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Hatse S, Lambrechts Y, Antoranz Martinez A, De Schepper M, Geukens T, Vos H, Berben L, Messiaen J, Marcelis L, Van Herck Y, Neven P, Smeets A, Desmedt C, De Smet F, Bosisio FM, Wildiers H, Floris G. Dissecting the immune infiltrate of primary luminal B-like breast carcinomas in relation to age. J Pathol 2024. [PMID: 39344093 DOI: 10.1002/path.6354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/26/2024] [Accepted: 08/24/2024] [Indexed: 10/01/2024]
Abstract
The impact of aging on the immune landscape of luminal breast cancer (Lum-BC) is poorly characterized. Understanding the age-related dynamics of immune editing in Lum-BC is anticipated to improve the therapeutic benefit of immunotherapy in older patients. To this end, here we applied the 'multiple iterative labeling by antibody neo-deposition' (MILAN) technique, a spatially resolved single-cell multiplex immunohistochemistry method. We created tissue microarrays by sampling both the tumor center and invasive front of luminal breast tumors collected from a cohort of treatment-naïve patients enrolled in the prospective monocentric IMAGE (IMmune system and AGEing) study. Patients were subdivided into three nonoverlapping age categories (35-45 = 'young', n = 12; 55-65 = 'middle', n = 15; ≥70 = 'old', n = 26). Additionally, depending on localization and amount of cytotoxic T lymphocytes, the tumor immune types 'desert' (n = 22), 'excluded' (n = 19), and 'inflamed' (n = 12) were identified. For the MILAN technique we used 58 markers comprising phenotypic and functional markers allowing in-depth characterization of T and B lymphocytes (T&B-lym). These were compared between age groups and tumor immune types using Wilcoxon's test and Pearson's correlation. Cytometric analysis revealed a decline of the immune cell compartment with aging. T&B-lym were numerically less abundant in tumors from middle-aged and old compared to young patients, regardless of the geographical tumor zone. Likewise, desert-type tumors showed the smallest immune-cell compartment and were not represented in the group of young patients. Analysis of immune checkpoint molecules revealed a heterogeneous geographical pattern of expression, indicating higher numbers of PD-L1 and OX40-positive T&B-lym in young compared to old patients. Despite the numerical decline of immune infiltration, old patients retained higher expression levels of OX40 in T helper cells located near cancer cells, compared to middle-aged and young patients. Aging is associated with important numerical and functional changes of the immune landscape in Lum-BC. © 2024 The Author(s). The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Sigrid Hatse
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium
| | - Yentl Lambrechts
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium
| | - Asier Antoranz Martinez
- Laboratory for Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Maxim De Schepper
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - Tatjana Geukens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - Hanne Vos
- Department of Surgical Oncology, University Hospitals Leuven/KU Leuven, Leuven, Belgium
| | - Lieze Berben
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium
| | - Julie Messiaen
- Laboratory for Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lukas Marcelis
- Laboratory for Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Yannick Van Herck
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven/KU Leuven, Leuven, Belgium
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - Frederik De Smet
- Laboratory for Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Francesca Maria Bosisio
- Laboratory for Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium
- Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium
| | - Giuseppe Floris
- Laboratory for Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
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Boér K, Kaposi A, Kocsis J, Horváth Z, Madaras B, Sávolt Á, Klément GB, Rubovszky G. How to Tackle Discordance in Adjuvant Chemotherapy Recommendations by Using Oncotype DX Results, in Early-Stage Breast Cancer. Cancers (Basel) 2024; 16:2928. [PMID: 39272786 PMCID: PMC11393992 DOI: 10.3390/cancers16172928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND The use of the Oncotype DX test reduces the rate of adjuvant chemotherapy recommendations. Few in-depth analyses have been performed on this decision-making process. METHODS We retrospectively analyzed patient data based on available Oncotype DX test results (RS) irrespective of nodal status at a single center. We collected recommendations from six oncologists, first without RS (pre-RS) and then with RS results (post-RS). We investigated changes in recommendations, agreement between oncologist decisions, and the effect of different National Comprehensive Cancer Network (NCCN) recommendation categories (for, against, and considering chemotherapy). RESULTS Data from 201 patients were included in the analysis. Recommendation of chemotherapy decreased by an average of 39.5%. Agreement improved substantially with RS, with a kappa value pre-RS of 0.37 (fair agreement) and post-RS of 0.75 (substantial agreement). Discordance remained substantial in cases where the NCCN recommendations considered chemotherapy only (32%). Pre-RS consensus against chemotherapy predicted low RS results (50 out of 51 patients). Post-RS consensus was highest in the NCCN chemotherapy recommendation group. CONCLUSIONS The Oncotype DX test substantially improves decision accuracy in recommending adjuvant chemotherapy. It may be further improved with a consensus decision. In the case of pre-RS consensus against chemotherapy, the test can be spared.
