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Buyukbayram ME, Hannarici Z, Duzkopru Y, Turhan A, Caglar AA, Coban Esdur P, Bilici M, Tekin SB, Yazılıtaş D. The Effect of C-Reactive Protein/Lymphocyte Ratio (CLR) on PFS in Metastatic Breast Cancer Patients Treated with CDK4/6 Inhibitors: A Novel Biomarker. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:329-339. [PMID: 38974895 PMCID: PMC11227876 DOI: 10.2147/bctt.s464161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024]
Abstract
Objective Hormone positive breast cancer is a tumor with high mortality. Combining antihormonal therapy with cyclin dependent kinase 4/6 inhibitors (CDK4/6i) has resulted in longer survival. The effect of inflammatory parameters such as c-reactive protein and c-reactive protein/lymphocyte ratio (CLR) on efficacy and survival in CDK4/6i treatment is unknown. In our study, we aimed to investigate the role of CLR and some parameters in predicting progression-free survival (PFS) with CDK4/6i. Methods This retrospective cohort study included 78 patients with denovo and recurrent metastatic breast cancer treated with CDK4/6i. Cut off values for the prediction of mortality by various numerical parameter scores were performed by ROC Curve analysis. The effect of clinical variables, inflammatory and histopathological parameters on survival was analyzed by Kaplan-Meier method. Results Neutrophil/lymphocyte ratio (NLR) and CLR were statistically significant in predicting mortality (p < 0.05). Ki67 and CLR were correlated with PFS. Age and CLR were correlated with OS (p < 0.05). CLR was statistically significant for both PFS (p = 0.022) and OS (p = 0.006). Conclusion In patients with metastatic hormone-positive breast cancer using CDK4/6i, low CLR and low Ki67 were correlated with longer PFS duration.
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Affiliation(s)
| | - Zekeriya Hannarici
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Yakup Duzkopru
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Aykut Turhan
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | | | - Pınar Coban Esdur
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Mehmet Bilici
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Salim Basol Tekin
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Doğan Yazılıtaş
- Department of Medical Oncology, Ankara Etlik City Hospital, Ankara, Turkey
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2
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Holm JB, Baggesen E, Cronin-Fenton D, Frystyk J, Bruun JM, Christiansen P, Borgquist S. Circulating C-reactive protein levels as a prognostic biomarker in breast cancer across body mass index groups. Sci Rep 2024; 14:14486. [PMID: 38914635 PMCID: PMC11196728 DOI: 10.1038/s41598-024-64428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
Obesity and systemic inflammation are associated with breast cancer (BC) outcomes. Systemic inflammation is increased in obesity. We examined the association between C-reactive protein (CRP) and disease-free survival (DFS) and overall survival (OS) overall, and according to body mass index (BMI). We assembled a cohort of women with BC (stage I-III) seen at Aarhus University Hospital between 2010 and 2020 who donated blood at BC diagnosis (N = 2673). CRP levels were measured and divided into quartiles. We followed patients from surgery to recurrence, contralateral BC, other malignancy, death, emigration, or end-of-follow-up. We used Cox regression to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs) to compare outcomes across CRP quartiles, overall and stratified by BMI (normal-weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obesity (BMI ≥ 30 kg/m2)). During follow-up, 368 events (212 recurrences, 38 contralateral BCs, and 118 deaths) occurred (median follow-up 5.55 years). For DFS, high CRP (CRP ≥ 3.19 mg/L) was associated with an increased risk of events (HRadj:1.62 [95% CI = 1.14-2.28]). In BMI-stratified analyses, high CRP was associated with elevated risk of events in normal-weight and overweight (HRadj:1.70 [95% CI = 1.09-2.66]; HRadj:1.75 [95% CI = 1.08-2.86]), but in obesity, the estimate was less precise (HRadj:1.73 [95% CI = 0.78-3.83]). For OS, high CRP was associated with increased risk of death (HRadj:2.47 [95% CI = 1.62-3.76]). The association was strong in normal-weight and overweight (HRadj:3.66 [95% CI = 1.95-6.87]; HRadj:1.92 [95% CI = 1.06-3.46]), but less clear in obesity (HRadj:1.40 [95% CI = 0.64-3.09]). To sum up, high CRP levels at BC diagnosis were associated with inferior prognosis in early BC irrespective of BMI, although less clear in patients with obesity.
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Affiliation(s)
- J B Holm
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - E Baggesen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - D Cronin-Fenton
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Frystyk
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - J M Bruun
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - P Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - S Borgquist
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Garcia-Torralba E, Pérez Ramos M, Ivars Rubio A, Navarro Manzano E, Blaya Boluda N, Lloret Gil M, Aller A, de la Morena Barrio P, García Garre E, Martínez Díaz F, García Molina F, Chaves Benito A, García-Martínez E, Ayala de la Peña F. Deconstructing neutrophil to lymphocyte ratio (NLR) in early breast cancer: lack of prognostic utility and biological correlates across tumor subtypes. Breast Cancer Res Treat 2024; 205:475-485. [PMID: 38453782 PMCID: PMC11101577 DOI: 10.1007/s10549-024-07286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE The prognostic utility and biological correlates of neutrophil to lymphocyte ratio (NLR), a potential biomarker of the balance between immune response and the inflammatory status, are still uncertain in breast cancer (BC). METHODS We analysed a cohort of 959 women with early breast cancer, mostly treated with neoadjuvant or adjuvant chemotherapy. Clinical and pathological data, survival, NLR (continuous and categorical) and stromal tumor infiltrating lymphocytes (sTIL) were evaluated. RESULTS NLR was only weakly associated with Ki67, while no association was found for grade, histology, immunohistochemical subtype or stage. Lymphocyte infiltration of the tumor did not correlate with NLR (Rho: 0.05, p = 0.30). These results were similar in the whole group and across the different BC subtypes, with no differences in triple negative BC. Relapse free interval (RFI), breast cancer specific survival (BCSS) and overall survival (OS) changed according to pre-treatment NLR neither in the univariate nor in the multivariate Cox models (RFI: HR 0.948, p = 0.61; BCSS: HR 0.920, p = 0.57; OS: HR 0.96, p = 0.59). CONCLUSION These results question the utility of NLR as a prognostic biomarker in early breast cancer and suggest the lack of correlation of NLR with tumor microenvironment immune response.
