follow-up, patients with LumA tumor had breast cancer mortality comparable to that of patients with LumB tumor (20%) and lower than Lum-HER2+ tumor (39%). Among the older patients, no distinct mortality pattern was observed, and the 20-year breast cancer mortality was not associated with intrinsic subtypes. CONCLUSION Among low-risk patients, 96% of the tumors were Luminal and the distribution of intrinsic subtypes between younger (≤45 years) and older (>45 years) patients was similar. The observed higher frequency of LRR among younger low-risk BCT patients was not associated intrinsic subtype. The 20-year breast cancer mortality was non-significant for LumA tumors among the older patients, whereas among the younger patients, LumA tumors had a comparable mortality with LumB, but lower than for Lum-HER2 + tumors.
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Affiliation(s)
- Tinne Laurberg
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Pathology, Aarhus University Hospital, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Trine Tramm
- Department of Pathology, Aarhus University Hospital, Denmark
| | - Vibeke Jensen
- Department of Pathology, Aarhus University Hospital, Denmark
| | | | - Peer M. Christiansen
- Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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Leonardi MC, Ricotti R, Dicuonzo S, Cattani F, Morra A, Dell'Acqua V, Orecchia R, Jereczek-Fossa BA. From technological advances to biological understanding: The main steps toward high-precision RT in breast cancer. Breast 2016; 29:213-22. [DOI: 10.1016/j.breast.2016.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/27/2016] [Accepted: 07/08/2016] [Indexed: 12/23/2022] Open
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Ozguven S, Inanir S, Turoglu HT, Erdil TY, Ugurlu MU, Gulluoglu B. 2-(fluorine-18)-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography after breast conserving surgery: Correlation with molecular markers of breast cancer. Indian J Nucl Med 2016; 31:166-71. [PMID: 27385883 PMCID: PMC4918476 DOI: 10.4103/0972-3919.181848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: To investigate the role of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) early after breast-conserving surgery (BCS) in patients with breast cancer (BC) and whether we can determine which molecular biomarkers of breast carcinoma put the patients at risk. Materials and Methods: This retrospective study involved 88 patients with histologically proven T1 or T2 BC, who were treated with BCS and underwent 18F-FDG PET/CT study. The correlation between biological markers (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 [HER2], and Ki-67) of the primary tumor and 18F-FDG PET/CT findings was analyzed. Results: 18F-FDG PET/CT demonstrated the presence of BC disease (locoregional disease [LRD], distant metastases, or contralateral BC) in 26 of 88 patients (29.5%). Regarding immunohistochemical profiles, BC expressing high levels of Ki-67 were associated with an increased percentage of LRD, which was the major recurrence pattern on 18F-FDG PET/CT. Although the BC disease was observed more commonly in patients with HER2 positivity compared to those of HER2 negative, the difference did not reach statistical significance. The patients with T2 tumor or a higher histopathological grade had a higher percentage of BC disease. Conclusions: This study demonstrated that patients with early stage BC treated with BCS have a remarkable risk of the presence of BC even early after surgery, and there was a clinically important relationship between 18F-FDG PET/CT findings and biological markers of BC. These findings suggest that high-risk molecular biomarkers (Ki-67, HER2) can be taken into account in the decision-making the process for both preoperative imaging and planning of the surgical approach.
