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Zhou H, Liu D, Chen L, Zhang Y, Zhao X, Ge Y, Liu M, Kong T. Metastasis to the bladder from primary breast cancer: A case report and literature review. Oncol Lett 2024; 27:249. [PMID: 38638844 PMCID: PMC11024766 DOI: 10.3892/ol.2024.14382] [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: 05/14/2023] [Accepted: 01/11/2024] [Indexed: 04/20/2024] Open
Abstract
Breast cancer is the most prevalent malignant tumor affecting women and represents the leading cause of female cancer-related mortality worldwide. Although distant organ metastasis accounts for the majority of breast cancer-related deaths, reports on bladder metastasis are limited in the existing literature. The present study describes the case of a patient with bladder metastasis originating from breast cancer. In addition, the present study also provides a review of 54 cases of similar disease that have been documented in the currently available literature. The literature review aims to elucidate the clinicopathological characteristics and therapeutic approaches for such conditions. The median time from breast cancer diagnosis to bladder metastasis was found to be 5.6 years (range, 0-28 years). The origin of the bladder metastases was predominantly invasive ductal carcinoma (IDC) accounting for 52.3% of cases, followed by invasive lobular carcinoma, accounting for 40.9% of cases. The pathology in the primary tumor was the same as the pathology of the bladder metastases in all cases. There was an 88.9% concordance rate for estrogen receptor status, while the progesterone receptor status was 83.3% and the human epidermal growth factor receptor 2 expression status was 100%. The primary initial symptoms included urinary system manifestations, such as increased frequency, urgency, dysuria, urinary incontinence, nocturia and gross hematuria. For the cystoscopic examination, the predominant findings were bladder wall thickening or masses, along with ureteral orifice masses. Overall, the present study demonstrated that the occurrence of bladder metastasis often follows the metastasis of other organs, with IDC being the most prevalent subtype. The pathological characteristics between the primary tumor and bladder metastasis exhibit a high degree of concordance.
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Affiliation(s)
- Hanli Zhou
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Danna Liu
- Department of Pharmacy, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Lu Chen
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Yujie Zhang
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Xiaoli Zhao
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Yongchao Ge
- Department of Urology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Mengmeng Liu
- Department of Pathology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Tiandong Kong
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
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2
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Dopeso H, Gazzo AM, Derakhshan F, Brown DN, Selenica P, Jalali S, Da Cruz Paula A, Marra A, da Silva EM, Basili T, Gusain L, Colon-Cartagena L, Bhaloo SI, Green H, Vanderbilt C, Oesterreich S, Grabenstetter A, Kuba MG, Ross D, Giri D, Wen HY, Zhang H, Brogi E, Weigelt B, Pareja F, Reis-Filho JS. Genomic and epigenomic basis of breast invasive lobular carcinomas lacking CDH1 genetic alterations. NPJ Precis Oncol 2024; 8:33. [PMID: 38347189 PMCID: PMC10861500 DOI: 10.1038/s41698-024-00508-x] [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: 05/10/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024] Open
Abstract
CDH1 (E-cadherin) bi-allelic inactivation is the hallmark alteration of breast invasive lobular carcinoma (ILC), resulting in its discohesive phenotype. A subset of ILCs, however, lack CDH1 genetic/epigenetic inactivation, and their genetic underpinning is unknown. Through clinical targeted sequencing data reanalysis of 364 primary ILCs, we identified 25 ILCs lacking CDH1 bi-allelic genetic alterations. CDH1 promoter methylation was frequent (63%) in these cases. Targeted sequencing reanalysis revealed 3 ILCs harboring AXIN2 deleterious fusions (n = 2) or loss-of-function mutation (n = 1). Whole-genome sequencing of 3 cases lacking bi-allelic CDH1 genetic/epigenetic inactivation confirmed the AXIN2 mutation and no other cell-cell adhesion genetic alterations but revealed a new CTNND1 (p120) deleterious fusion. AXIN2 knock-out in MCF7 cells resulted in lobular-like features, including increased cellular migration and resistance to anoikis. Taken together, ILCs lacking CDH1 genetic/epigenetic alterations are driven by inactivating alterations in other cell adhesion genes (CTNND1 or AXIN2), endorsing a convergent phenotype in ILC.
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Affiliation(s)
- Higinio Dopeso
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea M Gazzo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fatemeh Derakhshan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - David N Brown
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pier Selenica
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sahar Jalali
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arnaud Da Cruz Paula
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonio Marra
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edaise M da Silva
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thais Basili
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laxmi Gusain
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lorraine Colon-Cartagena
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirin Issa Bhaloo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hunter Green
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chad Vanderbilt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steffi Oesterreich
- Department of Pharmacology & Chemical Biology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anne Grabenstetter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Gabriela Kuba
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dara Ross
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dilip Giri
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hannah Y Wen
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hong Zhang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edi Brogi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fresia Pareja
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jorge S Reis-Filho
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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3
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Nathanson SD, Dieterich LC, Zhang XHF, Chitale DA, Pusztai L, Reynaud E, Wu YH, Ríos-Hoyo A. Associations amongst genes, molecules, cells, and organs in breast cancer metastasis. Clin Exp Metastasis 2023:10.1007/s10585-023-10230-w. [PMID: 37688650 DOI: 10.1007/s10585-023-10230-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/18/2023] [Indexed: 09/11/2023]
Abstract
This paper is a cross fertilization of ideas about the importance of molecular aspects of breast cancer metastasis by basic scientists, a pathologist, and clinical oncologists at the Henry Ford Health symposium. We address four major topics: (i) the complex roles of lymphatic endothelial cells and the molecules that stimulate them to enhance lymph node and systemic metastasis and influence the anti-tumor immunity that might inhibit metastasis; (ii) the interaction of molecules and cells when breast cancer spreads to bone, and how bone metastases may themselves spread to internal viscera; (iii) how molecular expression and morphologic subtypes of breast cancer assist clinicians in determining which patients to treat with more or less aggressive therapies; (iv) how the outcomes of patients with oligometastases in breast cancer are different from those with multiple metastases and how that could justify the aggressive treatment of these patients with the hope of cure.
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Affiliation(s)
- S David Nathanson
- Department of Surgery, Henry Ford Health, 2799 W. Grand Blvd, Detroit, MI, 48202, USA.
- Cancer Center, Henry Ford Health, Detroit, MI, USA.
| | - Lothar C Dieterich
- European Center for Angioscience (ECAS), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Xiang H-F Zhang
- Lester and Sue Smith Breast Center, Dan L. Duncan Cancer Center, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | | | - Lajos Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Emma Reynaud
- European Center for Angioscience (ECAS), Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Yi-Hsuan Wu
- Lester and Sue Smith Breast Center, Dan L. Duncan Cancer Center, Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
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4
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Joshi U, Budhathoki P, Gaire S, Yadav SK, Shah A, Adhikari A, Choong G, Couzi R, Giridhar KV, Leon-Ferre RA, Boughey JC, Hieken TJ, Mutter R, Ruddy KJ, Haddad TC, Goetz MP, Couch FJ, Yadav S. Clinical outcomes and prognostic factors in triple-negative invasive lobular carcinoma of the breast. Breast Cancer Res Treat 2023; 200:217-224. [PMID: 37210429 PMCID: PMC10782581 DOI: 10.1007/s10549-023-06959-3] [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: 03/06/2023] [Accepted: 04/21/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE Triple-negative invasive lobular carcinoma (TN-ILC) of breast cancer is a rare disease and the clinical outcomes and prognostic factors are not well-defined. METHODS Women with stage I-III TN-ILC or triple-negative invasive ductal carcinoma (TN-IDC) of the breast undergoing mastectomy or breast-conserving surgery between 2010 and 2018 in the National Cancer Database were included. Kaplan-Meier curves and multivariate Cox proportional hazard regression were used to compare overall survival (OS) and evaluate prognostic factors. Multivariate logistic regression was performed to analyze the factors associated with pathological response to neoadjuvant chemotherapy. RESULTS The median age at diagnosis for women with TN-ILC was 67 years compared to 58 years in TN-IDC (p < 0.001). There was no significant difference in the OS between TN-ILC and TN-IDC in multivariate analysis (HR 0.96, p = 0.44). Black race and higher TNM stage were associated with worse OS, whereas receipt of chemotherapy or radiation was associated with better OS in TN-ILC. Among women with TN-ILC receiving neoadjuvant chemotherapy, the 5-year OS was 77.3% in women with a complete pathological response (pCR) compared to 39.8% in women without any response. The odds of achieving pCR following neoadjuvant chemotherapy were significantly lower in women with TN-ILC compared to TN-IDC (OR 0.53, p < 0.001). CONCLUSION Women with TN-ILC are older at diagnosis but have similar OS compared to TN-IDC after adjusting for tumor and demographic characteristics. Administration of chemotherapy was associated with improved OS in TN-ILC, but women with TN-ILC were less likely to achieve complete response to neoadjuvant therapy compared to TN-IDC.
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Affiliation(s)
- Utsav Joshi
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Pravash Budhathoki
- Department of Internal Medicine, Bronxcare Health System, Bronx, NY, 10457, USA
| | - Suman Gaire
- Department of Internal Medicine, Mount Sinai Hospital Chicago, Chicago, IL, 60608, USA
| | - Sumeet K Yadav
- Department of Hospital Internal Medicine, Mayo Clinic, Mankato, MN, 56001, USA
| | - Anish Shah
- Department of Internal Medicine, Bronxcare Health System, Bronx, NY, 10457, USA
| | - Anurag Adhikari
- Department of Internal Medicine, Jacobi Medical Center, New York, NY, 10461, USA
| | - Grace Choong
- Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rima Couzi
- Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, 21231, USA
| | | | | | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Tina J Hieken
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robert Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Tufia C Haddad
- Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Matthew P Goetz
- Department of Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
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Gilardi L, Airò Farulla LS, Curigliano G, Corso G, Leonardi MC, Ceci F. FDG and Non-FDG Radiopharmaceuticals for PET Imaging in Invasive Lobular Breast Carcinoma. Biomedicines 2023; 11:biomedicines11051350. [PMID: 37239021 DOI: 10.3390/biomedicines11051350] [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: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most frequent histological type of breast cancer (BC) and includes a heterogeneous spectrum of diseases with unique characteristics, especially the infiltrative growth pattern and metastatic spread. [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is extensively used in oncology and BC patient evaluation. Its role in ILCs is considered suboptimal due to its low FDG avidity. Therefore, ILCs could benefit from molecular imaging with non-FDG tracers that target other specific pathways, contributing to precision medicine. This narrative review aims to summarize the current literature on the use of FDG-PET/CT in ILC and to discuss future opportunities given by the development of innovative non-FDG radiotracers.