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Affiliation(s)
- Esmeralda Garcia-Torralba
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Miguel Pérez Ramos
- Department of Pathology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
| | - Alejandra Ivars Rubio
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Esther Navarro Manzano
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
- Centro Regional de Hemodonación, Murcia, 30003, Spain
| | - Noel Blaya Boluda
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Miguel Lloret Gil
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Alberto Aller
- Department of Medicine, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Pilar de la Morena Barrio
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Elisa García Garre
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
| | - Francisco Martínez Díaz
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
- Department of Pathology, Hospital Universitario Reina Sofía, Murcia, 30003, Spain
- Department of Pathology, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Francisco García Molina
- Department of Pathology, Hospital Universitario Reina Sofía, Murcia, 30003, Spain
- Department of Pathology, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Asunción Chaves Benito
- Department of Pathology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Department of Pathology, Medical School, University of Murcia, Murcia, 30001, Spain
| | - Elena García-Martínez
- Department of Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, 30008, Spain
- Instituto Murciano de Investigación Biosanitaria, IMIB, Murcia, 30120, Spain
- Medical School, Universidad Católica San Antonio, Murcia, 30107, Spain
| | - Francisco Ayala de la Peña
- Department of Medical Oncology, School of Medicine, Hospital Universitario Morales Meseguer, University of Murcia, Avda. Marqués de los Vélez, s/n, Murcia, 30008, Spain.
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4
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Cui Y, Cui S, Lu W, Wang Y, Zhuo Z, Wang R, Zhang D, Wu X, Chang L, Zuo X, Zhang W, Mei H, Zhang M. CRP, IL-1α, IL-1β, and IL-6 levels and the risk of breast cancer: a two-sample Mendelian randomization study. Sci Rep 2024; 14:1982. [PMID: 38263420 PMCID: PMC10805756 DOI: 10.1038/s41598-024-52080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
Epidemiological studies have reported a positive association between chronic inflammation and cancer risk. However, the causal association between chronic inflammation and breast cancer (BC) risk remains unclear. Here, we performed a Mendelian randomization study to investigate the etiological role of chronic inflammation in BC risk. We acquired data regarding C-reactive protein (CRP), interleukin (IL)-1a, IL-1b, and IL-6 expression and BC related to single nucleotide polymorphisms (SNPs) from two larger consortia (the genome-wide association studies and the Breast Cancer Association Consortium). Next, we conducted the two-sample Mendelian randomization study to investigate the relationship of the abovementioned inflammatory factors with the incidence of BC. We found that genetically predicted CRP, IL-6, and IL-1a levels did not increase BC incidence (odds ratio (OR)CRP 1.06, 95% confidence interval (CI) 0.98-1.12, P = 0.2059, ORIL-6 1.05, 95% CI 0.95-1.16, P = 0.3297 and ORIL-1a 1.01, 95% CI 0.99-1.03, P = 0.2167). However, in subgroup analysis, genetically predicted IL-1b levels increased ER + BC incidence (OR 1.15, 95% CI 1.03-1.27, P = 0.0088). Our study suggested that genetically predicted IL-1b levels were found to increase ER + BC susceptibility. However, due to the support of only one SNP, heterogeneity and pleiotropy tests cannot be performed, which deserves further research.
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Affiliation(s)
- Yongjia Cui
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Shasha Cui
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Wenping Lu
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Ya'nan Wang
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Zhili Zhuo
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Ruipeng Wang
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Dongni Zhang
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xiaoqing Wu
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Lei Chang
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xi Zuo
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Weixuan Zhang
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Heting Mei
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Mengfan Zhang
- Guang An'men Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
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5
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Shinde A, Tang X, Singh R, Brindley DN. Infliximab, a Monoclonal Antibody against TNF-α, Inhibits NF-κB Activation, Autotaxin Expression and Breast Cancer Metastasis to Lungs. Cancers (Basel) 2023; 16:52. [PMID: 38201482 PMCID: PMC10778319 DOI: 10.3390/cancers16010052] [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: 11/24/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
An inflammatory milieu in the tumor microenvironment leads to immune evasion, resistance to cell death, metastasis and poor prognosis in breast cancer patients. TNF-α is a proinflammatory cytokine that regulates multiple aspects of tumor biology from initiation to progression. TNF-α-induced NF-κB activation initiates inflammatory pathways, which determine cell survival, death and tumor progression. One candidate pathway involves the increased secretion of autotaxin, which produces lysophosphatidate that signals through six G-protein-coupled receptors. Significantly, autotaxin is one of the 40-50 most upregulated genes in metastatic tumors. In this study, we investigated the effects of TNF-α by blocking its action with a monoclonal antibody, Infliximab, and studied the effects on autotaxin secretion and tumor progression. Infliximab had little effect on tumor growth, but it decreased lung metastasis by 60% in a syngeneic BALB/c mouse model using 4T1 breast cancer cells. Infliximab-treated mice also showed a decrease in proliferation and metastatic markers like Ki-67 and vimentin in tumors. This was accompanied by decreases in NF-κB activation, autotaxin expression and the concentrations of plasma and tumor cytokines/chemokines which are involved in metastasis. We also demonstrated a positive correlation of TNF-α -NF-κB and ATX expression in breast cancer patients using cancer databases. Studies in vitro showed that TNF-α-induced NF-κB activation increases autotaxin expression and the clone forming ability of 4T1 breast cancer cells. This report highlights the potential role of Infliximab as an additional approach to attenuate signaling through the autotaxin-lysophosphatidate-inflammatory cycle and decrease mortality from metastatic cancer.