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Affiliation(s)
- Salih Ozguven
- Department of Nuclear Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Sabahat Inanir
- Department of Nuclear Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Halil Turgut Turoglu
- Department of Nuclear Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tanju Yusuf Erdil
- Department of Nuclear Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Mustafa Umit Ugurlu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Bahadir Gulluoglu
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Zhong F, Bi R, Yu B, Yang F, Yang W, Shui R. A Comparison of Visual Assessment and Automated Digital Image Analysis of Ki67 Labeling Index in Breast Cancer. PLoS One 2016; 11:e0150505. [PMID: 26928407 PMCID: PMC4771161 DOI: 10.1371/journal.pone.0150505] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/14/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Ki67 labeling index (LI) is critical for treatment options and prognosis evaluation in breast cancer. Visual assessment (VA) is widely used to assess Ki67 LI, but has some limitations. In this study, we compared the consistency between VA and automated digital image analysis (DIA) of Ki67 LI in breast cancer, and to evaluate the application value of DIA in Ki67 LI assessment. METHODS Ki67 immunostained slides of 155 cases of primary invasive breast cancer were eyeballing assessed by five breast pathologists and automated digital image analyzed by one breast pathologist respectively. Two score methods, hot-spot score and average score, were used to choose score areas. The intra-class correlation coefficient (ICC) was used to analyze the consistency between VA and DIA, and Wilcoxon signed-rank test was used to compare the median of paired-difference between VA and DIA values. RESULTS (1) A perfect agreement was demonstrated between VA and DIA of Ki67 LI by ICC analysis (P<0.0001) in the whole cohort. A perfect agreement between VA and DIA of Ki67 LI was also showed in G2-G3, ER positive/HER2 negative cases. Average score and hot-spot score methods both demonstrated a perfect concordance between VA and DIA of Ki67 LI. (2) All cases were classified into three groups by VA values (≤10%, 11%-30% and >30% Ki67 LI). The concordance was relatively lower in intermediate Ki67 LI group (11%-30%) compared with high (>30%) Ki67 LI groups according to both methods. (3) All cases were classified into three groups by paired-difference (d) between VA values of hot-spot score and average score (d<5, 5≤d<10, d≥10) to evaluate the correlation between Ki67 staining distribution (heterogeneous or homogenous) and reproducibility of assessment. A perfect agreement was all demonstrated in three groups, and a slightly better Ki67 LI agreement between VA and DIA was indicated in homogenous staining slides than in heterogeneous staining ones. (4) VA values were relatively smaller than DIA values (average score: median of paired-difference -3.72; hot-spot score: median of paired-difference -9.12). CONCLUSIONS An excellent agreement between VA and DIA of Ki67 LI in breast cancer was demonstrated in the whole mixed cohort, suggesting that VA and DIA both could be used to assess Ki67 LI in clinical practice. Average score and hot-spot score methods both demonstrated a perfect concordance between VA and DIA of Ki67 LI. The almost perfect agreement between VA and DIA was observed in high Ki67 LI cases, displaying a homogenous staining pattern. The consistency between VA and DIA was relatively low in intermediate Ki67 LI group. The heterogeneity of tumors may slightly affect the concordance between VA and DIA of Ki67 LI. Assessment of VA provides lower Ki67 values than DIA, the biological importance of these values are not known at the moment.
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Affiliation(s)
- Fangfang Zhong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui Bi
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Baohua Yu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fei Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wentao Yang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruohong Shui
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- * E-mail:
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Jwa E, Shin KH, Lim HW, Jung SY, Lee S, Kang HS, Lee E, Park YH. Identification of Risk Factors for Locoregional Recurrence in Breast Cancer Patients with Nodal Stage N0 and N1: Who Could Benefit from Post-Mastectomy Radiotherapy? PLoS One 2015; 10:e0145463. [PMID: 26691445 PMCID: PMC4686923 DOI: 10.1371/journal.pone.0145463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/03/2015] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The locoregional recurrence (LRR) rate was reported as high as approximately 20% in stage I-II breast cancer following mastectomy. To investigate the risk factors for LRR in pT1-2N0-1 breast cancer patients treated with mastectomy but not radiation, and to define a subgroup of patients at high risk of LRR who may benefit from postmastectomy radiotherapy (PMRT). METHODS AND MATERIALS In total, 390 patients with pT1-2N0M0 (n = 307) and pT1-2N1M0 (n = 83) breast cancer who underwent total mastectomy without adjuvant radiotherapy from 2002 to 2011 were enrolled in the study. RESULTS After a median follow-up period of 5.6 years (range, 0.6-11.3 years), 21 patients had 18 systemic relapses and 12 LRRs including six in the chest wall and eight in the regional nodal area. The 5-year LRR-free survival (LRRFS) rates were 97.0% in pN0, 98.8% in pN1, and 97.4% in all patients. Multivariate analysis revealed that age < 50 years (Hazard Ratio, 11.4; p = 0.01) and no adjuvant chemotherapy (Hazard Ratio, 10.2; p = 0.04) were independent risk factors for LRR in pN0 patients. Using these factors, the 5-year LRRFS rates were 100% without any risk factors, 96.4% with one risk factor, and 86.7% with two risk factors. In pN1 patients, multivariate analysis revealed that having a hormone receptor negative tumor (Hazard Ratio, 18.3; p = 0.03) was the only independent risk factor for LRR. The 5-year LRRFS rates were 100.0% for luminal type, and 92.3% for non-luminal type cancer. CONCLUSION Patients with pT1-2N0-1 breast cancer who underwent total mastectomy without PMRT could be stratified by nodal stage and risk factors for LRR. PMRT may have of value for node negative patients aged less than 50 years and who are not treated with adjuvant chemotherapy, and for non-luminal type patients with one to three positive nodes.