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Affiliation(s)
- Laura Gilardi
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lighea Simona Airò Farulla
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of New Drugs and Early Drug Development, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | | | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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6
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Thill M, Zahn MO, Welt A, Stickeler E, Nusch A, Fietz T, Rauh J, Wetzel N, Kruggel L, Jänicke M, Marschner N, Harbeck N, Wöckel A, Decker T. Treatment and outcome in metastatic lobular breast cancer in the prospective German research platform OPAL. Breast Cancer Res Treat 2023; 198:545-553. [PMID: 36807725 PMCID: PMC10036409 DOI: 10.1007/s10549-023-06882-7] [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: 12/07/2022] [Accepted: 02/01/2023] [Indexed: 02/20/2023]
Abstract
PURPOSE Evidence about routine treatment and outcome of patients with invasive lobular cancer (ILC) is limited, especially regarding metastatic disease. Here we present prospective real-world data of patients with metastatic ILC (mILC) as compared to patients with metastatic invasive ductal cancer (mIDC) receiving systemic therapy in routine care in Germany. METHODS Prospective data on patient and tumor characteristics, treatments, and outcomes of patients with mILC (n = 466) and mIDC (n = 2100), recruited between 2007 and 2021 into the Tumor Registry Breast Cancer/OPAL were analyzed. RESULTS Compared to mIDCs, patients with mILC were older at start of first-line treatment (median 69 vs. 63 years) and had more often lower grade (G1/G2: 72.8% vs. 51.2%), hormone receptor (HR)-positive (83.7% vs. 73.2%) and less often HER2-positive (14.2% vs. 28.6%) tumors, which metastasized more frequently to the bone (19.7% vs. 14.5%) or peritoneum (9.9% vs. 2.0%), and less frequently to the lungs (0.9% vs. 4.0%). Median OS of patients with mILC (n = 209) and mIDC (n = 1158) was 30.2 months [95% confidence interval (CI) 25.3, 36.0] and 33.7 months [95% CI 30.3, 37.9], respectively. Multivariate survival analysis did not show a significant prognostic impact of the histological subtype [HR mILC vs. mIDC 1.18 (95% CI 0.97-1.42)]. CONCLUSION Overall, our real-world data confirm clinicopathological differences between mILC and mIDC breast cancer patients. Despite patients with mILC presenting with some favorable prognostic factors, ILC histopathology was not associated with a better clinical outcome in multivariate analysis, suggesting the need for more tailored treatment strategies for patients with the lobular subtype.
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Affiliation(s)
- M Thill
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - M-O Zahn
- MVZ Onkologische Kooperation Harz, Goslar, Germany
| | - A Welt
- Universitätsklinikum Essen, Essen, Germany
| | - E Stickeler
- Universitätsklinikum Aachen, Aachen, Germany
| | - A Nusch
- Praxis für Hämatologie und internistische Onkologie, Ratingen, Germany
| | - T Fietz
- Schwerpunktpraxis für Hämatologie und internistische Onkologie, Singen, Germany
| | - J Rauh
- Gemeinschaftspraxis Innere Medizin, Witten, Germany
| | | | | | | | - N Marschner
- Praxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | - N Harbeck
- Brustzentrum, Frauenklinik LMU Klinikum, Munich, Germany
| | - A Wöckel
- Universitätsklinikum Würzburg, Würzburg, Germany
| | - T Decker
- Onkologie Ravensburg, Praxis für Hämatologie und Onkologie GbR, Ravensburg, Germany.
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Kada Mohammed S, Billa O, Ladoire S, Jankowski C, Desmoulins I, Poillot ML, Coutant C, Beltjens F, Dabakuyo S, Arnould L. HER2-positive invasive lobular carcinoma: a rare breast cancer which may not necessarily require anti-HER2 therapy. A population-based study. Breast Cancer 2023; 30:343-353. [PMID: 36715845 DOI: 10.1007/s12282-022-01432-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND HER2-positive (HER2 +) invasive lobular breast cancer (ILC) is rare and poorly characterised. In particular, patient outcomes compared to those associated with HER2 + invasive ductal cancer (IDC) and HER2-negative (HER2 -) ILC, as well as the benefits of anti-HER2 therapy, are not well established. METHODS We analysed the data from the Côte d'Or Registry of Breast and Gynaecological Cancers (France) for all patients diagnosed with early-stage HER2 + ILC (62 cases), HER2 + IDC (833 cases) and HER2 - ILC (685 cases) between 1998 and 2015 to compare overall and disease-free survival (OS and DFS) between these groups in correlation with anti-HER2 therapy. RESULTS ILCs were associated with older age, larger tumours, lower histological grades, higher hormonal receptor positivity rates and multifocality, and more common endocrine therapy. OS and DFS between the three groups did not differ. We found that anti-HER2 therapy was associated with a survival benefit in patients with HER2 + IDC. In contrast, the survival of HER2 + ILC patients was not improved by anti-HER2 treatment, remaining close to that of HER2 - ILC patients. CONCLUSION HER2 + ILC seems not to be associated with better outcomes than HER2 + IDC but may not differ from HER2 - ILC in terms of survival.
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Affiliation(s)
- Samia Kada Mohammed
- Department of Gynaecology and Obstetrics, Jean Verdier Hospital, Assistance Publique Des Hôpitaux de Paris (APHP), Avenue du 14 Juillet, 93140, Bondy, France.
| | - Oumar Billa
- Department of Epidemiology, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
- INSERM U1231, 21000, Dijon, France
- University of Burgundy-Franche Comté, 21000, Dijon, France
| | - Clementine Jankowski
- Department of Surgery, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Marie-Laure Poillot
- Department of Epidemiology, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Charles Coutant
- University of Burgundy-Franche Comté, 21000, Dijon, France
- Department of Surgery, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Françoise Beltjens
- Unit of Pathology, Department of Tumour Biology and Pathology, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Sandrine Dabakuyo
- Department of Epidemiology, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Laurent Arnould
- INSERM U1231, 21000, Dijon, France
- Unit of Pathology, Department of Tumour Biology and Pathology, Georges-François Leclerc Centre, 1 Rue du Professeur Marion, 21000, Dijon, France
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8
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Mamtani A, Grabenstetter A, Sevilimedu V, Morrow M, Gemignani ML. Do non-classic invasive lobular carcinomas derive a benefit from neoadjuvant chemotherapy? Breast Cancer Res Treat 2023; 197:417-423. [PMID: 36394689 PMCID: PMC10118744 DOI: 10.1007/s10549-022-06813-y] [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: 10/03/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Invasive lobular breast cancers (ILCs) respond poorly to neoadjuvant chemotherapy (NAC). The degree of benefit of NAC among non-classic ILC (NC-ILC) variants compared with classic ILCs (C-ILCs) is unknown. METHODS Consecutive patients with Stage I-III ILC treated from 2003 to 2019 with NAC and surgery were identified, and grouped as C-ILC or NC-ILC as per the original surgical pathology report, with pathologist (A.G.) review performed if original categorization was unclear. A subset of similarly treated invasive ductal cancers (IDCs) was identified for comparison. Clinicopathologic characteristics and pathologic complete response (pCR) rates were evaluated. RESULTS Of 145 patients with ILC, 101 (70%) were C-ILC and 44 (30%) were NC-ILC (IDC cohort: 1157 patients). ILC patients were older, more often cT3/T4 and cN2/N3, and less often high-grade compared to IDC patients. Those with NC-ILC were less often ER+/HER2- (55% versus 93%), and more often HER2 + (25% versus 7%) and TN (21% versus 0%, all p < 0.001). Breast pCR was more common among NC-ILC, but most frequent in IDC. Nodal pCR rates were also lowest among C-ILC patients, but similar among NC-ILC and IDC patients. On multivariable analysis, C-ILC (OR 0.09) and LVI (OR 0.51) were predictive of lack of breast pCR; non-ER+/HER2- subtypes and breast pCR were predictive of nodal pCR. When our analysis was repeated with patients stratified by receptor subtype, histology was not independently predictive of either breast or nodal pCR. CONCLUSION NC-ILC patients were significantly more likely to achieve breast and nodal pCR compared with C-ILC patients, but when stratified by subtype, histology was not independently predictive of breast or nodal pCR.
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Affiliation(s)
- Anita Mamtani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA.
| | - Anne Grabenstetter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA
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9
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Rakha EA, Tse GM, Quinn CM. An update on the pathological classification of breast cancer. Histopathology 2023; 82:5-16. [PMID: 36482272 PMCID: PMC10108289 DOI: 10.1111/his.14786] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 12/13/2022]
Abstract
Breast cancer (BC) is a heterogeneous disease, encompassing a diverse spectrum of tumours with varying morphological, biological, and clinical phenotypes. Although tumours may show phenotypic overlap, they often display different biological behaviour and response to therapy. Advances in high-throughput molecular techniques and bioinformatics have contributed to improved understanding of BC biology and refinement of molecular taxonomy with the identification of specific molecular subclasses. Although the traditional pathological morphological classification of BC is of paramount importance and provides diagnostic and prognostic information, current interest focusses on the use of a single gene and multigene assays to stratify BC into distinct groups to guide decisions on systemic therapy. This review considers approaches to the classification of BC, including their limitations, and with particular emphasis on the fundamental role of morphology in establishing an accurate diagnosis of primary invasive carcinoma of breast origin. This forms the basis for further morphological characterization and for all other approaches to BC classification that are used to provide prognostic and therapeutic predictive information.