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Affiliation(s)
- Katalin Boér
- Department of Medical Oncology, Szent Margit Hospital, 1032 Budapest, Hungary
| | - Ambrus Kaposi
- Department of Programming Languages and Compilers, Faculty of Informatics, Eötvös Loránd University (ELTE), 1117 Budapest, Hungary
| | - Judit Kocsis
- Department of Oncoradiology, Bács-Kiskun County Hospital, 6000 Kecskemét, Hungary
| | - Zsolt Horváth
- Department of Oncoradiology, Bács-Kiskun County Hospital, 6000 Kecskemét, Hungary
- Department of Thoracic and Abdominal Tumors and Clinical Pharmacology, National Institute of Oncology, 1122 Budapest, Hungary
| | - Balázs Madaras
- Department of Thoracic and Abdominal Tumors and Clinical Pharmacology, National Institute of Oncology, 1122 Budapest, Hungary
| | - Ákos Sávolt
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, 1122 Budapest, Hungary
- National Tumor Biology Laboratory, 1122 Budapest, Hungary
| | - Gyorgy Benjamin Klément
- Department of Thoracic and Abdominal Tumors and Clinical Pharmacology, National Institute of Oncology, 1122 Budapest, Hungary
- National Tumor Biology Laboratory, 1122 Budapest, Hungary
| | - Gábor Rubovszky
- Department of Thoracic and Abdominal Tumors and Clinical Pharmacology, National Institute of Oncology, 1122 Budapest, Hungary
- National Tumor Biology Laboratory, 1122 Budapest, Hungary
- Department of Oncology, Semmelweis University, 1122 Budapest, Hungary
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Rodríguez-Candela Mateos M, Azmat M, Santiago-Freijanes P, Galán-Moya EM, Fernández-Delgado M, Aponte RB, Mosquera J, Acea B, Cernadas E, Mayán MD. Software BreastAnalyser for the semi-automatic analysis of breast cancer immunohistochemical images. Sci Rep 2024; 14:2995. [PMID: 38316810 PMCID: PMC10844656 DOI: 10.1038/s41598-024-53002-6] [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: 07/17/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
Breast cancer is the most diagnosed cancer worldwide and represents the fifth cause of cancer mortality globally. It is a highly heterogeneous disease, that comprises various molecular subtypes, often diagnosed by immunohistochemistry. This technique is widely employed in basic, translational and pathological anatomy research, where it can support the oncological diagnosis, therapeutic decisions and biomarker discovery. Nevertheless, its evaluation is often qualitative, raising the need for accurate quantitation methodologies. We present the software BreastAnalyser, a valuable and reliable tool to automatically measure the area of 3,3'-diaminobenzidine tetrahydrocholoride (DAB)-brown-stained proteins detected by immunohistochemistry. BreastAnalyser also automatically counts cell nuclei and classifies them according to their DAB-brown-staining level. This is performed using sophisticated segmentation algorithms that consider intrinsic image variability and save image normalization time. BreastAnalyser has a clean, friendly and intuitive interface that allows to supervise the quantitations performed by the user, to annotate images and to unify the experts' criteria. BreastAnalyser was validated in representative human breast cancer immunohistochemistry images detecting various antigens. According to the automatic processing, the DAB-brown area was almost perfectly recognized, being the average difference between true and computer DAB-brown percentage lower than 0.7 points for all sets. The detection of nuclei allowed proper cell density relativization of the brown signal for comparison purposes between the different patients. BreastAnalyser obtained a score of 85.5 using the system usability scale questionnaire, which means that the tool is perceived as excellent by the experts. In the biomedical context, the connexin43 (Cx43) protein was found to be significantly downregulated in human core needle invasive breast cancer samples when compared to normal breast, with a trend to decrease as the subtype malignancy increased. Higher Cx43 protein levels were significantly associated to lower cancer recurrence risk in Oncotype DX-tested luminal B HER2- breast cancer tissues. BreastAnalyser and the annotated images are publically available https://citius.usc.es/transferencia/software/breastanalyser for research purposes.
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Affiliation(s)
- Marina Rodríguez-Candela Mateos
- Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, A Coruña, Spain
| | - Maria Azmat
- CiTIUS - Centro Singular de Investigación en Tecnoloxías Intelixentes da USC, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Paz Santiago-Freijanes
- Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, A Coruña, Spain
- Department of Pathology, Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, A Coruña, Spain
| | - Eva María Galán-Moya
- Physiology and Cell Dynamics, Centro Regional de Investigaciones Biomédicas (CRIB) and Faculty of Nursing, Universidad de Castilla-La Mancha, Albacete, Spain
- Grupo Mixto de Oncología Traslacional UCLM-GAI Albacete, Universidad de Castilla-La Mancha, Servicio de Salud de Castilla-La Mancha, Ciudad Real, Spain
| | - Manuel Fernández-Delgado
- CiTIUS - Centro Singular de Investigación en Tecnoloxías Intelixentes da USC, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Rosa Barbella Aponte
- Anatomic Pathology Unit, Hospital General Universitario de Albacete, Albacete, Spain
| | - Joaquín Mosquera
- Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, A Coruña, Spain
- Breast Unit, Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, A Coruña, Spain
| | - Benigno Acea
- Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, A Coruña, Spain
- Breast Unit, Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, A Coruña, Spain
| | - Eva Cernadas
- CiTIUS - Centro Singular de Investigación en Tecnoloxías Intelixentes da USC, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
| | - María D Mayán
- Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS, A Coruña, Spain.