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Affiliation(s)
- Eunjin Jwa
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kyung Hwan Shin
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Departments of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Woo Lim
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - So-Youn Jung
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seeyoun Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Han-Sung Kang
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - EunSook Lee
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Young Hee Park
- Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Radiation Oncology, Soonchunhyang University College of Medicine, Seoul, Korea
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Shao Y, Sun X, He Y, Liu C, Liu H. Elevated Levels of Serum Tumor Markers CEA and CA15-3 Are Prognostic Parameters for Different Molecular Subtypes of Breast Cancer. PLoS One 2015. [PMID: 26207909 PMCID: PMC4514648 DOI: 10.1371/journal.pone.0133830] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background & Aims The utility of measuring carcinoembryonic antigen(CEA) and cancer antigen 15-3 (CA15-3) levels in patients with breast cancer remains controversial. The present study aims to investigate the prognostic value of preoperative serum CEA and CA15-3 levels in breast cancer patients. Methods Serum preoperative CEA and CA 15-3 concentration levels were measured in a total of 432 breast cancer patients. The association of tumor markers levels with clinicopathological parameters and outcomes were analyzed. Results Elevated serum levels of CEA and CA15-3 were identified in 47 (10.9%) and 60(13.9%) patients, respectively. Larger tumor size, advanced axillary lymph nodal and TNM stage exhibited higher proportion of elevated CEA and CA15-3 levels. The elevation of CEA levels was significantly greater in patients with HER2 positive tumors, and the elevation of CA15-3 levels was significantly greater in ER negative breast patients. Univariate and multivariate Cox’s regression analysis revealed that elevated preoperative CEA and CA 15-3 levels were independent prognostic factors for DFS and OS. When considering the combination of both markers levels, patients with both elevated markers presented the worst survival. Independent prognostic significance of elevated preoperative serum CEA and CA15-3 levels were reconfirmed in Luminal B breast cancer. Conclusions Preoperative serum levels of CEA and CA15-3 are independent prognostic parameters for breast cancer.