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Affiliation(s)
- Anjali Shinde
- Department of Biochemistry, Faculty of Science, The MS University of Baroda, Vadodara 390002, Gujarat, India;
- Cancer Research Institute of Northern Alberta, Department of Biochemistry, University of Alberta, Edmonton, AB T6G 2S2, Canada;
| | - Xiaoyun Tang
- Cancer Research Institute of Northern Alberta, Department of Biochemistry, University of Alberta, Edmonton, AB T6G 2S2, Canada;
| | - Rajesh Singh
- Department of Biochemistry, Faculty of Science, The MS University of Baroda, Vadodara 390002, Gujarat, India;
- Department of Molecular and Human Genetics, Banaras Hindu University (BHU), Varanasi 221005, Uttar Pradesh, India
| | - David N. Brindley
- Cancer Research Institute of Northern Alberta, Department of Biochemistry, University of Alberta, Edmonton, AB T6G 2S2, Canada;
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Chalmers JD, Kettritz R, Korkmaz B. Dipeptidyl peptidase 1 inhibition as a potential therapeutic approach in neutrophil-mediated inflammatory disease. Front Immunol 2023; 14:1239151. [PMID: 38162644 PMCID: PMC10755895 DOI: 10.3389/fimmu.2023.1239151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Neutrophils have a critical role in the innate immune response to infection and the control of inflammation. A key component of this process is the release of neutrophil serine proteases (NSPs), primarily neutrophil elastase, proteinase 3, cathepsin G, and NSP4, which have essential functions in immune modulation and tissue repair following injury. Normally, NSP activity is controlled and modulated by endogenous antiproteases. However, disruption of this homeostatic relationship can cause diseases in which neutrophilic inflammation is central to the pathology, such as chronic obstructive pulmonary disease (COPD), alpha-1 antitrypsin deficiency, bronchiectasis, and cystic fibrosis, as well as many non-pulmonary pathologies. Although the pathobiology of these diseases varies, evidence indicates that excessive NSP activity is common and a principal mediator of tissue damage and clinical decline. NSPs are synthesized as inactive zymogens and activated primarily by the ubiquitous enzyme dipeptidyl peptidase 1, also known as cathepsin C. Preclinical data confirm that inactivation of this protease reduces activation of NSPs. Thus, pharmacological inhibition of dipeptidyl peptidase 1 potentially reduces the contribution of aberrant NSP activity to the severity and/or progression of multiple inflammatory diseases. Initial clinical data support this view. Ongoing research continues to explore the role of NSP activation by dipeptidyl peptidase 1 in different disease states and the potential clinical benefits of dipeptidyl peptidase 1 inhibition.
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Affiliation(s)
- James D. Chalmers
- Department of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Ralph Kettritz
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin, Berlin, Germany
| | - Brice Korkmaz
- INSERM UMR-1100, Research Center for Respiratory Diseases, University of Tours, Tours, France
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7
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Pannu MK, Constantinou C. Inflammation, Nutrition, and Clinical Outcomes in Breast Cancer Survivors: A Narrative Review. Curr Nutr Rep 2023; 12:643-661. [PMID: 37751147 DOI: 10.1007/s13668-023-00495-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW Breast cancer (BC) is the leading cause of death among women aged 44-55 years globally. Pro-inflammatory food can cause tissue-level inflammation, thereby creating a carcinogenic microenvironment and promoting breast cancer. The aim of this review is to provide an overview of the association between inflammation and nutrition and clinical outcomes in breast cancer survivors. RECENT FINDINGS Pro-inflammatory diets are associated with a higher mortality risk after diagnosis and worse prognosis after treatment. On the other hand, anti-inflammatory diets may improve tissue-level inflammation and improve the overall prognosis and quality of life of survivors. There is strong evidence that the Mediterranean diet in particular is associated with reduced recurrence risk of breast cancer and improved quality of life of survivors. This narrative review provides evidence that there is a strong association between inflammation, dietary habits, and adverse clinical outcomes in breast cancer survivors. It further discusses the current evidence for the role of dietary management in improving clinical outcomes in breast cancer survivors.
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Affiliation(s)
- Manjinder Kaur Pannu
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, 21 Ilia Papakyriakou, 2414 Engomi, P.O. Box 24005, CY-1700, Nicosia, Cyprus
| | - Constantina Constantinou
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, 21 Ilia Papakyriakou, 2414 Engomi, P.O. Box 24005, CY-1700, Nicosia, Cyprus.
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8
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Ronco AL, Storz MA. Dietary Acid Load and Cancer Risk: A Review of the Uruguayan Experience. Nutrients 2023; 15:3098. [PMID: 37513516 PMCID: PMC10385454 DOI: 10.3390/nu15143098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Dietary acid load (DAL) is recognized as a risk factor for several chronic disorders, including obesity, diabetes, and osteoporosis. Recent evidence suggests that an elevated DAL, as measured by the validated potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores, could also increase the risk for several cancers. This narrative review summarizes the potential role of DAL in Uruguayan cancer patients and outlines the potentially involved pathophysiological pathways that mediate the role of DAL in both cancer development and growth. Although Uruguay is a developing country, its average diet is a heavily meat-based Western one, translating into a supraphysiological acid burden from diet. In recent years, we have published epidemiologic evidence based on ten case-control studies involving 3736 cancer cases and 9534 hospital-based controls. Odds ratios and 95% confidence intervals were estimated for each interest variable to analyze the association between the exposure levels of DAL scores and cancer, calculated by unconditional logistic regression. In a majority of the cases, the highest DAL scores tended to double the cancer risk as compared to the lowest category. We also found high risks for methionine intake, an acidifying amino acid found in higher concentrations in animal-based foods, which may increase cancer risks at least by a joint action based on the pH and the proliferation enhancing properties of the amino acid itself.