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Affiliation(s)
- Emad A Rakha
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Cellular Pathology, Nottingham University Hospitals NHS Trust, Nottingham City Hospital Nottingham, Nottingham, UK
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, NT, Hong Kong SAR
| | - Cecily M Quinn
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
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10
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Calhoun BC, Dabbs DJ. Lack of Standardization in the Diagnosis of Invasive Lobular Carcinoma of the Breast. Mod Pathol 2023; 36:100041. [PMID: 36788075 DOI: 10.1016/j.modpat.2022.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/09/2022] [Accepted: 10/09/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - David J Dabbs
- Pathology and Second Opinion Service, PreludeDX, Laguna Hills, California
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11
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Kuba MG, Brogi E. Update on lobular lesions of the breast. Histopathology 2023; 82:36-52. [PMID: 36482279 PMCID: PMC9752180 DOI: 10.1111/his.14829] [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: 09/18/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
The current histological classification of in-situ and invasive lobular carcinomas (ILCs) includes different morphological variants, some of which have been recently described. In this review, we will focus upon: (i) the diagnostic criteria of non-invasive lobular neoplasia and treatment implications across different countries; (ii) utility and limitations of immunohistochemistry; (iii) recently described variants of ILC; and (iv) the significance of lobular differentiation in invasive carcinoma for clinical management.
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Affiliation(s)
- Maria Gabriela Kuba
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edi Brogi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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12
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Controversies and Opportunities in the Clinical Daily Use of the 21-Gene Assay for Prognostication and Prediction of Chemotherapy Benefit in HR+/HER2- Early Breast Cancer. Cancers (Basel) 2022; 15:cancers15010148. [PMID: 36612144 PMCID: PMC9817989 DOI: 10.3390/cancers15010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Several multigene assays have been developed to help clinicians in defining adjuvant treatment for patients with hormone-receptor-positive (HR+), human epidermal growth factor receptor-2 (HER2)-negative early breast cancer. Despite the 21-gene assay having been available for decades, it has only recently been included in the healthcare systems of several countries. Clinical optimisation of the test remains of critical interest to achieve a greater impact of genomic information in HR+/HER2- early breast cancer. Although current guidelines recommend the use of the 21-gene assay in early breast cancer at intermediate risk of relapse, the implication of the Recurrence Score (RS) in some grey areas still remains uncertain. Our aim is to critically discuss the role of RS in peculiar circumstances. In particular, we focus on the complex integration of genomic data with clinicopathological factors; the potential clinical impact of RS in node-positive premenopausal women and in the neoadjuvant setting; the significance of RS in special histologies and in male patients; and the management and time-optimisation of test ordering. In the absence of robust evidence in these areas, we provide perspectives for improving the use of the 21-gene assay in the decision-making process and guide adjuvant treatment decisions even in challenging cases.
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13
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Circulating tumour DNA characterisation of invasive lobular carcinoma in patients with metastatic breast cancer. EBioMedicine 2022; 86:104316. [PMID: 36332363 PMCID: PMC9637866 DOI: 10.1016/j.ebiom.2022.104316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Limited data exist to characterise molecular differences in circulating tumour DNA (ctDNA) for patients with invasive lobular carcinoma (ILC). We analysed metastatic breast cancer patients with ctDNA testing to assess genomic differences among patients with ILC, invasive ductal carcinoma (IDC), and mixed histology. METHODS We retrospectively analysed 980 clinically annotated patients (121 ILC, 792 IDC, and 67 mixed histology) from three academic centers with ctDNA evaluation by Guardant360™. Single nucleotide variations (SNVs), copy number variations (CNVs), and oncogenic pathways were compared across histologies. FINDINGS ILC was significantly associated with HR+ HER2 negative and HER2 low. SNVs were higher in patients with ILC compared to IDC or mixed histology (Mann Whitney U test, P < 0.05). In multivariable analysis, HR+ HER2 negative ILC was significantly associated with mutations in CDH1 (odds ratio (OR) 9.4, [95% CI 3.3-27.2]), ERBB2 (OR 3.6, [95% confidence interval (CI) 1.6-8.2]), and PTEN (OR 2.5, [95% CI 1.05-5.8]) genes. CDH1 mutations were not present in the mixed histology cohort. Mutations in the PI3K pathway genes (OR 1.76 95% CI [1.18-2.64]) were more common in patients with ILC. In an independent cohort of nearly 7000 metastatic breast cancer patients, CDH1 was significantly co-mutated with targetable alterations (PIK3CA, ERBB2) and mutations associated with endocrine resistance (ARID1A, NF1, RB1, ESR1, FGFR2) (Benjamini-Hochberg Procedure, all q < 0.05). INTERPRETATION Evaluation of ctDNA revealed differences in pathogenic alterations and oncogenic pathways across breast cancer histologies with implications for histologic classification and precision medicine treatment. FUNDING Lynn Sage Cancer Research Foundation, OncoSET Precision Medicine Program, and UL1TR001422.
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14
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Lee J, Kim H, Bae SJ, Ji JH, Lee JW, Son BH, Ahn SH, Jeong J, Lee SB, Ahn SG. Association of Body Mass Index With 21-Gene Recurrence Score Among Women With Estrogen Receptor-Positive, ERBB2-Negative Breast Cancer. JAMA Netw Open 2022; 5:e2243935. [PMID: 36441548 PMCID: PMC9706366 DOI: 10.1001/jamanetworkopen.2022.43935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Body mass index (BMI) may affect the 21-gene recurrence score (RS) in patients with ER-positive, ERBB2-negative breast cancer. If high BMI increases genomic risk in ER-positive, ERBB2-negative breast cancer, weight control will become more important. OBJECTIVE To assess the association between RS and BMI according to age groups and address BMI as a factor associated with high RS. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 2295 patients with ER-positive, ERBB2-negative breast cancer who had undergone a multigene assay between March 29, 2010, and December 31, 2020, in 2 hospitals. All of the study patients were Korean women, and the median follow-up period was 45 months (range, 1-40 months). The correlations between continuous RS and BMI were investigated. A high BMI was defined as a body mass index greater than or equal to 25. In the younger age group (age ≤45 years), a high RS was defined as an RS of greater than 20. EXPOSURES Body mass index. MAIN OUTCOMES AND MEASURES The Pearson correlation coefficient was used to estimate the association between RS and BMI. A multivariable binary logistic model was used to identify high RS. RESULTS Among the 2295 women included (mean [SD] age, 49.8 [4.00] years; range, 22-81 years), 776 were aged 45 years or younger; RS and BMI were weakly correlated (correlation coefficient, 0.119; P < .001) in this younger group. Among them, the proportion of patients with an RS greater than 20 was significantly higher in the high BMI group than in the normal BMI group (45.5% [46 of 101] vs 27.3% [184 of 675]; P < .001). In the multivariable analysis, high BMI was an associated factor for high RS (odds ratio, 2.06; 95% CI, 1.28-3.32; P = .003). The 21-gene multigene assay-guided chemotherapy rate was significantly higher in patients with high BMI (30.7% [31 of 101] vs 20.2% [136 of 674]; P = .02). CONCLUSIONS AND RELEVANCE In this cohort study of women aged 45 years or younger, high BMI was associated with higher RS in those with ER-positive, ERBB2-negative breast cancer; further studies are necessary to examine the underlying mechanisms.
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Affiliation(s)
- Janghee Lee
- Department of Surgery, Sacred Heart Hospital, Hallym University, Dongtan, Republic of Korea
| | - Hakyoung Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Ji
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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15
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Kong D, Dong X, Qin P, Sun D, Zhang Z, Zhang Y, Hao F, Wang M. Asymptomatic uterine metastasis of breast cancer: Case report and literature review. Medicine (Baltimore) 2022; 101:e31061. [PMID: 36254025 PMCID: PMC9575808 DOI: 10.1097/md.0000000000031061] [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: 11/25/2022] Open
Abstract
RATIONALE Uterine metastasis from breast cancer is extremely rare. Asymptomatic patients with cervical metastases from breast cancer are rarer and more likely to be missed. We present an asymptomatic patient with breast cancer metastasized to the uterus and share opinions on diagnosing and treating for this kind of cases. PATIENT CONCERNS We present the case of a 64-year-old woman who was diagnosed with both breast cancer and uterine fibroids after examination. She had no symptoms of gynecological disease during breast cancer treatment. A positron emission tomography/computed tomography (PET/CT) scan was performed during reexamination, revealing multiple metastases of the bone throughout the body and an abnormal hypermetabolic mass in the uterus. It was later confirmed as uterine metastasis by pathology. DIAGNOSIS A diagnosis of metastatic breast invasive lobular carcinoma was established after a uterine curettage. INTERVENTIONS AND OUTCOMES Treatment of the uterine metastasis included systemic chemotherapy, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO), postoperative radiotherapy, and postoperative chemotherapy. The patient eventually refused further treatment for personal reasons and died at home. LESSONS Breast cancer metastases to the uterus are very rare and further research is needed for their diagnosis and treatment. During reexamination of breast cancer patients, clinicians must be alert to metastasis to gynecologic organs. This is particularly important in hormone receptor-positive patients with asymptomatic distant metastasis.