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Affiliation(s)
- Yingbo Shao
- Department of Breast oncology, The Affiliated Cancer Hospital Of Zhengzhou University, Zhengzhou, China
- He’nan Province Tumor Hospital, Zhengzhou, China
| | - Xianfu Sun
- Department of Breast oncology, The Affiliated Cancer Hospital Of Zhengzhou University, Zhengzhou, China
- He’nan Province Tumor Hospital, Zhengzhou, China
| | - Yaning He
- Department of Breast oncology, The Affiliated Cancer Hospital Of Zhengzhou University, Zhengzhou, China
- He’nan Province Tumor Hospital, Zhengzhou, China
| | - Chaojun Liu
- Department of Breast oncology, The Affiliated Cancer Hospital Of Zhengzhou University, Zhengzhou, China
- He’nan Province Tumor Hospital, Zhengzhou, China
| | - Hui Liu
- Department of Breast oncology, The Affiliated Cancer Hospital Of Zhengzhou University, Zhengzhou, China
- He’nan Province Tumor Hospital, Zhengzhou, China
- * E-mail:
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21
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Tseng YD, Uno H, Hughes ME, Niland JC, Wong YN, Theriault R, Blitzblau RC, Moy B, Breslin T, Edge SB, Hassett MJ, Punglia RS. Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database. Int J Radiat Oncol Biol Phys 2015; 93:622-30. [PMID: 26461004 DOI: 10.1016/j.ijrobp.2015.07.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/17/2015] [Accepted: 07/06/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate locoregional recurrence (LRR) after mastectomy and impact of postmastectomy radiation (PMRT) by breast cancer subtype. METHODS AND MATERIALS Between 2000 and 2009, 5673 patients with stage I to III breast carcinoma underwent mastectomy and nodal evaluation; 30% received PMRT. Isolated LRR (iLRR) and LRR were compared across groups defined by biological subtype and receipt of trastuzumab: luminal A (estrogen [ER]/progesterone [PR]+, HER2-, low/intermediate grade), luminal B (ER/PR+, HER2-, high grade), HER2 with trastuzumab, HER2 without trastuzumab, and triple negative (TN; ER-, PR-, HER2-). LRR hazard ratios (HR) were estimated with multivariable Fine and Gray models. The effect of PMRT on LRR was evaluated with Fine and Gray models stratified by propensity for PMRT. RESULTS With a median follow-up time of 50.1 months, there were 19 iLRR and 109 LRR events. HER2 patients with trastuzumab had no iLRR and only a single LRR. Compared with luminal A patients, TN patients had significantly greater adjusted risk of iLRR (HR 14.10; 95% CI 2.97%-66.90%), with a similar trend among luminal B (HR 4.94; 95% CI 0.94%-25.82%) and HER2 patients without trastuzumab (HR 4.41; 95% CI 0.61%-32.11%). Although PMRT reduced LRR, the effect of PMRT varied by subgroup, with the greatest and smallest effects seen among luminal A (HR 0.17; 95% CI 0.05%-0.62%) and TN patients (HR 0.59; 95% CI 0.25%-1.35%), respectively. CONCLUSIONS TN patients had the highest risk of LRR and the least benefit from PMRT; these patients may benefit from alternative treatment strategies. In contrast, in the era of HER2-directed therapy, the role of local therapy may need to be reassessed among HER2 patients.
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Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, Washington.
| | - Hajime Uno
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Melissa E Hughes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joyce C Niland
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Yu-Ning Wong
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard Theriault
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel C Blitzblau
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Beverly Moy
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tara Breslin
- Division of Surgical Oncology, Department of Surgery, Northwestern Lake Forest Hospital, Lake Forest, Illinois
| | - Stephen B Edge
- Baptist Cancer Center, Memphis, Tennessee; Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rinaa S Punglia
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
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22
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Whose Disease Will Recur After Mastectomy for Early Stage, Node-Negative Breast Cancer? A Systematic Review. Clin Breast Cancer 2015. [PMID: 26198331 DOI: 10.1016/j.clbc.2015.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective local control is associated with improved overall survival, particularly for women with early-stage cancers. No other local therapy is typically offered to women with T1-2 N0 breast cancer after mastectomy, although in select women the 5-year local recurrence rate can be as high as 20%. Therefore, accurately predicting the women who are at highest risk for recurrence after mastectomy will identify those who might benefit from more aggressive adjuvant treatment. A systematic search was conducted identifying risk factors associated with locoregional recurrence, including age, menopausal status, receptor status, lymphovascular invasion (LVI), margin status, use of systemic therapy, size, grade, and genomic classifer score. Although associations varied among studies, the risk factors most consistently identified were age ≤ 40 years, LVI, positive/close margin, and larger tumor size. In women with multiple high risk factors, risk of local recurrence was as high as 20% at 10 years. Additional multicenter studies are needed to investigate risk factors for locoregional recurrence after mastectomy without radiotherapy in T1-2N0 breast cancer. Consideration of additional adjuvant local therapy might be warranted in a subset of women at high risk of local recurrence.