- CELLCOM Research Group. Biomedical Research Center (CINBIO) and Institute of Biomedical Research of Ourense-Pontevedra-Vigo (IBI), University of Vigo. Edificio Olimpia Valencia, Campus Universitario Lagoas Marcosende, 36310, Pontevedra, Spain.
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Dannehl D, Engler T, Volmer LL, Staebler A, Fischer AK, Weiss M, Hahn M, Walter CB, Grischke EM, Fend F, Taran FA, Brucker SY, Hartkopf AD. Recurrence Score ® Result Impacts Treatment Decisions in Hormone Receptor-Positive, HER2-Negative Patients with Early Breast Cancer in a Real-World Setting-Results of the IRMA Trial. Cancers (Basel) 2022; 14:5365. [PMID: 36358784 PMCID: PMC9657368 DOI: 10.3390/cancers14215365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Patients with hormone receptor-positive (HR+), HER2-negative (HER2-) early breast cancer (eBC) with a high risk of relapse often undergo adjuvant chemotherapy. However, only a few patients will gain benefit from chemotherapy. Since classical tumor characteristics (grade, tumor size, lymph node involvement, and Ki67) are of limited value to predict chemotherapy efficacy, multigene expression assays such as the Oncotype DX® test were developed to reduce over- and undertreatment. The IRMA trial analyzed the impact of Recurrence Score® (RS) assessment on adjuvant treatment recommendations. MATERIALS AND METHODS The RS result was assessed in patients with HR+/HER2- unilateral eBC with 0-3 pathologic lymph nodes who underwent primary surgical treatment at the Department for Women's Health of Tuebingen University, Germany. Therapy recommendations without knowledge of the RS result were compared to therapy recommendations with awareness of the RS result. RESULTS In total, 245 patients underwent RS assessment. Without knowledge of the RS result, 92/245 patients (37.6%) would have been advised to receive chemotherapy. After RS assessment, 56/245 patients (22.9%) were advised to undergo chemotherapy. Chemotherapy was waived in 47/92 patients (51.1%) that were initially recommended to receive it. Chemotherapy was added in 11/153 patients (7.2%) that were recommended to not receive it initially. SUMMARY Using the RS result to guide adjuvant treatment decisions in HR+/HER2- breast cancer led to a substantial reduction of chemotherapy. In view of the results achieved in prospective studies, the RS result is among other risk-factors suitable for the individualization of adjuvant systemic therapy.
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Affiliation(s)
- Dominik Dannehl
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Tobias Engler
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Lea L. Volmer
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Annette Staebler
- Department for Pathology and Neuropathology, Tuebingen University, 72076 Tübingen, Germany
| | - Anna K. Fischer
- Department for Pathology and Neuropathology, Tuebingen University, 72076 Tübingen, Germany
| | - Martin Weiss
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Markus Hahn
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Christina B. Walter
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Eva-Maria Grischke
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Falko Fend
- Department for Pathology and Neuropathology, Tuebingen University, 72076 Tübingen, Germany
| | - Florin-Andrei Taran
- Department for Gynecology and Obstetrics, Freiburg University, 79085 Freiburg im Breisgau, Germany
| | - Sara Y. Brucker
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
| | - Andreas D. Hartkopf
- Department for Womens’ Health, Tuebingen University, 72076 Tübingen, Germany
- Department for Gynecology and Obstetrics, Ulm University, 89081 Ulm, Germany
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Jayasekera J, Sparano JA, O'Neill S, Chandler Y, Isaacs C, Kurian AW, Kushi L, Schechter CB, Mandelblatt J. Development and Validation of a Simulation Model-Based Clinical Decision Tool: Identifying Patients Where 21-Gene Recurrence Score Testing May Change Decisions. J Clin Oncol 2021; 39:2893-2902. [PMID: 34251881 PMCID: PMC8425835 DOI: 10.1200/jco.21.00651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There is a need for industry-independent decision tools that integrate clinicopathologic features, comorbidities, and genomic information for women with node-negative, invasive, hormone receptor–positive, human epidermal growth factor receptor-2–negative (early-stage) breast cancer.
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Affiliation(s)
- Jinani Jayasekera
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Joseph A Sparano
- Department of Oncology at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Suzanne O'Neill
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Young Chandler
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Claudine Isaacs
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
| | - Allison W Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Lawrence Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Clyde B Schechter
- Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jeanne Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC
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