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Affiliation(s)
- Dechen Kong
- Clinical School, Weifang Medical University, Weifang, China
| | - Xiaotong Dong
- Department of Pathology, Weifang People’s Hospital, Weifang, China
| | - Peiyan Qin
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Daqing Sun
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
| | - Zhengtao Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Yan Zhang
- Clinical School, Weifang Medical University, Weifang, China
| | - Furong Hao
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
- Weifang Key Laboratory of Radiophysics and Oncological Radiobiology, Weifang, China
| | - Mingchen Wang
- Department of Radiation Oncology, Weifang People’s Hospital, Weifang, China
- *Correspondence: Mingchen Wang, Department of Radiation Oncology, Weifang People’s Hospital, No.151, Guangwen Street, Weifang, China (e-mail: )
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16
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Soong TR, Dillon DA, Rice-Stitt TL, Wieczorek TJ, Baker GM, Darvishian F, Collins LC, Lester SC, Schnitt SJ, Harrison BT. Invasive lobular carcinoma with extracellular mucin (ILCEM): clinicopathologic and molecular characterization of a rare entity. Mod Pathol 2022; 35:1370-1382. [PMID: 35477749 DOI: 10.1038/s41379-022-01084-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
Invasive lobular carcinoma with extracellular mucin (ILCEM) is a rare histologic subtype of breast cancer. Little is known about the pathologic or genomic signatures that distinguish ILCEM from classic invasive lobular carcinoma (ILC) or mucinous carcinoma. We studied 17 breast cancers with lobular morphology and extracellular mucin. Thirteen tumors with sufficient tissue for DNA extraction were analyzed by a next generation sequencing (NGS) assay that interrogates 447 genes for mutations and copy number variations (CNVs). Median patient age was 66 yrs (range: 31-77 yrs). Sixteen patients presented with masses, 7 of which were >2 cm. Seven patients had lymph node metastases. The cases of ILCEM were moderately (n = 13) or poorly differentiated (n = 4), frequently exhibiting variant morphology that has not been previously described or emphasized, including grade 3 nuclei (n = 11), diffuse signet ring cells (n = 10), solid growth (n = 4), tumor necrosis (n = 3) or apocrine features (n = 2). All tumors showed absent or reduced membranous E-cadherin expression. Concurrent lobular carcinoma in situ (LCIS) was seen in 11/17 cases, 1 of which was a striking example of signet ring cell LCIS with extracellular mucin. Receptor profiles were ER+/HER2- (n = 15) and ER+/HER2+ (n = 2). With a median follow-up of 83.5 months (range: 3-171 months) in 12 patients with available information, 8 patients had recurrences resulting in 4 cancer-related deaths. The most common CNVs were 16q loss (n = 11) and 1q gain (n = 9). CDH1 gene-level alterations were detected in all but one case, including frameshift (n = 7), nonsense (n = 2), and donor splice site (n = 1) mutations and indels (n = 2). Recurrent mutations were also seen in PIK3CA (n = 3), POLQ (n = 3), TP53 (n = 3), ERBB3 (n = 3), ERBB2 (n = 2), and RUNX1 (n = 2). Genes with recurrent amplifications included GATA3 (n = 4), FOXA1 (n = 3), CCND1 (n = 2). Our data highlights ILCEM as a distinct variant of ILC that often presents with higher-grade and variant morphologic features and is associated with an aggressive clinical course. NGS data support an overall lobular-type molecular profile and reveal potentially targetable alterations in a subset of cases with recurrence.
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Affiliation(s)
- T Rinda Soong
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Deborah A Dillon
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Tad John Wieczorek
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Pathology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Gabrielle M Baker
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Farbod Darvishian
- Department of Pathology, New York University Langone Medical Center, New York, NY, USA
| | - Laura C Collins
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Susan C Lester
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Beth T Harrison
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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17
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Elangovan A, Hooda J, Savariau L, Puthanmadhomnarayanan S, Yates ME, Chen J, Brown DD, McAuliffe PF, Oesterreich S, Atkinson JM, Lee AV. Loss of E-cadherin Induces IGF1R Activation and Reveals a Targetable Pathway in Invasive Lobular Breast Carcinoma. Mol Cancer Res 2022; 20:1405-1419. [PMID: 35665642 PMCID: PMC9444924 DOI: 10.1158/1541-7786.mcr-22-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/23/2022] [Accepted: 06/02/2022] [Indexed: 01/30/2023]
Abstract
No special-type breast cancer [NST; commonly known as invasive ductal carcinoma (IDC)] and invasive lobular carcinoma (ILC) are the two major histological subtypes of breast cancer with significant differences in clinicopathological and molecular characteristics. The defining pathognomonic feature of ILC is loss of cellular adhesion protein, E-cadherin (CDH1). We have previously shown that E-cadherin functions as a negative regulator of the IGF1R and propose that E-cadherin loss in ILC sensitizes cells to growth factor signaling that thus alters their sensitivity to growth factor-signaling inhibitors and their downstream activators. To investigate this potential therapeutic vulnerability, we generated CRISPR-mediated CDH1 knockout (CDH1 KO) IDC cell lines (MCF7, T47D, and ZR75.1) to uncover the mechanism by which loss of E-cadherin results in IGF pathway activation. CDH1 KO cells demonstrated enhanced invasion and migration that was further elevated in response to IGF1, serum and collagen I. CDH1 KO cells exhibited increased sensitivity to IGF resulting in elevated downstream signaling. Despite minimal differences in membranous IGF1R levels between wild-type (WT) and CDH1 KO cells, significantly higher ligand-receptor interaction was observed in the CDH1 KO cells, potentially conferring enhanced downstream signaling activation. Critically, increased sensitivity to IGF1R, PI3K, Akt, and MEK inhibitors was observed in CDH1 KO cells and ILC patient-derived organoids. IMPLICATIONS Overall, this suggests that these targets require further exploration in ILC treatment and that CDH1 loss may be exploited as a biomarker of response for patient stratification.
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Affiliation(s)
- Ashuvinee Elangovan
- Molecular Genetics and Developmental Biology Graduate Program, University of Pittsburgh School of Medicine, Pittsburgh PA.,Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA
| | - Jagmohan Hooda
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA
| | - Laura Savariau
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA.,Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Susrutha Puthanmadhomnarayanan
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA
| | - Megan E. Yates
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA.,Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jian Chen
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA
| | | | - Priscilla F. McAuliffe
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA.,Department of Surgery, Division of Surgical Oncology, Section of Breast Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Steffi Oesterreich
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA.,Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer M. Atkinson
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA.,Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA.,Corresponding Authors: Adrian V. Lee, PhD, , Phone: 4126417724, Fax: 4126416456, Women’s Cancer Research Center, UPMC Hillman Cancer Center, 204 Craft Avenue, Pittsburgh, PA 15213, USA, Jennifer M. Atkinson, PhD, , Phone: 4126417724, Fax: 4126416456, Women’s Cancer Research Center, UPMC Hillman Cancer Center, 204 Craft Avenue, Pittsburgh, PA 15213, USA
| | - Adrian V. Lee
- Women’s Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, Pittsburgh, PA.,Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA.,Corresponding Authors: Adrian V. Lee, PhD, , Phone: 4126417724, Fax: 4126416456, Women’s Cancer Research Center, UPMC Hillman Cancer Center, 204 Craft Avenue, Pittsburgh, PA 15213, USA, Jennifer M. Atkinson, PhD, , Phone: 4126417724, Fax: 4126416456, Women’s Cancer Research Center, UPMC Hillman Cancer Center, 204 Craft Avenue, Pittsburgh, PA 15213, USA
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18
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Mouabbi JA, Hassan A, Lim B, Hortobagyi GN, Tripathy D, Layman RM. Invasive lobular carcinoma: an understudied emergent subtype of breast cancer. Breast Cancer Res Treat 2022; 193:253-264. [DOI: 10.1007/s10549-022-06572-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 12/22/2022]
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19
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Tan BY, Lim EH, Tan PH. Special Histologic Type and Rare Breast Tumors - Diagnostic Review and Clinico-Pathological Implications. Surg Pathol Clin 2022; 15:29-55. [PMID: 35236633 DOI: 10.1016/j.path.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Breast cancer is the most common malignant tumor in females. While most carcinomas are categorized as invasive carcinoma, no special type (NST), a diverse group of tumors with distinct pathologic and clinical features is also recognized, ranging in incidence from relatively more common to rare. So-called "special histologic type" tumors display more than 90% of a specific, distinctive histologic pattern, while a spectrum of tumors more often encountered in the salivary gland may also arise in the breast. Metaplastic carcinomas can present diagnostic challenges. Some uncommon tumors harbor pathognomonic genetic alterations. This article provides an overview of the key diagnostic points and differential diagnoses for this group of disparate lesions, as well as the salient clinical characteristics of each entity.
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Affiliation(s)
- Benjamin Yongcheng Tan
- Department of Anatomical Pathology, Singapore General Hospital, Level 10, Academia, 20 College Road, Singapore 169856, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Level 7, Diagnostics Tower, Academia, 20 College Road, Singapore 189856, Singapore.
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20
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Okines A, Irfan T, Asare B, Mohammed K, Osin P, Nerurkar A, Smith IE, Parton M, Ring A, Johnston S, Turner NC. Clinical outcomes in patients with triple negative or HER2 positive lobular breast cancer: a single institution experience. Breast Cancer Res Treat 2022; 192:563-571. [PMID: 35119530 DOI: 10.1007/s10549-021-06432-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Invasive lobular carcinomas (ILC) are characterised by loss of the cell adhesion molecule E-cadherin. Approximately 15% of ILC are ER negative at the time of breast cancer diagnosis, or at relapse due to loss of ER expression. Less than 5% of classical ILC but up to 35% of pleomorphic ILC are HER2 positive (HER2+). METHODS Retrospective analysis of clinic-pathological data from patients with Triple negative (TN) or HER2+ ILC diagnosed 2004-2014 at the Royal Marsden Hospital. The primary endpoint was median overall survival (OS) in patients with metastatic disease. Secondary endpoints included response rate to neo-adjuvant chemotherapy (NAC), median disease-free interval (DFI) and OS for patients with early disease. RESULTS Three of 16 patients with early TN ILC and 7/33 with early HER2+ ILC received NAC with pCR rates of 0/3 and 3/5 patients who underwent surgery, respectively. Median DFI was 28.5 months [95% Confidence interval (95%CI) 15-78.8] for TN ILC and not reached (NR) (111.2-NR) for HER2+ early ILC. Five-year OS was 52% (95%CI 23-74%) and 77% (95%CI 58-88%), respectively. Twenty-three patients with advanced TN ILC and 14 patients with advanced HER2+ ILC were identified. Median OS was 18.3 months (95%CI 13.0-32.8 months) and 30.4 months (95%CI 8.8-NR), respectively. CONCLUSIONS In our institution we report a high relapse rate after treatment for early TN ILC, but median OS from metastatic disease is similar to that expected from TN IDC. Outcomes for patients with advanced HER2+ ILC were less favourable than those expected for IDC, possibly reflecting incomplete exposure to anti-HER2 therapies. CLINICAL TRIAL REGISTRATION ROLo (ClinicalTrials.gov Identifier: NCT03620643), ROSALINE (ClinicalTrials.gov Identifier: NCT04551495).