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Affiliation(s)
- Alvaro Luis Ronco
- Unit of Oncology and Radiotherapy, Pereira Rossell Women's Hospital, Bvard. Artigas 1590, Montevideo 11600, Uruguay
| | - Maximilian Andreas Storz
- Department of Internal Medicine II, Centre for Complementary Medicine, Freiburg University Hospital, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
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9
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García-Torralba E, Navarro Manzano E, Luengo-Gil G, De la Morena Barrio P, Chaves Benito A, Pérez-Ramos M, Álvarez-Abril B, Ivars Rubio A, García-Garre E, Ayala de la Peña F, García-Martínez E. A new prognostic model including immune biomarkers, genomic proliferation tumor markers ( AURKA and MYBL2) and clinical-pathological features optimizes prognosis in neoadjuvant breast cancer patients. Front Oncol 2023; 13:1182725. [PMID: 37313470 PMCID: PMC10258327 DOI: 10.3389/fonc.2023.1182725] [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: 03/09/2023] [Accepted: 05/17/2023] [Indexed: 06/15/2023] Open
Abstract
Background Up to 30% of breast cancer (BC) patients treated with neoadjuvant chemotherapy (NCT) will relapse. Our objective was to analyze the predictive capacity of several markers associated with immune response and cell proliferation combined with clinical parameters. Methods This was a single-center, retrospective cohort study of BC patients treated with NCT (2001-2010), in whom pretreatment biomarkers were analyzed: neutrophil-to-lymphocyte ratio (NLR) in peripheral blood, CD3+ tumor-infiltrating lymphocytes (TILs), and gene expression of AURKA, MYBL2 and MKI67 using qRT-PCR. Results A total of 121 patients were included. Median followup was 12 years. In a univariate analysis, NLR, TILs, AURKA, and MYBL2 showed prognostic value for overall survival. In multivariate analyses, including hormone receptor, HER2 status, and response to NCT, NLR (HR 1.23, 95% CI 1.01-1.75), TILs (HR 0.84, 95% CI 0.73-0.93), AURKA (HR 1.05, 95% CI 1.00-1.11) and MYBL2 (HR 1.19, 95% CI 1.05-1.35) remained as independent predictor variables. Conclusion Consecutive addition of these biomarkers to a regression model progressively increased its discriminatory capacity for survival. Should independent cohort studies validate these findings, management of early BC patients may well be changed.
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Affiliation(s)
- Esmeralda García-Torralba
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Esther Navarro Manzano
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Gines Luengo-Gil
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Pilar De la Morena Barrio
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | | | - Miguel Pérez-Ramos
- Department of Pathology, University Hospital Morales Meseguer, Murcia, Spain
| | - Beatriz Álvarez-Abril
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Alejandra Ivars Rubio
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Elisa García-Garre
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Francisco Ayala de la Peña
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Elena García-Martínez
- Department of Haematology and Medical Oncology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Medicine, Medical School, University of Murcia, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Medical School, Catholic University of Murcia, Murcia, Spain
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10
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18F-FDG uptake of visceral adipose tissue on preoperative PET/CT as a predictive marker for breast cancer recurrence. Sci Rep 2022; 12:21109. [PMID: 36473927 PMCID: PMC9727140 DOI: 10.1038/s41598-022-25540-4] [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: 06/03/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Glucose utilization by visceral adipose tissue (VAT) reflects inflammatory activity, which also promotes tumor growth and carcinogenesis. The effect of metabolically active VAT on survival outcomes in breast cancer is unknown. We investigated survival outcomes in patients with breast cancer based on the standardized uptake value (SUV) of VAT (SUVmean-VAT) using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). A total of 148 patients with breast cancer were divided into high- and low groups according to their SUVmean-VAT and SUVmax-tumor. Clinical characteristics and survival outcomes were compared between the groups. High SUVmean-VAT was associated with poor recurrence-free survival (RFS; hazard ratio [HR], 2.754; 95% confidence interval [CI], 1.090-6.958, p = 0.032) and distant metastasis-free survival (DMFS; HR, 3.500; 95% CI, 1.224-10.01, p = 0.019). Multivariate analysis showed that high SUVmean-VAT was a significant factor for poor RFS and poor DMFS (p = 0.023 and 0.039, respectively). High SUVmax-tumor was significantly associated with short RFS (p = 0.0388). Tumors with a high SUV tended to have a short DMFS, although the difference was not significant (p = 0.0718). Our findings showed that upregulated glucose metabolism in the VAT measured using 18F-FDG PET/CT may be a prognostic biomarker for adverse outcomes in breast cancer.
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11
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Makhlin I, McAndrew NP, Wileyto EP, Clark AS, Holmes R, Bottalico LN, Mesaros C, Blair IA, Jeschke GR, Fox KR, Domchek SM, Matro JM, Bradbury AR, Feldman MD, Hexner EO, Bromberg JF, DeMichele A. Ruxolitinib and exemestane for estrogen receptor positive, aromatase inhibitor resistant advanced breast cancer. NPJ Breast Cancer 2022; 8:122. [PMID: 36369506 PMCID: PMC9652412 DOI: 10.1038/s41523-022-00487-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Circulating IL-6, an activator of JAK/STAT signaling, is associated with poor prognosis and aromatase inhibitor (AI) resistance in hormone-receptor positive (HR+) breast cancer. Here we report the results of a phase 2 single-arm Simon 2-stage trial combining Ruxolitinib, an oral selective inhibitor of JAK1/2, with exemestane, a steroidal AI, in patients with HR+ metastatic breast cancer (MBC) after progression on non-steroidal AI (NSAI). Safety and efficacy were primary objectives, and analysis of inflammatory markers as predictors of response was a key secondary objective. Twenty-five subjects enrolled. The combination of ruxolitinib and exemestane was safe, though anemia requiring transfusion in 5/15 (33%) at the 25 mg dose in stage 1 led to a reduction to 15 mg twice daily in stage 2 (with no additional transfusions). Clinical benefit rate (CBR) in the overall study population was 24% (95% CI 9.4-45.1); 6/25 patients demonstrated stable disease for ≥6 months. Median progression-free survival was 2.8 months (95% CI 2.6-3.9). Exploratory biomarkers revealed high levels of systemic inflammation and 60% harbored a high-risk IL-6 genotype. Pharmacodynamics demonstrated modest on-target inhibition of phosphorylated-STAT3 by ruxolitinib at a tolerable dose. Thus, ruxolitinib combined with exemestane at a tolerable dose was safe but minimally active in AI-resistant tumors of patients with high levels of systemic inflammation. These findings highlight the need for more potent and specific therapies targeting inflammation in MBC.