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Jegadeesh NK, Kim S, Prabhu RS, Oprea GM, Yu DS, Godette KG, Zelnak AB, Mister D, Switchenko JM, Torres MA. The 21-gene recurrence score and locoregional recurrence in breast cancer patients. Ann Surg Oncol 2015; 22:1088-94. [PMID: 25472643 PMCID: PMC4869872 DOI: 10.1245/s10434-014-4252-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE Although the 21-gene recurrence score (RS) assay has been validated to assess the risk of distant recurrence in hormone receptor-positive breast cancer patients, the relationship between RS and the risk of locoregional recurrence (LRR) remains unclear. The purpose of this study was to determine if RS is associated with LRR in breast cancer patients and whether this relationship varies based on the type of local treatment [mastectomy or breast-conserving therapy (BCT)]. METHODS 163 consecutive estrogen receptor-positive breast cancer patients at our institution had an RS generated from the primary breast tumor between August 2006 and October 2009. Patients were treated with lumpectomy and radiation (BCT) (n = 110) or mastectomy alone (n = 53). Patients were stratified using a pre-determined RS of 25 and then grouped according to local therapy type. RESULTS Median follow-up was 68.2 months. Patients who developed an LRR had stage I or IIA disease, >2 mm surgical margins, and received chemotherapy as directed by RS. While an RS > 25 did not predict for a higher rate of LRR, an RS > 24 was associated with LRR in our subjects. Among mastectomy patients, the 5-year LRR rate was 27.3 % in patients with an RS > 24 versus 10.7 % (p = 0.04) in those whose RS was ≤ 24. RS was not associated with LRR in patients who received BCT. CONCLUSIONS Breast cancer patients treated with mastectomy for tumors that have an RS > 24 are at high risk of LRR and may benefit from post-mastectomy radiation.
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Affiliation(s)
- Naresh K. Jegadeesh
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Sunjin Kim
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Roshan S. Prabhu
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Gabriela M. Oprea
- Department of Pathology and Laboratory Medicine, Winship Cancer Institute, Emory University, Atlanta, GA
| | - David S. Yu
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Karen G. Godette
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Amelia B. Zelnak
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Donna Mister
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mylin A. Torres
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
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Tumor biology in older breast cancer patients--what is the impact on survival stratified for guideline adherence? A retrospective multi-centre cohort study of 5378 patients. Breast 2015; 24:256-62. [PMID: 25769974 DOI: 10.1016/j.breast.2015.02.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/30/2014] [Accepted: 02/19/2015] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The tumor biology of older breast cancer patients (oBCP) is usually less aggressive, however applied adjuvant treatment is often less potent resulting in an impaired disease free survival and overall survival in this group. This study tries to answer the following questions for the biological subtypes of oBCP (70+ y): METHODS Between 1992 and 2008 the BRENDA ('BRENDA' = quality of BREast caNcer care unDer evidence-bAsed guidelines) study group recorded medical data of 17 participating certified breast cancer centers in Germany. We performed a retrospective multi-center database analysis of 5632 patient records. Guideline-adherent-treatment (GL+) of oBCP(n = 1918) was compared to GL+ of yBCP(n = 3714). RESULTS OBCP were more likely to have hormone receptor positive (HR+) and HER2neu negative (HER2-) breast cancer (77.5% vs 74.5%). The rate of GL- was significantly different (p < 0.001) between the age groups and the biological subgroups (yBCP vs oBCP: 21.8%vs38.8% (HR+/HER2-); 30.6%vs49.7% (HR+/HER2+); 23.6%vs69.5% (HR-/HER2+); 31.4%vs67.8% (TNBC)). The survival parameters for HR+/HER2- and TNBC were significantly worse in case of GL- regarding chemotherapy, and if applicable endocrine therapy. A similar association only existed in HR-/HER2+ tumors for GL- for radiotherapy and in HR+/HER2+ tumors for chemotherapy. CONCLUSIONS Beside the significantly different distribution of biological subtypes in the age groups there is an association between biological subtype, and GL+ influencing survival parameters in oBCP.