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Affiliation(s)
- Alicia Okines
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
| | - Tazia Irfan
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Bernice Asare
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Kabir Mohammed
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Peter Osin
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Ashutosh Nerurkar
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Ian E Smith
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Marina Parton
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Alistair Ring
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Stephen Johnston
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Nicholas C Turner
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
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21
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Makower D, Qin J, Lin J, Xue X, Sparano JA. The 21-gene recurrence score in early non-ductal breast cancer: a National Cancer Database analysis. NPJ Breast Cancer 2022; 8:4. [PMID: 35027533 PMCID: PMC8758772 DOI: 10.1038/s41523-021-00368-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
The 21-gene recurrence score (RS) is prognostic for recurrence and predictive of chemotherapy benefit in early estrogen receptor-positive (ER +) HER2-negative (HER2-) breast cancer (BCA). We evaluated clinicopathologic characteristics, RS and chemotherapy benefit in invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and carcinomas of mixed histologies (ductal + lobular (DLC), ductal + other (DOC), lobular + other (LOC)). Women diagnosed between 1/1/2010 and 1/1/2014 with ER + HER2- BCA, measuring <5 cm, with 0–3 involved axillary nodes, surgery as first treatment, and available RS, were identified from the NCDB. Associations between categorical variables were examined using chi-square test. Cox proportional hazards model was used to examine overall survival (OS) differences among histology subtypes. IDC was associated with smaller size, high grade, and RS > 26. ILC was associated with larger size, and least likely to be high grade (p < 0.0001). Lobular histology was associated with lower incidence of RS > 26. IDC patients (pts) were more likely to receive chemotherapy than pts with other histologies (p < 0.0001). OS for IDC, ILC and DOC were similar. DLC was associated with improved OS (HR 0.82, p = 0.02). Adjuvant chemotherapy was associated with improved OS in IDC (HR = 0.76, p < 0.0001) but not in ILC (HR = 0.99, p = 0.93), DLC (HR = 1.04, p = 0.86), DOC (HR = 0.87, p = 0.71), or LOC (HR = 2.91, p = 0.10). Lobular and mixed BCA histologies have distinct clinicopathologic features compared with IDC, and are less likely to have high RS. OS is similar for IDC and ILC. Although chemotherapy benefit was seen only in IDC, benefit for ILC with RS > 26 cannot be excluded.
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Affiliation(s)
- Della Makower
- Montefiore Einstein Center for Cancer Care, New York, NY, USA.
| | - Jiyue Qin
- Albert Einstein Cancer Center, Bronx, NY, USA
| | - Juan Lin
- Albert Einstein Cancer Center, Bronx, NY, USA
| | - Xiaonan Xue
- Albert Einstein Cancer Center, Bronx, NY, USA
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22
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Yadav S, Hu C, Nathanson KL, Weitzel JN, Goldgar DE, Kraft P, Gnanaolivu RD, Na J, Huang H, Boddicker NJ, Larson N, Gao C, Yao S, Weinberg C, Vachon CM, Trentham-Dietz A, Taylor JA, Sandler DR, Patel A, Palmer JR, Olson JE, Neuhausen S, Martinez E, Lindstrom S, Lacey JV, Kurian AW, John EM, Haiman C, Bernstein L, Auer PW, Anton-Culver H, Ambrosone CB, Karam R, Chao E, Yussuf A, Pesaran T, Dolinsky JS, Hart SN, LaDuca H, Polley EC, Domchek SM, Couch FJ. Germline Pathogenic Variants in Cancer Predisposition Genes Among Women With Invasive Lobular Carcinoma of the Breast. J Clin Oncol 2021; 39:3918-3926. [PMID: 34672684 PMCID: PMC8660003 DOI: 10.1200/jco.21.00640] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/16/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine the contribution of germline pathogenic variants (PVs) in hereditary cancer testing panel genes to invasive lobular carcinoma (ILC) of the breast. MATERIALS AND METHODS The study included 2,999 women with ILC from a population-based cohort and 3,796 women with ILC undergoing clinical multigene panel testing (clinical cohort). Frequencies of germline PVs in breast cancer predisposition genes (ATM, BARD1, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, PALB2, PTEN, RAD51C, RAD51D, and TP53) were compared between women with ILC and unaffected female controls and between women with ILC and infiltrating ductal carcinoma (IDC). RESULTS The frequency of PVs in breast cancer predisposition genes among women with ILC was 6.5% in the clinical cohort and 5.2% in the population-based cohort. In case-control analysis, CDH1 and BRCA2 PVs were associated with high risks of ILC (odds ratio [OR] > 4) and CHEK2, ATM, and PALB2 PVs were associated with moderate (OR = 2-4) risks. BRCA1 PVs and CHEK2 p.Ile157Thr were not associated with clinically relevant risks (OR < 2) of ILC. Compared with IDC, CDH1 PVs were > 10-fold enriched, whereas PVs in BRCA1 were substantially reduced in ILC. CONCLUSION The study establishes that PVs in ATM, BRCA2, CDH1, CHEK2, and PALB2 are associated with an increased risk of ILC, whereas BRCA1 PVs are not. The similar overall PV frequencies for ILC and IDC suggest that cancer histology should not influence the decision to proceed with genetic testing. Similar to IDC, multigene panel testing may be appropriate for women with ILC, but CDH1 should be specifically discussed because of low prevalence and gastric cancer risk.
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Affiliation(s)
| | | | - Katherine L. Nathanson
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Peter Kraft
- Harvard University T.H. Chan School of Public Health, Boston, MA
| | | | - Jie Na
- Mayo Clinic, Rochester, MN
| | - Hongyan Huang
- Harvard University T.H. Chan School of Public Health, Boston, MA
| | | | | | - Chi Gao
- Harvard University T.H. Chan School of Public Health, Boston, MA
| | - Song Yao
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | | | | | - Alpa Patel
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | | | | | | | | | | | | | | | | | - Christopher Haiman
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Paul W. Auer
- UWM Joseph J. Zilber School of Public Health, Milwaukee, WI
| | | | | | | | | | | | | | | | | | | | | | - Susan M. Domchek
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Basser Center for BRCA, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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23
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Mutai R, Barkan T, Moore A, Sarfaty M, Shochat T, Yerushalmi R, Stemmer SM, Goldvaser H. Prognostic impact of HER2-low expression in hormone receptor positive early breast cancer. Breast 2021; 60:62-69. [PMID: 34481367 PMCID: PMC8414540 DOI: 10.1016/j.breast.2021.08.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent data suggest that human epidermal growth factor receptor 2 (HER2)-low breast cancer may represent a distinct entity. We aimed to compare disease characteristics and outcomes between HER2-low and HER2-0 in estrogen receptor (ER) positive, early-stage breast cancer. METHODS A single center retrospective study comprising all women with ER positive, HER2 negative early breast cancer, for whom an Oncotype DX test was performed between 2005 and 2012. Women were grouped to HER2-low (immunohistochemistry +1 or +2 and in situ hybridization not amplified) or HER2-0. Clinico-pathological features and Oncotype recurrence score (RS) were collected. Data on overall-survival (OS), disease-free survival (DFS) and distant disease-free survival (DDFS) were evaluated according to HER2 expression status. RESULTS 608 women were included, of which 304 women had HER2-0 and 304 had HER2-low disease. Lobular subtype was significantly more common in HER-0 compared to HER2-low disease (17% vs. 8%, p = 0.005). The prevalence of other clinic-pathological characteristics and long-term prognosis were comparable between both groups. For women with high genomic risk (RS > 25), HER2-low expression was associated with significantly favorable OS (HR = 0.31, 95% CI 0.11-0.78, p = 0.01), DFS (HR = 0.40, 95% CI 0.20-0.82, p = 0.01) and DDFS (HR = 0.26, 95% CI 0.11-0.63, P = 0.002) compared to women with HER2-0. For women with low genomic risk (RS ≤ 25), long-term prognosis was unrelated to HER2 expression. CONCLUSION The prognostic impact of HER2-low expression in early-stage luminal disease varies across the genomic risk, with significant favorable outcomes of HER2-low expression compared to HER2-0 in women with high genomic risk.
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Affiliation(s)
- Raz Mutai
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel
| | - Tamar Barkan
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel
| | - Assaf Moore
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Sarfaty
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center, Petah Tikva, Israel
| | - Rinat Yerushalmi
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Salomon M Stemmer
- Davidoff Cancer Center, Institute of Oncology, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Goldvaser
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel.
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Rothschild HT, Abel MK, Patterson A, Goodman K, Shui A, van Baelen K, Desmedt C, Benz C, Mukhtar RA. Obesity and menopausal status impact the features and molecular phenotype of invasive lobular breast cancer. Breast Cancer Res Treat 2021; 191:451-458. [PMID: 34817747 PMCID: PMC8763723 DOI: 10.1007/s10549-021-06453-8] [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: 08/22/2021] [Accepted: 11/14/2021] [Indexed: 11/09/2022]
Abstract
Purpose We investigated the relationship between obesity, menopausal status, and invasive lobular carcinoma (ILC), the second most common histological subtype of breast cancer. Specifically, we evaluated the association between body mass index (BMI), metabolic syndrome, the 21-gene Oncotype Recurrence Score (Oncotype RS), and pathological features in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor-2-negative ILC. Methods The study cohort included 491 patients from a prospectively maintained institutional database consisting of patients with stage I-III, HR-positive ILC who underwent surgical treatment between 1996 and 2019. Results Contrary to our expectations, we found that lower BMI was significantly associated with having higher Oncotype RS (18.9% versus 4.8%, p = 0.028) in post-menopausal patients, but was not related to tumor characteristics in pre-menopausal patients. Multivariate network analyses suggested a strong relationship between post-menopausal status itself and tumor characteristics, with lesser influence of BMI. Conclusion These findings provide further insight into the recently appreciated heterogeneity within ILC and support the need for further investigation into the drivers of this disease and tailored treatment strategies.