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Affiliation(s)
- Igor Makhlin
- Division of Hematology/Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Nicholas P McAndrew
- Division of Hematology/Oncology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - E Paul Wileyto
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy S Clark
- Division of Hematology/Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Robin Holmes
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, USA
| | - Lisa N Bottalico
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Clementina Mesaros
- Center for Excellence in Environmental Toxicology, Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Ian A Blair
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kevin R Fox
- Division of Hematology/Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Susan M Domchek
- Division of Hematology/Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Basser Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer M Matro
- Division of Hematology/Oncology, UC San Diego, San Diego, CA, USA
| | - Angela R Bradbury
- Division of Hematology/Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael D Feldman
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth O Hexner
- Division of Hematology/Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Angela DeMichele
- Division of Hematology/Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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12
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Mikkelsen MK, Lindblom NAF, Dyhl-Polk A, Juhl CB, Johansen JS, Nielsen D. Systematic review and meta-analysis of C-reactive protein as a biomarker in breast cancer. Crit Rev Clin Lab Sci 2022; 59:480-500. [PMID: 35403550 DOI: 10.1080/10408363.2022.2050886] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Inflammation is an enabling characteristic of the hallmarks of cancer. There has therefore been increasing interest in the clinical value of circulating inflammatory biomarkers in cancer. In this review, we summarize results on C-reactive protein (CRP), alone or as part of the Glasgow Prognostic Score (GPS, composed of CRP and serum albumin), as a biomarker of prognosis or prediction and monitoring of therapeutic response in patients with breast cancer. A systematic literature search was performed in Medline and Embase from 1990 to August 2021. The association of serum CRP and overall survival and disease/progression-free survival was summarized in meta-analyses using a random effects model. The results from a total of 35 included studies (20,936 patients) were divided according to three identified patient settings (metastatic, non-metastatic, and general setting). Most of the studies examined prognostic utility. Several larger studies observed associations between high serum CRP and poor survival, but the meta-analyses suggested a limited value in a non-metastatic and general breast cancer setting (populations with unknown or varied disease stage). In metastatic patients, however, more consistent findings supported an association between serum CRP and prognosis (hazard ratio for overall survival: 1.87 (95% CI 1.31-2.67). Only five studies examined a role in prediction or monitoring of therapeutic response. One study reported a significant association between serum CRP levels and response to chemotherapy. Findings regarding serum CRP as a biomarker in breast cancer appear inconsistent, particularly in non-metastatic and general breast cancer, where the prognostic value could not be confirmed. In patients with metastatic breast cancer we suggest that high serum CRP is an indicator of poor prognosis. Too few studies assessed the role of serum CRP in prediction or monitoring of treatment response to allow conclusions.
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Affiliation(s)
- Marta Kramer Mikkelsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | | | - Anne Dyhl-Polk
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Carsten Bogh Juhl
- Department of Physiotherapy and Occupational Therapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Julia Sidenius Johansen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Hou Y, Zhao W, Yang Z, Zhang B. Serum amyloid A (SAA) and Interleukin-6 (IL-6) as the potential biomarkers for gastric cancer. Medicine (Baltimore) 2022; 101:e31514. [PMID: 36316846 PMCID: PMC9622617 DOI: 10.1097/md.0000000000031514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To explore serum amyloid A (SAA) and interleukin-6 (IL-6) as potential diagnostic biomarkers for gastric cancer (GCa) and the application value of the combined diagnosis of SAA, IL6, and Cancer embryonic antigen. Serum samples were collected before the initial surgery from 159 patients comprising samples from 122 patients with GCa and 37 patients with benign gastric disease. All patients were hospitalized at Beijing Aerospace General Hospital in China between 2018 and 2020. The IL-6 and SAA levels were assessed using standard laboratory protocols. The levels of SAA and IL-6 were significantly higher in patients with GCa than in controls. Compared with the healthy group, the concentration of SAA and IL-6 in FIGO III-IV group were significantly higher and the difference were statistically significant. In addition, significant differences were observed between the FIGO III-IV group and FIGO I-II groups. The Receiver operating characteristic (ROC) curve for the combined detection of SAA, IL-6, and Cancer embryonic antigen showed an area under the curve (AUC) of 0.948, sensitivity of 91.0%, and specificity of 89.2%. Spearman's correlation analysis indicated obvious correlations among the levels of serum SAA, IL-6, advanced FIGO stage, lymphatic invasion, and distant metastasis. AA and IL-6 may serve as useful biomarkers for poor prognosis of GCa. Clinical diagnosis combined with SAA and IL-6 may help assess therapeutic outcomes.
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Affiliation(s)
- Yongwang Hou
- Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
- * Correspondence: Yongwang Hou, Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China (e-mail: )
| | - Weidong Zhao
- Beijing Aerospace General Hospital, Beijing, China
| | - Zhicong Yang
- Central Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
| | - Bin Zhang
- Clinical Laboratory, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, China
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14
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Fan S, Xie X, Shen Y, Wang W, Gu X, Yao Z. The predictive value of preoperative serum neutrophil-to-lymphocyte ratio and tumor markers for early breast cancer patients: A retrospective study. Medicine (Baltimore) 2022; 101:e30011. [PMID: 35960055 PMCID: PMC9371529 DOI: 10.1097/md.0000000000030011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Peripheral blood of Neutrophil-to-Lymphocyte ratio (NLR), carcinoma embryonic antigen (CEA), cancer antigen 125 (CA125) and cancer antigen 15-3 (CA15-3) could be used as prognostic indicators for several types of tumors. The purpose of this study was to evaluate the predictive value of inflammatory cell ratio and tumor markers for postoperative breast cancer patients. Clinical data concerning 190 breast cancer patients who underwent radical surgery in Zhejiang Provincial Hospital of Chinese Medicine from 2013 and 2016 were retrospectively analyzed. The effects of NLR, CEA, CA125, and CA153 on the disease-free survival (DFS) of patients with breast cancer were analyzed by χ2 test and Cox regression analyses. There were totally 32 of 190 patients had local or distant metastases within 5 years after surgery. The peripheral blood NLR, CEA, CA125, and CA15-3 areas under the curve (AUC) were 0.8272, 0.667, 0.702, and 0.715, and the optimal cutoff values were 2.65, 1.47, 10.55, and 10.55, respectively. Univariate analysis and Kaplan-Meier survival analysis revealed that the serum NLR, CEA, CA125, and CA15-3 were related to postoperative 5-year DFS (P < .05). In addition, multivariate survival analysis identified the following independent prognostic factors: NLR (P < .001), CA125 (P = .045) and ki-67 (P = .020). Preoperative serum inflammatory biomarker of NLR and tumor marker of CA125 have potential prognostic value for breast carcinoma.