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Li H, Han X, Liu Y, Liu G, Dong G. Ki67 as a predictor of poor prognosis in patients with triple-negative breast cancer. Oncol Lett 2014; 9:149-152. [PMID: 25435949 PMCID: PMC4246616 DOI: 10.3892/ol.2014.2618] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/12/2014] [Indexed: 12/31/2022] Open
Abstract
The aim of the current study was to investigate the expression of the proliferation antigen, Ki67, in triple-negative breast cancer (TNBC) and its correlation with clinicopathological factors. The expression of Ki67 and other biological indicators in 24 cases of TNBC tissues and 178 cases of non-TNBC tissues were detected using immunohistochemistry. Their correlation with the clinicopathological factors were also analyzed using the χ2 test. The positive rate of Ki67 expression in TNBC tissues was 83.3%, exhibiting a statistically significant difference when compared with that in non-TNBC tissues (73.0%) (P<0.05). The expression of Ki67 in breast cancer tissue significantly correlated with the tumor size and lymph node metastases; however, no correlation was observed with the age and the clinical stage. Ki67 may be an indicator of poor prognosis in TNBC patients.
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Affiliation(s)
- Haitao Li
- Department of General Surgery, The Affiliated Qingzhou Hospital of Weifang Medical College, Qingzhou, Shandong 262500, P.R. China
| | - Xinghua Han
- Department of General Surgery, The Affiliated Qingzhou Hospital of Weifang Medical College, Qingzhou, Shandong 262500, P.R. China
| | - Yingxin Liu
- Department of General Surgery, The Affiliated Qingzhou Hospital of Weifang Medical College, Qingzhou, Shandong 262500, P.R. China
| | - Guodong Liu
- Department of General Surgery, The Affiliated Qingzhou Hospital of Weifang Medical College, Qingzhou, Shandong 262500, P.R. China
| | - Guomin Dong
- Department of General Surgery, The Affiliated Qingzhou Hospital of Weifang Medical College, Qingzhou, Shandong 262500, P.R. China
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26
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Proliferative index activity in oral squamous cell carcinoma: indication for postoperative radiotherapy? Int J Oral Maxillofac Surg 2014; 43:1189-94. [DOI: 10.1016/j.ijom.2014.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 02/06/2014] [Accepted: 03/27/2014] [Indexed: 11/17/2022]
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Inic Z, Zegarac M, Inic M, Markovic I, Kozomara Z, Djurisic I, Inic I, Pupic G, Jancic S. Difference between Luminal A and Luminal B Subtypes According to Ki-67, Tumor Size, and Progesterone Receptor Negativity Providing Prognostic Information. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2014; 8:107-11. [PMID: 25249766 PMCID: PMC4167319 DOI: 10.4137/cmo.s18006] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/27/2014] [Accepted: 07/30/2014] [Indexed: 12/05/2022]
Abstract
BACKGROUND The St. Gallen International Expert Consensus of 2011 proposes a new classification system for breast cancer based on its division into five subgroups. The criteria to identify these subtypes were recently refined at the 2013 Conference. In this respect, the authors of this paper have conducted a retrospective analysis of breast cancer subtypes, related to Ki-67 and involvement of the axillary lymph nodes (ALNs). The analysis was performed only in the cases of invasive breast cancer in the pT2 stages. The research and results of the paper have shown that investigating the value of these parameters could be of great benefit in future treatment strategies of invasive breast cancer. METHODS A retrospective analysis of breast cancer subtypes, tumor nodal metastatic staging, and histopathological grading of 108 cases has been performed according to the methods recommended and provided by the St. Gallen International Expert Consensus Report, 2011. The estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), and Ki-67 of 108 tumor samples were all investigated by immunohistochemistry according to the methods used to classify breast cancer subtypes as proposed in the St. Gallen Consensus Report, 2011. Invasive breast cancers (n = 108) were immunohistochemically classified as follows: 28 (25.92%) as Luminal A, 51 (47.22%) as Luminal B (HER2 negative), 21 (19.44%) as Luminal B-like (HER2 negative), 2 (1.85%) as HER2 positive, and 6 (5.55%) as being a triple-negative subtype. RESULTS The conclusion was made that when Ki-67 was found to be higher, patients also showed a higher involvement in their ALNs. The chi-square test shows the difference to be significant (chi-square = 4.757; P = 0.029). Luminal B subtypes had the highest percentage (54.9%) of involvement of lymph nodes when compared to the other four subtypes. The Luminal B subtype had a higher percentage (51.4%) of involvement of lymph nodes than did Luminal A (10.7%). The chi-square test also shows the difference to be significant (P < 0.05). CONCLUSION A combination of the Ki-67 index, HER negative tumors, PR negativity, and a low value that can be used to segregate ER positive pT2 tumors into prognostically significantly different clinical outcomes may be utilized clinically to guide patient management in accordance with these tumor characteristics.