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Affiliation(s)
| | - Mary Kathryn Abel
- School of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Anne Patterson
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, 94143, USA
| | - Kent Goodman
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, 94143, USA
| | - Amy Shui
- Department of Surgery Biostatistics Core, University of California, San Francisco, CA, 94143, USA
| | - Karen van Baelen
- Department of Oncology, Laboratory for Translational Breast Cancer Research, KU Leuven, B-3000, Leuven, Belgium
| | - Christine Desmedt
- Department of Oncology, Laboratory for Translational Breast Cancer Research, KU Leuven, B-3000, Leuven, Belgium
| | | | - Rita A Mukhtar
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, CA, 94143, USA
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25
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Nunes R, Sella T, Treuner K, Atkinson JM, Wong J, Zhang Y, Exman P, Dabbs D, Richardson AL, Schnabel CA, Sgroi DC, Oesterreich S, Cimino-Mathews A, Metzger O. Prognostic Utility of Breast Cancer Index to Stratify Distant Recurrence Risk in Invasive Lobular Carcinoma. Clin Cancer Res 2021; 27:5688-5696. [PMID: 34376532 PMCID: PMC9401569 DOI: 10.1158/1078-0432.ccr-21-0733] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/21/2021] [Accepted: 07/29/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE The prognostic utility of Breast Cancer Index (BCI) for risk assessment of overall (0-10 years), early (0-5 years), and late (5-10 years) distant recurrence (DR) in hormone receptor-positive (HR+) invasive lobular carcinoma (ILC) was evaluated. EXPERIMENTAL DESIGN BCI gene expression analysis was performed blinded to clinical outcome utilizing tumor specimens from patients with HR+ ILC from a multi-institutional cohort. The primary endpoint was time to DR. Kaplan-Meier analyses of overall, early, and late DR risk were performed, and statistical significance was evaluated by log-rank test and Cox proportional hazards regression. The prognostic contribution of BCI in addition to clinicopathologic factors was evaluated by likelihood ratio analysis. RESULTS Analysis of 307 patients (99% ER+, 53% T1, 42% N+, 70% grade II) showed significant differences in DR over 10 years based on BCI risk categories. BCI low- and intermediate-risk patients demonstrated similar DR rates of 7.6% and 8.0%, respectively, compared with 27.0% for BCI high-risk patients. BCI was a significant independent prognostic factor for overall 10-year DR [HR = 4.09; 95% confidence interval (CI), 2.00-8.34; P = 0.0001] as well as for both early (HR = 8.19; 95% CI, 1.85-36.30; P = 0.0042) and late (HR = 3.04; 95% CI, 1.32-7.00; P = 0.0224) DR. In multivariate analysis, BCI remained the only statistically significant prognostic factor for DR (HR = 3.49; 95% CI, 1.28-9.54; P = 0.0150). CONCLUSIONS BCI is an independent prognostic factor for ILC and significantly stratified patients for cumulative risk of 10-year, early, and late DR. BCI added prognostic value beyond clinicopathologic characteristics in this distinct subtype of breast cancer.
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Affiliation(s)
- Raquel Nunes
- Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Tal Sella
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kai Treuner
- Biotheranostics, Inc., San Diego, California
| | - Jennifer M. Atkinson
- UPMC Hillman Cancer Center, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Jenna Wong
- Biotheranostics, Inc., San Diego, California
| | - Yi Zhang
- Biotheranostics, Inc., San Diego, California
| | - Pedro Exman
- Hospital Alemao Oswaldo Cruz, São Paulo, Brazil
| | - David Dabbs
- UPMC Hillman Cancer Center, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Andrea L. Richardson
- Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | | | | | - Steffi Oesterreich
- UPMC Hillman Cancer Center, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Ashley Cimino-Mathews
- Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Otto Metzger
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Corresponding Author: Otto Metzger, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215. E-mail:
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26
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Clinicopathological features of and neoadjuvant therapy for human epidermal growth factor receptor 2-positive classic invasive lobular carcinoma. Hum Pathol 2021; 117:51-59. [PMID: 34363799 DOI: 10.1016/j.humpath.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022]
Abstract
Human epidermal growth factor receptor 2 (HER2)-positive classic invasive lobular carcinoma (ILC) is a rare entity, and its specific pathological characteristics and clinical behavior are unclear. Therefore, we retrospectively investigated the clinicopathological features of HER2-positive classic ILC and described HER2-targeted neoadjuvant chemotherapy outcome. Fourteen HER2-positive classic ILC cases were identified, their clinicopathological data were collected, and their clinical management was investigated. In general, HER2 positivity is associated with higher grade carcinoma in ductal lesions; however, our 14 cases had typical morphologic features of classic ILC. We did not identify unique morphologic features in HER2-positive classic ILC with the clinicopathological parameters examined, including age, menopausal status, histological grade, and hormone receptor status. Four of six patients who received HER2-targeted neoadjuvant chemotherapy had a pathological complete or partial response. Based on our findings, clinicopathological features of classic ILC may not predict HER2 overexpression or amplification. HER2-targeted neoadjuvant chemotherapy was effective against some HER2-positive classic ILCs. Taken together, these results demonstrate that HER2 immunohistochemistry and fluorescence in situ hybridization should be considered for all ILC patients regardless of subtype.
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27
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How Researchers, Clinicians and Patient Advocates Can Accelerate Lobular Breast Cancer Research. Cancers (Basel) 2021; 13:cancers13133094. [PMID: 34206261 PMCID: PMC8268486 DOI: 10.3390/cancers13133094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary This commentary reflects a collaborative effort between international Invasive Lobular Carcinoma (ILC)-focused breast cancer researchers, clinicians and patient advocate leaders. It offers a perspective on the progress made in ILC research in recent years and discusses the recent rise in patient advocate involvement to advance ILC research, raise awareness and educate about this disease. It outlines several distinct challenges in conducting ILC research and describes opportunities and suggestions for ways researchers, clinicians and advocates can work together to advance ILC research to develop new therapies and refine the care offered to patients. Abstract Breast cancer research and therapies have significantly advanced in recent years. However, Invasive Lobular Carcinoma (ILC), the second most common histological type of breast cancer and the sixth most frequently diagnosed cancer of women, has not always benefited from critical analysis, missing opportunities to better understand this important subtype. Recent progress understanding the biological and behavioral differences of ILC demonstrates that it is a unique subtype of breast cancer which can respond differently to common therapies. These new insights have increased interest in researching lobular breast disease. Concurrently, the formation of motivated patient-led advocacy organizations working in partnership with basic, translational and clinical researchers creates new opportunities, including connecting a dispersed patient population to research, encouraging new research funding and connecting patient advocates to researchers to advance common goals. This commentary will explore the unprecedented opportunity to drive multidisciplinary, multicenter and international collaborative research into lobular breast cancer that builds on recent research progress. Collaborative research partnerships that include advocates can result in a better understanding of ILC, identify targeted therapies and refine standard of care therapies that are currently equally applied to all breast cancers, resulting in improvements in the diagnosis, treatment and follow-up care for patients with ILC.
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28
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Timbres J, Moss C, Mera A, Haire A, Gillett C, Van Hemelrijck M, Sawyer E. Survival Outcomes in Invasive Lobular Carcinoma Compared to Oestrogen Receptor-Positive Invasive Ductal Carcinoma. Cancers (Basel) 2021; 13:cancers13123036. [PMID: 34207042 PMCID: PMC8234044 DOI: 10.3390/cancers13123036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 01/19/2023] Open
Abstract
Invasive lobular breast cancer (ILC) accounts for 10-15% of breast cancers and has distinct characteristics compared with the more common invasive ductal carcinoma (IDC). Studies have shown that ILC may be less sensitive to chemotherapy than IDC, with lower rates of complete pathological response after neo-adjuvant chemotherapy, but it is not clear how this affects long-term survival. Patients at Guy's and St Thomas' NHS Foundation Trust between 1975 and 2016 diagnosed with ER+ IDC or ER+ ILC were eligible for inclusion. Kaplan-Meier plots and Cox proportional-hazards regression models were used for analysis. There was no difference in overall survival comparing ER+ ILC to ER+ IDC (OR: 0.94, 95% CI: 0.83, 1.04) with a median follow-up time of 8.3 years compared to 8.4 years in IDC. However, ER+HER2- ILC had worse survival compared to ER+HER2- IDC in those that received chemotherapy (OR: 1.46, 95% CI: 1.06, 2.01). Here, median follow-up time was 7.0 years in ILC compared to 8.1 years in IDC. These results indicate worse overall survival after chemotherapy (neo-adjuvant and adjuvant) in ILC compared to ER+HER2- IDC even when correcting for tumour grade, age, size, and nodal involvement, but validation is needed in a larger study population.
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Affiliation(s)
- Jasmine Timbres
- Breast Cancer Genetics, King’s College London, London SE1 9RT, UK;
- Correspondence:
| | - Charlotte Moss
- Translational Oncology and Urology Research, King’s College London, London SE1 9RT, UK; (C.M.); (A.H.); (M.V.H.)
| | - Anca Mera
- Guy’s & St. Thomas’ Hospital, London SE1 9RT, UK;
| | - Anna Haire
- Translational Oncology and Urology Research, King’s College London, London SE1 9RT, UK; (C.M.); (A.H.); (M.V.H.)
| | - Cheryl Gillett
- KHP Cancer Biobank, King’s College London, London SE1 9RT, UK;
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, King’s College London, London SE1 9RT, UK; (C.M.); (A.H.); (M.V.H.)
| | - Elinor Sawyer
- Breast Cancer Genetics, King’s College London, London SE1 9RT, UK;
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Omran MH, Fotouh BE, Shousha WG, Ismail A, Ibrahim NE, Ramadan SS. Strong Correlation of MTHFR Gene Polymorphisms with Breast Cancer and its Prognostic Clinical Factors among Egyptian Females. Asian Pac J Cancer Prev 2021; 22:617-626. [PMID: 33639682 PMCID: PMC8190368 DOI: 10.31557/apjcp.2021.22.2.617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Globally, Breast cancer (BC) is considered the second most common type of cancer and the principal cause of death among affected women. Aim: In this study, we targeted to demonstrate the association of MTHFR single gene polymorphisms (SNPs) with the susceptibility of breast cancer, in addition to its correlation with the clinical patient features. Patients and Methods: This work was conducted on 100 Egyptian females with breast cancer and 60 healthy matched controls. Clinical examinations and pathological investigations were recorded. Genotyping of MTHFR polymorphisms C677T (rs1801133) and A1298C (rs1801131) by using Restriction Fragment length Polymorphisms (RFLP) and Sequencing assays were performed. Univariate, Multivariate and Haplotype analysis for the allelic frequencies and the association with clinicopathological features of BC were assessed. Results: The present data showed a strong significant association between the CT and TT of MTHFR (C677T), and AC and CC of (A1289C) with the susceptibility of BC showing highly statistical P- value (0.001). It was also demonstrated that the most frequent haplotype of the two loci of MTHFR (rs1801133-rs1801131) was TC. The latter was strongly associated with the aggressive clinical features of each of tumor size, advanced stage, involvement of cancer in lymph nodes, overexpression of HER2neu and dual negativity of both ER and PR hormones. Conclusions: SNPs within the MTHFR gene (C677T) and (A1289C) have strong correlation with BC among Egyptian females; These SNPs should be considered as important prognostic markers for identifying the individuals at high risk of developing BC and its progression.