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Affiliation(s)
- Shuyao Fan
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Xiaohong Xie
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Yong Shen
- Department of Breast Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Wenjun Wang
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xidong Gu
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Shangcheng District, Hangzhou, China
| | - Zhiyuan Yao
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Hangzhou Economic and Technological Development Zone, Hangzhou, China
- *Correspondence: Zhiyuan Yao, Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 9 Ninth Avenue, Hangzhou Economic and Technological Development Zone, Hangzhou 310018, China (e-mail: )
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15
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Bower JE, Ganz PA, Irwin MR, Cole SW, Carroll J, Kuhlman KR, Petersen L, Garet D, Asher A, Hurvitz SA, Crespi CM. Acute and chronic effects of adjuvant therapy on inflammatory markers in breast cancer patients. JNCI Cancer Spectr 2022; 6:6651075. [PMID: 35900175 PMCID: PMC9420043 DOI: 10.1093/jncics/pkac052] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/20/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Inflammation contributes to poor behavioral, functional, and clinical outcomes in cancer survivors. We examined whether standard cancer treatments—radiation and chemotherapy—led to acute and persistent changes in circulating markers of inflammation in breast cancer patients. Methods A total of 192 women diagnosed with early stage breast cancer provided blood samples before and after completion of radiation and/or chemotherapy and at 6-, 12-, and 18-month posttreatment follow-ups. Samples were assayed for circulating inflammatory markers, including tumor necrosis factor-α (TNF-α) and interleukin (IL)–6, downstream markers of their activity (soluble TNF receptor type II [sTNF-RII], C reactive protein), and other inflammatory mediators (IL-8, interferon-γ [IFN-γ]). Analyses evaluated within-group changes in inflammatory markers in 4 treatment groups: no radiation or chemotherapy (n = 39), radiation only (n = 77), chemotherapy only (n = 18), and chemotherapy with radiation (n = 58). Results Patients treated with chemotherapy showed statistically significant increases in circulating concentrations of TNF-α, sTNF-RII, IL-6, and IFN-γ from pre- to posttreatment, with parameter estimates in standard deviation units ranging from 0.55 to 1.20. Those who received chemotherapy with radiation also showed statistically significant increases in IL-8 over this period. Statistically significant increases in TNF-α, sTNF-RII, IL-6, IFN-γ, and IL-8 persisted at 6, 12, and 18 months posttreatment among patients treated with chemotherapy and radiation (all P < .05). Patients treated with radiation only showed a statistically significant increase in IL-8 at 18 months posttreatment; no increases in any markers were observed in patients treated with surgery only. Conclusions Chemotherapy is associated with acute increases in systemic inflammation that persist for months after treatment completion in patients who also receive radiation therapy. These increases may contribute to common behavioral symptoms and other comorbidities in cancer survivors.
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Affiliation(s)
- Julienne E Bower
- Department of Psychology, University of California, Los Angeles; Los Angeles, California, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Los Angeles, California, United States.,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles; Los Angeles, California, United States.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles; Los Angeles, California, United States
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles; Los Angeles, California, United States.,Schools of Medicine and Public Health, University of California, Los Angeles; Los Angeles, California, United States
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Los Angeles, California, United States.,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles; Los Angeles, California, United States
| | - Steve W Cole
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Los Angeles, California, United States.,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles; Los Angeles, California, United States.,Department of Medicine, University of California, Los Angeles; Los Angeles, California, United States
| | - Judith Carroll
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Los Angeles, California, United States.,Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles; Los Angeles, California, United States
| | - Kate R Kuhlman
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles; Los Angeles, California, United States.,Department of Psychological Science of California, University of California, Irvine; Irvine, California, United States
| | - Laura Petersen
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles; Los Angeles, California, United States
| | - Deborah Garet
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles; Los Angeles, California, United States
| | - Arash Asher
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California, United States
| | - Sara A Hurvitz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles; Los Angeles, California, United States.,Department of Medicine, University of California, Los Angeles; Los Angeles, California, United States
| | - Catherine M Crespi
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles; Los Angeles, California, United States.,Department of Biostatistics, University of California, Los Angeles; Los Angeles, California, United States
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16
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Storz MA, Ronco AL. Quantifying dietary acid load in U.S. cancer survivors: an exploratory study using NHANES data. BMC Nutr 2022; 8:43. [PMID: 35505426 PMCID: PMC9063047 DOI: 10.1186/s40795-022-00537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Diet is an important determinant of systemic pH and acid–base regulation. A frequent consumption of acid-inducing foods (including processed meats and cheese) combined with a low intake of base-inducing foods (such as fruits, legumes and vegetables) increases Dietary Acid Load (DAL), which has been associated with an increased risk for certain cancers. DAL also appears to be of paramount importance in cancer survivors, in whom it was associated with increased mortality and poor overall physical health. Literature on DAL in cancer survivors, however, is scarce and limited to a few studies. Methods Using cross-sectional data from the National Health and Nutrition Examination Surveys (NHANES), we sought to quantify DAL in U.S. cancer survivors and contrasted the results to the general population. DAL was estimated using established formulas (Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP)). Results Our study comprised 19,413 participants, of which 1444 were self-reported cancer survivors. Almost 63% of cancer survivors were female (weighted proportion) with a mean age of 61.75 (0.51) years. DAL scores were consistently higher in cancer survivors (as compared to the general population) after adjustment for confounders in multivariate regression models. These differences, however, were not statistically significant (p = 0.506 for NEAPF, 0.768 for PRALR and 0.468 for NEAPR, respectively). Notably, DAL scores were positive throughout (> 0 mEq/d) in cancer survivors, suggesting an acidifying diet. Specific examples include mean PRALR scores > 11 mEq/d in cancer survivors aged 55 years and mean NEAPF scores > 50 mEq/d in cancer survivors aged 40–60 years). Conclusions The acidifying diet in this sample of cancer survivors warrants caution and requires further investigation. Comparably high DAL scores have been associated with adverse health outcomes and an increased mortality in previous studies in breast cancer survivors. Thus, increased awareness as well as additional clinical trials in this field are urgently warranted.