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Affiliation(s)
- Zorka Inic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Milan Zegarac
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Momcilo Inic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ivan Markovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Zoran Kozomara
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Igor Djurisic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ivana Inic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Gordana Pupic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Snezana Jancic
- Institute for Pathology, Faculty of Medicine University of Kragujevac, Serbia
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Mukesh MB, Duke S, Parashar D, Wishart G, Coles CE, Wilson C. The Cambridge post-mastectomy radiotherapy (C-PMRT) index: A practical tool for patient selection. Radiother Oncol 2014; 110:461-6. [DOI: 10.1016/j.radonc.2013.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 08/29/2013] [Accepted: 09/11/2013] [Indexed: 10/25/2022]
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Is Biological Subtype Prognostic of Locoregional Recurrence Risk in Women With pT1-2N0 Breast Cancer Treated With Mastectomy? Int J Radiat Oncol Biol Phys 2014; 88:57-64. [DOI: 10.1016/j.ijrobp.2013.09.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/29/2013] [Accepted: 09/13/2013] [Indexed: 11/21/2022]
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30
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Koo TR, Eom KY, Kang EY, Kim YJ, Kim SW, Kim JH, Kim JS, Kim IA. Prognostic value of the nodal ratio and ki-67 expression in breast cancer patients treated with postmastectomy radiotherapy. J Breast Cancer 2013; 16:274-84. [PMID: 24155756 PMCID: PMC3800723 DOI: 10.4048/jbc.2013.16.3.274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/21/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This pilot study aimed to evaluate prognostic factors of postmastectomy radiotherapy (PMRT) for breast cancer patients undergoing systemic therapy in either preoperative or postoperative setting. METHODS Between 2003 and 2009, 113 patients received PMRT: 61 underwent preoperative systemic therapy (PST subgroup) and 52 received postoperative systemic therapy (non-PST subgroup). RESULTS The median follow-up time was 72.3 months (range, 34.0-109.4 months) for surviving patients. In univariate analysis of all patients, disease-free survival (DFS) was associated with age, nodal ratio (NR), and Ki-67 expression; overall survival (OS) was associated with NR and Ki-67 expression. Pathologic N stage and HER2 expression were marginally associated with DFS and OS. In the non-PST subgroup, DFS was associated with age, NR, venous invasion, and Ki-67 expression; OS was associated with age. In the PST subgroup, DFS was associated with ypN stage and NR; OS was associated with ypN, histologic grade, HER2 expression, and p53 expression. In multivariate analysis of all patients, DFS and OS were significantly associated with NR (p=0.003 and p=0.019, respectively) and Ki-67 expression (p=0.002 and p=0.015, respectively). Patients were classified into low-risk (NR ≤0.2 and Ki-67 ≤20%; n=34), intermediate-risk (NR >0.2 or Ki-67 >20%; n=63), and high-risk (NR >0.2 and Ki-67 >20%; n=16) subgroups. All low-risk patients were alive at the time of analysis. High-risk (p<0.001 and p=0.001, respectively) and intermediate-risk (p=0.022 and p=0.008, respectively) patients had significantly shorter DFS and OS than low-risk patients. This prognostic model was statistically significant for DFS when applied to the PST (p=0.001) and non-PST (p=0.016) subgroups separately. CONCLUSION For breast cancer patients undergoing PMRT, NR and Ki-67 are potential prognostic factors. A model using these factors might help predict a poor prognosis. Whether NR and Ki-67 are also prognostic for different setting of systemic therapy, preoperative or postoperative, warrants further study.