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Affiliation(s)
- Moataza H Omran
- Department of Microbial Biotechnology, Genetic Engineering Division, National Research Centre, Cairo, Egypt
| | - Basma E Fotouh
- Department of Microbial Biotechnology, Genetic Engineering Division, National Research Centre, Cairo, Egypt
| | - Wafaa G Shousha
- Department of Chemistry, Faculty of Science, Helwan University, Cairo, Egypt
| | - Abeer Ismail
- Department of Clinical and Chemical Pathology, National Cancer Institute, Cairo University, Giza, Egypt
| | - Noha E Ibrahim
- Department of Microbial Biotechnology, Genetic Engineering Division, National Research Centre, Cairo, Egypt
| | - Shimaa S Ramadan
- Department of Chemistry, Faculty of Science, Helwan University, Cairo, Egypt
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30
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Yang C, Lei C, Zhang Y, Zhang J, Ji F, Pan W, Zhang L, Gao H, Yang M, Li J, Wang K. Comparison of Overall Survival Between Invasive Lobular Breast Carcinoma and Invasive Ductal Breast Carcinoma: A Propensity Score Matching Study Based on SEER Database. Front Oncol 2020; 10:590643. [PMID: 33415073 PMCID: PMC7783385 DOI: 10.3389/fonc.2020.590643] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022] Open
Abstract
Objective Invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) account for most breast cancers. However, the overall survival (OS) differences between ILC and IDC remain controversial. This study aimed to compare nonmetastatic ILC to IDC in terms of survival and prognostic factors for ILC. Methods This retrospective cohort study used data from the Surveillance, Epidemiology and End Results (SEER) Cancer Database (www.seer.cancer.gov). Women diagnosed with nonmetastatic ILC and IDC between 2006 and 2016 were included. A propensity score matching (PSM) method was used in our analysis to reduce baseline differences in clinicopathological characteristics and survival outcomes. Kaplan-Meier curves and log-rank test were used for survival analysis. Results Compared to IDC patients, ILC patients were diagnosed later in life with poorly differentiated and larger lesions, as well as increased expression of estrogen receptors (ERs) and/or progesterone receptors (PRs). A lower rate of radiation therapy and chemotherapy was observed in ILC. After PSM, ILC, and IDC patients exhibited similar OS (HR=1.017, p=0.409, 95% CI: 0.967–1.069). In subgroup analysis of HR-negative, AJCC stage III, N2/N3 stage patients, or those who received radiotherapy, ILC patients exhibited worse OS compared to IDC patients. Furthermore, multivariate analysis revealed a 47% survival benefit for IDC compared to ILC in HR-negative patients who received chemotherapy (HR=1.47, p=0.01, 95% CI: 1.09–1.97). Conclusions Our results demonstrated that ILC and IDC patients had similar OS after PSM. However, ILC patients with high risk indicators had worse OS compared to IDC patients by subgroup analysis.
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Affiliation(s)
- Ciqiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chuqian Lei
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Breast and Thyroid Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yi Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junsheng Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fei Ji
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weijun Pan
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liulu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongfei Gao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jieqing Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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31
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Clinicopathological and Molecular Characteristics of Pleomorphic Invasive Lobular Carcinoma. Int J Breast Cancer 2020; 2020:8816824. [PMID: 33299611 PMCID: PMC7704199 DOI: 10.1155/2020/8816824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/15/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022] Open
Abstract
Pleomorphic invasive lobular carcinoma (PILC) is a distinct morphological and biologically aggressive variant of invasive lobular carcinoma (ILC). We hypothesized that was due to de novo activation of PI3K/Akt/mTOR pathway in PILC resulting in higher proliferation rate and markers of cell cycle activation. We identified PILC and ILC tumors and tested for PI3K/Akt/mTOR pathway activation by immunohistochemistry (PTEN and pS6K1) and gene expression analysis (by Nanostring nCounter system). Proliferation index (Ki67) was elevated in 85% of PILCs compared to 20% of ILCs (p < 0.007). PTEN expression was high in all while pS6K1 was high in 8/9 PILCs compared to 3/9 ILCs (p < 0.007). Gene expression analysis shows that PILCs have overexpression of genes involved in cell cycle proliferation, cellular proliferation, DNA damage, and repair genes but no difference in PI3K/Akt/mTOR pathway genes. PILCs are a biologically distinct group of ILC, and clinicopathological characteristics suggest they would have a more clinically aggressive behavior. In addition, our results indicate that PI3k/Akt/mTOR pathway and cell cycle proliferation are activated in majority of these tumors. Further studies are needed to investigate these mechanisms as there are approved therapies available that may benefit PILCs.
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32
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Sreekumar S, Levine KM, Sikora MJ, Chen J, Tasdemir N, Carter D, Dabbs DJ, Meier C, Basudan A, Boone D, McAuliffe PF, Jankowitz RC, Lee AV, Atkinson JM, Oesterreich S. Differential Regulation and Targeting of Estrogen Receptor α Turnover in Invasive Lobular Breast Carcinoma. Endocrinology 2020; 161:bqaa109. [PMID: 32609836 PMCID: PMC7438704 DOI: 10.1210/endocr/bqaa109] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/27/2020] [Indexed: 02/08/2023]
Abstract
Invasive lobular breast carcinoma (ILC) accounts for 10% to 15% of breast cancers diagnosed annually. Evidence suggests that some aspects of endocrine treatment response might differ between invasive ductal carcinoma (IDC) and ILC, and that patients with ILC have worse long-term survival. We analyzed The Cancer Genome Atlas dataset and observed lower levels of ESR1 mRNA (P = 0.002) and ERα protein (P = 0.038) in ER+ ILC (n = 137) compared to IDC (n = 554), and further confirmed the mRNA difference in a local UPMC cohort (ILC, n = 143; IDC, n = 877; P < 0.005). In both datasets, the correlation between ESR1 mRNA and ERα protein was weaker in ILC, suggesting differential post-transcriptional regulation of ERα. In vitro, 17β-estradiol (E2) decreased the rate of degradation and increased the half-life of ERα in ILC cell lines, whereas the opposite was observed in IDC cell lines. Further, E2 failed to induce robust ubiquitination of ERα in ILC cells. To determine the potential clinical relevance of these findings, we evaluated the effect of 2 selective estrogen receptor downregulators (SERDs), ICI 182,780 and AZD9496, on ERα turnover and cell growth. While ICI 182,780 and AZD9496 showed similar effects in IDC cells, in ILC cell lines, AZD9496 was not as effective as ICI 182,780 in decreasing ERα stability and E2-induced proliferation. Furthermore, AZD9496 exhibited partial agonist activity in growth assays in ILC cell lines. Our study provides evidence for a distinct ERα regulation by SERDs in ILC cell lines, and therefore it is important to include ILC models into preclinical and clinical testing of novel SERDs.
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MESH Headings
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/pathology
- Cell Line, Tumor
- Estradiol/pharmacology
- Estrogen Receptor alpha/genetics
- Estrogen Receptor alpha/metabolism
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- MCF-7 Cells
- Neoplasm Invasiveness
- Protein Processing, Post-Translational/drug effects
- Proteolysis/drug effects
- Ubiquitination/drug effects
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Affiliation(s)
- Sreeja Sreekumar
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin M Levine
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Medicine, University of Washington, Seattle, Washington DC
| | - Matthew J Sikora
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jian Chen
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
| | - Nilgun Tasdemir
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dorothy Carter
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David J Dabbs
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carolin Meier
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Technische Universität, Dresden, Germany
| | - Ahmed Basudan
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Clinical Laboratory Sciences, King Saud University, Riyadh, Saudi Arabia
| | - David Boone
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Priscilla F McAuliffe
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rachel C Jankowitz
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Division of Medical Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Adrian V Lee
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer M Atkinson
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steffi Oesterreich
- Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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33
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Sestak I, Filipits M, Buus R, Rudas M, Balic M, Knauer M, Kronenwett R, Fitzal F, Cuzick J, Gnant M, Greil R, Dowsett M, Dubsky P. Prognostic Value of EndoPredict in Women with Hormone Receptor-Positive, HER2-Negative Invasive Lobular Breast Cancer. Clin Cancer Res 2020; 26:4682-4687. [PMID: 32561662 DOI: 10.1158/1078-0432.ccr-20-0260] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/25/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Invasive lobular carcinoma (ILC) accounts for approximately 5%-15% of all invasive breast cancer cases. Most of the correlations between multigene assays and patient outcome were derived from studies based on patients with invasive ductal carcinoma (IDC) or without distinction between the subtypes. Here, we investigate the prognostic value of EndoPredict (EPclin) in a large cohort of ILCs pooled from three phase III randomized trials (ABCSG-6, ABCSG-8, TransATAC). EXPERIMENTAL DESIGN The primary objective of this analysis was to determine the prognostic value of EPclin for distant recurrence (DR) in years 0-10 in postmenopausal women with ILC. The primary outcome was DR. RESULTS 470 women (17.9%) presented with ILC, 1,944 (73.9%) with IDC, and 216 (8.2%) with other histologic types. EPclin was highly prognostic in women with ILC [HR = 3.32 (2.54-4.34)] and provided more prognostic value than the Clinical Treatment Score [CTS; HR = 2.17 (1.73-2.72)]. 63.4% of women were categorized into the low EPclin risk group and they had a 10-year DR of 4.8% (2.7-8.4) compared with 36.6% of women in the high-risk group with a 10-year DR risk of 26.6% (20.0-35.0). EPclin also provided highly prognostic information in women with node-negative disease [HR = 2.56 (1.63-4.02)] and node-positive disease [HR = 3.70 (2.49-5.50)]. CONCLUSIONS EPclin provided highly significant prognostic value and significant risk stratification for women with ILC. Ten-year DR risk in the EPclin low-risk groups were similar between ILC and IDC. Our results show that EPclin is informative in women with ILC and suggest that it is equally valid in both histologic subtypes.