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Affiliation(s)
- Maximilian Andreas Storz
- Department of Internal Medicine II, Center for Complementary Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Alvaro Luis Ronco
- Unit of Oncology and Radiotherapy, Pereira Rossell Women's Hospital, Bvard. Artigas 1590, 11600, Montevideo, Uruguay.,School of Medicine, CLAEH University, Prado and Salt Lake, 20100, Maldonado, Uruguay.,Biomedical Sciences Center, University of Montevideo, Puntas de Santiago 1604, 11500, Montevideo, Uruguay
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17
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Socioeconomic Status and Inflammation in Women with Early-stage Breast Cancer: Mediation by Body Mass Index. Brain Behav Immun 2022; 99:307-316. [PMID: 34673177 PMCID: PMC9802182 DOI: 10.1016/j.bbi.2021.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer among women in the US, and women of low socioeconomic status (SES) show markedly poorer outcomes than those of high SES. SES may influence health through inflammation, although links between SES and inflammatory biomarkers have not been investigated in women with breast cancer. This study tested the hypothesis that breast cancer patients of lower SES would show higher levels of inflammation than those of higher SES. BMI was examined as a mediator of this association. METHODS Women recently diagnosed with early-stage breast cancer (N = 194) were recruited before neoadjuvant or adjuvant therapy. Participants completed questionnaires and provided blood samples for immune assessment. SES was indexed by participants' self-reported education and annual household income, BMI was determined by height and weight measurements, and blood was assayed for inflammatory biomarkers linked with cancer outcomes: IL-6, CRP, TNF-α, and sTNF-RII. General linear models tested associations between SES and inflammation, and mediation models examined indirect effects through BMI. RESULTS Consistent with hypotheses, education status was associated with CRP, (F(2,185) = 4.72, p = 0.001), and sTNF-RII, (F(2,185) = 4.19, p = 0.02), such that lower education was associated with higher levels of both biomarkers. Further, BMI mediated the associations between education and CRP, (95% CIs [-0.62, -0.11; -0.76, -0.21]), sTNF-RII, (95% CIs [-0.09, -0.01; -0.10, -0.02]), and IL-6, (95% CIs [-0.32, -0.05; -0.38, -0.09]). Annual household income was not significantly associated with inflammation (ps > 0.25), and indirect effects on inflammation through BMI were not significant. CONCLUSIONS Lower education was associated with higher levels of inflammation in this sample, which may presage poor breast cancer-related and clinical outcomes. SES should inform the development of interventions targeting BMI and inflammation in breast cancer.
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18
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Maharjan CK, Mo J, Wang L, Kim MC, Wang S, Borcherding N, Vikas P, Zhang W. Natural and Synthetic Estrogens in Chronic Inflammation and Breast Cancer. Cancers (Basel) 2021; 14:cancers14010206. [PMID: 35008370 PMCID: PMC8744660 DOI: 10.3390/cancers14010206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 12/17/2022] Open
Abstract
The oncogenic role of estrogen receptor (ER) signaling in breast cancer has long been established. Interaction of estrogen with estrogen receptor (ER) in the nucleus activates genomic pathways of estrogen signaling. In contrast, estrogen interaction with the cell membrane-bound G-protein-coupled estrogen receptor (GPER) activates the rapid receptor-mediated signaling transduction cascades. Aberrant estrogen signaling enhances mammary epithelial cell proliferation, survival, and angiogenesis, hence is an important step towards breast cancer initiation and progression. Meanwhile, a growing number of studies also provide evidence for estrogen's pro- or anti-inflammatory roles. As other articles in this issue cover classic ER and GPER signaling mediated by estrogen, this review will discuss the crucial mechanisms by which estrogen signaling influences chronic inflammation and how that is involved in breast cancer. Xenoestrogens acquired from plant diet or exposure to industrial products constantly interact with and alter innate estrogen signaling at various levels. As such, they can modulate chronic inflammation and breast cancer development. Natural xenoestrogens generally have anti-inflammatory properties, which is consistent with their chemoprotective role in breast cancer. In contrast, synthetic xenoestrogens are proinflammatory and carcinogenic compounds that can increase the risk of breast cancer. This article also highlights important xenoestrogens with a particular focus on their role in inflammation and breast cancer. Improved understanding of the complex relationship between estrogens, inflammation, and breast cancer will guide clinical research on agents that could advance breast cancer prevention and therapy.
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Affiliation(s)
- Chandra K. Maharjan
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA; (C.K.M.); (J.M.); (L.W.); (M.-C.K.)
| | - Jiao Mo
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA; (C.K.M.); (J.M.); (L.W.); (M.-C.K.)
| | - Lei Wang
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA; (C.K.M.); (J.M.); (L.W.); (M.-C.K.)
| | - Myung-Chul Kim
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA; (C.K.M.); (J.M.); (L.W.); (M.-C.K.)
| | - Sameul Wang
- Canyonoak Consulting LLC, San Diego, CA 92127, USA;
| | - Nicholas Borcherding
- Department of Pathology and Immunology, School of Medicine, Washington University, St. Louis, MO 63110, USA;
| | - Praveen Vikas
- Department of Internal Medicine, Carver College of Medicine, Iowa City, IA 52242, USA;
| | - Weizhou Zhang
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA; (C.K.M.); (J.M.); (L.W.); (M.-C.K.)