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Affiliation(s)
- Tae Ryool Koo
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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31
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Is Ki-67 expression prognostic for local relapse in early-stage breast cancer patients treated with breast conservation therapy (BCT)? Int J Radiat Oncol Biol Phys 2013; 87:344-8. [PMID: 23910708 DOI: 10.1016/j.ijrobp.2013.05.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/16/2013] [Accepted: 05/21/2013] [Indexed: 02/03/2023]
Abstract
PURPOSE Ki-67 is a human nuclear protein whose expression is strongly up-regulated in proliferating cells and can be used to determine the growth fraction in clonal cell populations. Although there are some data to suggest that Ki-67 overexpression may be prognostic for endpoints such as survival or postmastectomy recurrence, further elucidation of its prognostic significance is warranted. Specifically after breast conservation therapy (BCT) (defined in this setting as breast-conserving surgery and adjuvant radiation therapy), whether Ki-67 predicts for locoregional recurrence has not been investigated. The purpose of this study was to assess Ki-67 expression in a cohort of early-stage breast cancer patients to determine whether a significant independent association between Ki-67 and locoregional relapse exists. METHODS AND MATERIALS Ki-67 staining was conducted on a tissue microarray of 438 patients previously treated with BCT, and expression was analyzed with clinicopathologic features and outcomes from our database. RESULTS Ki-67 expression was more prevalent in black patients (37% of black patients vs 17% of white patients, P<.01), younger patients (27% of patients aged ≤50 years vs 15% of patients aged >50 years, P<.01), estrogen receptor (ER)-negative tumors (25% of ER-negative tumors vs 17% of ER-positive tumors, P=.04), human epidermal growth factor receptor 2 (HER2)/neu-positive tumors (35% of HER2-positive tumors vs 18% of HER2-negative tumors, P=.01), and larger tumors (26% of T2 tumors vs 16% of T1 tumors, P=.03). On univariate/multivariate analysis, Ki-67 did not predict for overall survival (74.4% vs 72.6%), cause-specific survival (82.9% vs 82.1%), local relapse-free survival (83.6% vs 88.5%), distant metastasis-free survival (76.1% vs 81.4%), recurrence-free survival (65.5% vs 74.6%), and locoregional recurrence-free survival (81.6% vs 84.7%): P>.05 for all. CONCLUSIONS Ki-67 appears to be a surrogate marker for aggressive disease and significantly correlates with known prognostic features such as age, race, hormone receptor status, and HER2 status but independently does not predict for locoregional outcomes after BCT when these other prognostic clinicopathologic features are taken into consideration. The independent associations of Ki-67 with race and age appear to be novel to our study.
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Kaidar-Person O, Lai C, Kuten A, Belkacemi Y. "The Infinite Maze" of breast cancer, signaling pathways and radioresistance. Breast 2013; 22:411-8. [PMID: 23642528 DOI: 10.1016/j.breast.2013.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/16/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022] Open
Abstract
The parallel growth in our understanding of tumor biology and genetics might be the key to understanding local recurrence after optimal treatment is applied. Data suggest that genetic alterations and breast cancer molecular subtypes have an effect on radiotherapy efficacy and that the HER2, EGFR/PI3K/Akt signaling pathways play a pivotal role in modulation of post-irradiation survival. These pathways have been found to be involved in radiosensitivity and/or radioresistance, tumor cell proliferation, and hypoxia. Therefore, affecting the functional activity of key players combined with radiotherapy might be the future of breast irradiation.
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Affiliation(s)
- Orit Kaidar-Person
- Division of Oncology, Rambam Health Care Campus, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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