- Mechanism of Oncogenesis Program, University of Florida Health Cancer Center, University of Florida, Gainesville, FL 32610, USA
- Correspondence: to: ; Tel.: +1-352-273-6748
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19
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Korkmaz B, Lamort AS, Domain R, Beauvillain C, Gieldon A, Yildirim AÖ, Stathopoulos GT, Rhimi M, Jenne DE, Kettritz R. Cathepsin C inhibition as a potential treatment strategy in cancer. Biochem Pharmacol 2021; 194:114803. [PMID: 34678221 DOI: 10.1016/j.bcp.2021.114803] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
Epidemiological studies established an association between chronic inflammation and higher risk of cancer. Inhibition of proteolytic enzymes represents a potential treatment strategy for cancer and prevention of cancer metastasis. Cathepsin C (CatC) is a highly conserved lysosomal cysteine dipeptidyl aminopeptidase required for the activation of pro-inflammatory neutrophil serine proteases (NSPs, elastase, proteinase 3, cathepsin G and NSP-4). NSPs are locally released by activated neutrophils in response to pathogens and non-infectious danger signals. Activated neutrophils also release neutrophil extracellular traps (NETs) that are decorated with several neutrophil proteins, including NSPs. NSPs are not only NETs constituents but also play a role in NET formation and release. Although immune cells harbor large amounts of CatC, additional cell sources for this protease exists. Upregulation of CatC expression was observed in different tissues during carcinogenesis and correlated with metastasis and poor patient survival. Recent mechanistic studies indicated an important interaction of tumor-associated CatC, NSPs, and NETs in cancer development and metastasis and suggested CatC as a therapeutic target in a several cancer types. Cancer cell-derived CatC promotes neutrophil recruitment in the inflammatory tumor microenvironment. Because the clinical consequences of genetic CatC deficiency in humans resulting in the elimination of NSPs are mild, small molecule inhibitors of CatC are assumed as safe drugs to reduce the NSP burden. Brensocatib, a nitrile CatC inhibitor is currently tested in a phase 3 clinical trial as a novel anti-inflammatory therapy for patients with bronchiectasis. However, recently developed CatC inhibitors possibly have protective effects beyond inflammation. In this review, we describe the pathophysiological function of CatC and discuss molecular mechanisms substantiating pharmacological CatC inhibition as a potential strategy for cancer treatment.
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Affiliation(s)
- Brice Korkmaz
- INSERM UMR-1100, "Research Center for Respiratory Diseases" and University of Tours, 37032 Tours, France.
| | - Anne-Sophie Lamort
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU) and Ludwig-Maximilian-University (LMU), Munich, Bavaria 81377, Germany(2)
| | - Roxane Domain
- INSERM UMR-1100, "Research Center for Respiratory Diseases" and University of Tours, 37032 Tours, France
| | - Céline Beauvillain
- University of Angers, University of Nantes, Angers University Hospital, INSERM UMR-1232, CRCINA, Innate Immunity and Immunotherapy, SFR ICAT, 49000 Angers, France
| | - Artur Gieldon
- Faculty of Chemistry, University of Gdansk, 80-308 Gdansk, Poland
| | - Ali Önder Yildirim
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU) and Ludwig-Maximilian-University (LMU), Munich, Bavaria 81377, Germany(2)
| | - Georgios T Stathopoulos
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU) and Ludwig-Maximilian-University (LMU), Munich, Bavaria 81377, Germany(2)
| | - Moez Rhimi
- Microbiota Interaction with Human and Animal Team (MIHA), Micalis Institute, AgroParisTech, Université Paris-Saclay, INRAE, Jouy-en-Josas, France
| | - Dieter E Jenne
- Comprehensive Pneumology Center (CPC) and Institute for Lung Biology and Disease (iLBD), Helmholtz Center Munich-German Research Center for Environmental Health (HMGU) and Ludwig-Maximilian-University (LMU), Munich, Bavaria 81377, Germany(2); Max Planck Institute of Neurobiology, 82152 Planegg-Martinsried, Germany
| | - Ralph Kettritz
- Experimental and Clinical Research Center, Charité und Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Germany; Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin, Berlin, Germany
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The Role of Chronic Inflammation in the Development of Breast Cancer. Cancers (Basel) 2021; 13:cancers13153918. [PMID: 34359821 PMCID: PMC8345713 DOI: 10.3390/cancers13153918] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/20/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic inflammation contributes to the malignant transformation of several malignancies and is an important component of breast cancer. The role of chronic inflammation in the initiation and development of breast cancer from normal breast tissue, however, is unclear and needs to be clarified. A review of the literature was conducted to define the chronic inflammatory processes in normal breast tissue at risk for breast cancer and in breast cancer, including the role of lymphocyte and macrophage infiltrates, chronic active adipocytes and fibroblasts, and processes that may promote chronic inflammation including the microbiome and factors related to genomic abnormalities and cellular injury. The findings indicate that in healthy normal breast tissue there is systemic evidence to suggest inflammatory changes are present and associated with breast cancer risk, and adipocytes and crown-like structures in normal breast tissue may be associated with chronic inflammatory changes. The microbiome, genomic abnormalities, and cellular changes are present in healthy normal breast tissue, with the potential to elicit inflammatory changes, while infiltrating lymphocytes are uncommon in these tissues. Chronic inflammatory changes occur prominently in breast cancer tissues, with important contributions from tumor-infiltrating lymphocytes and tumor-associated macrophages, cancer-associated adipocytes and crown-like structures, and cancer-associated fibroblasts, while the microbiome and DNA damage may serve to promote inflammatory events. Together, these findings suggest that chronic inflammation may play a role in influencing the initiation, development and conduct of breast cancer, although several chronic inflammatory processes in breast tissue may occur later in breast carcinogenesis.
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