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MESH Headings
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Chemotherapy, Adjuvant/methods
- Clinical Trials, Phase III as Topic
- Datasets as Topic
- Disease-Free Survival
- Female
- Follow-Up Studies
- Gene Expression Profiling
- Humans
- Kaplan-Meier Estimate
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Randomized Controlled Trials as Topic
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Risk Assessment/methods
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Affiliation(s)
- Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom.
| | - Martin Filipits
- Medical University of Vienna, Cancer Research Institute, Department for Internal Medicine I and Comprehensive Cancer Centre, Vienna, Austria
| | - Richard Buus
- The Breast Cancer Now Research Centre, Institute of Cancer, London, United Kingdom
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, United Kingdom
| | - Margaretha Rudas
- Medical University of Vienna, Cancer Research Institute, Department for Internal Medicine I and Comprehensive Cancer Centre, Vienna, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Oncology and Comprehensive Cancer Centre Graz, Medical University of Graz, Graz, Austria
| | | | | | - Florian Fitzal
- Medical University of Vienna, Department of Surgery and Comprehensive Cancer Centre, Vienna, Austria
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom
| | - Michael Gnant
- Medical University of Vienna, Comprehensive Cancer Centre, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III, Oncologic Center, Salzburg Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mitch Dowsett
- The Breast Cancer Now Research Centre, Institute of Cancer, London, United Kingdom
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, United Kingdom
| | - Peter Dubsky
- Medical University of Vienna, Department of Surgery and Comprehensive Cancer Centre, Vienna, Austria
- St. Anna Breast Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland
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34
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Lo Gullo R, Daimiel I, Rossi Saccarelli C, Bitencourt A, Sevilimedu V, Martinez DF, Jochelson MS, Morris EA, Reiner JS, Pinker K. MRI background parenchymal enhancement, fibroglandular tissue, and mammographic breast density in patients with invasive lobular breast cancer on adjuvant endocrine hormonal treatment: associations with survival. Breast Cancer Res 2020; 22:93. [PMID: 32819432 PMCID: PMC7441557 DOI: 10.1186/s13058-020-01329-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/11/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To investigate if baseline and/or changes in contralateral background parenchymal enhancement (BPE) and fibroglandular tissue (FGT) measured on magnetic resonance imaging (MRI) and mammographic breast density (MD) can be used as imaging biomarkers for overall and recurrence-free survival in patients with invasive lobular carcinomas (ILCs) undergoing adjuvant endocrine treatment. METHODS Women who fulfilled the following inclusion criteria were included in this retrospective HIPAA-compliant IRB-approved study: unilateral ILC, pre-treatment breast MRI and/or mammography from 2000 to 2010, adjuvant endocrine treatment, follow-up MRI, and/or mammography 1-2 years after treatment onset. BPE, FGT, and mammographic MD of the contralateral breast were independently graded by four dedicated breast radiologists according to BI-RADS. Associations between the baseline levels and change in levels of BPE, FGT, and MD with overall survival and recurrence-free survival were assessed using Kaplan-Meier survival curves and Cox regression analysis. RESULTS Two hundred ninety-eight patients (average age = 54.1 years, range = 31-79) fulfilled the inclusion criteria. The average follow-up duration was 11.8 years (range = 2-19). Baseline and change in levels of BPE, FGT, and MD were not significantly associated with recurrence-free or overall survival. Recurrence-free and overall survival were affected by histological subtype (p < 0.0001), number of metastatic axillary lymph nodes (p < 0.0001), age (p = 0.01), and adjuvant endocrine treatment duration (p < 0.001). CONCLUSIONS Qualitative evaluation of BPE, FGT, and mammographic MD changes cannot predict which patients are more likely to benefit from adjuvant endocrine treatment.
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Affiliation(s)
- Roberto Lo Gullo
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Isaac Daimiel
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Carolina Rossi Saccarelli
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Almir Bitencourt
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, 10017, USA
| | - Danny F Martinez
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Maxine S Jochelson
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Elizabeth A Morris
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Jeffrey S Reiner
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, USA. .,Department of Biomedical Imaging and Image-guided Therapy, Molecular and Gender Imaging Service, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.
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35
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Narbe U, Bendahl PO, Aaltonen K, Fernö M, Forsare C, Jørgensen CLT, Larsson AM, Rydén L. The Distribution of Circulating Tumor Cells Is Different in Metastatic Lobular Compared to Ductal Carcinoma of the Breast-Long-Term Prognostic Significance. Cells 2020; 9:E1718. [PMID: 32709042 PMCID: PMC7407940 DOI: 10.3390/cells9071718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/13/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) has distinguishing features when compared to invasive ductal carcinoma of no special type (NST). In this study, we explored the distributional and prognostic characteristics of circulating tumor cells (CTCs) in metastatic ILC and NST. MATERIALS AND METHODS Patients were included in an observational trial (ClinicalTrials.gov NCT01322893) with ILC (n = 28) and NST (n = 111). CTC count (number/7.5 mL blood) was evaluated with serial sampling (CellSearch). The primary endpoint was progression-free survival (PFS). RESULTS The CTC counts were higher in ILC (median 70) than in NST cases (median 2) at baseline (p < 0.001). The evidence for ≥5 CTCs as a prognostic factor for PFS in ILC was weak, but stronger with higher cut-offs (CTC ≥ 20: hazard ratio (HR) 3.0, p = 0.01) (CTC ≥ 80: HR 3.6, p = 0.004). In NST, however, the prognostic effect of CTCs ≥5 was strong. Decline in CTC count from baseline to three months was associated with improved prognosis in ILC and NST. CONCLUSIONS The number of CTCs is higher in ILC than in NST, implying that a higher CTC cut-off could be considered for ILC when applying the CellSearch technique.
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Affiliation(s)
- Ulrik Narbe
- Department of Clinical Sciences, Division of Oncology, Lund University, SE-223 81 Lund, Sweden; (U.N.); (P.-O.B.); (M.F.); (C.F.); (C.L.T.J.); (A.-M.L.)
- Department of Oncology, Växjö Central Hospital, SE-352 34 Växjö, Sweden
| | - Pär-Ola Bendahl
- Department of Clinical Sciences, Division of Oncology, Lund University, SE-223 81 Lund, Sweden; (U.N.); (P.-O.B.); (M.F.); (C.F.); (C.L.T.J.); (A.-M.L.)
| | - Kristina Aaltonen
- Department of Laboratory Medicine, Division of Translational Cancer Research, Lund University, SE-223 81 Lund, Sweden;
| | - Mårten Fernö
- Department of Clinical Sciences, Division of Oncology, Lund University, SE-223 81 Lund, Sweden; (U.N.); (P.-O.B.); (M.F.); (C.F.); (C.L.T.J.); (A.-M.L.)
| | - Carina Forsare
- Department of Clinical Sciences, Division of Oncology, Lund University, SE-223 81 Lund, Sweden; (U.N.); (P.-O.B.); (M.F.); (C.F.); (C.L.T.J.); (A.-M.L.)
| | - Charlotte Levin Tykjær Jørgensen
- Department of Clinical Sciences, Division of Oncology, Lund University, SE-223 81 Lund, Sweden; (U.N.); (P.-O.B.); (M.F.); (C.F.); (C.L.T.J.); (A.-M.L.)
| | - Anna-Maria Larsson
- Department of Clinical Sciences, Division of Oncology, Lund University, SE-223 81 Lund, Sweden; (U.N.); (P.-O.B.); (M.F.); (C.F.); (C.L.T.J.); (A.-M.L.)
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, SE-221 85 Lund, Sweden
| | - Lisa Rydén
- Department of Clinical Sciences, Division of Surgery, Lund University, SE-223 81 Lund, Sweden
- Department of Surgery, Skåne University Hospital, SE-221 85 Lund, Sweden
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36
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Erber R, Hartmann A. Histology of Luminal Breast Cancer. Breast Care (Basel) 2020; 15:327-336. [PMID: 32982642 DOI: 10.1159/000509025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022] Open
Abstract
Background Invasive breast cancer (IBC) can be categorized into prognostic and predictive molecular subtypes (including luminal breast cancer) using gene expression profiling. Luminal IBC comprises a variety of histological subtypes with varying clinical and pathological features. Summary IBC of no special subtype is the most common histological subtype in general and likewise within luminal IBC. Classical invasive lobular breast cancer, typically clustering into luminal subgroup, is characterized by discohesive growth and loss of E-cadherin expression. Infrequent, morphologically distinct luminal IBC subtypes are tubular, invasive cribriform, mucinous, and invasive micropapillary carcinomas. Breast carcinoma with apocrine differentiation, with characteristic expression of androgen receptor (AR), often clusters into the luminal AR category. Rarely, neuroendocrine neoplasms of the breast can be seen. IBC of the male breast usually matches with the luminal subtype. Key Messages Independently from histological subtypes, invasive breast cancer (IBC) can be divided into molecular subtypes based on mRNA gene expression levels. Using this molecular subtyping, risk scores based on gene expression profiling (established for hormone receptor-positive, HER2-negative IBC), grading, and Ki-67 index, prognosis of patients with luminal breast cancer and response to chemotherapy can be predicted. In routine diagnostics, the expression of estrogen receptor (ER) and progesterone receptor (PR), HER2 status, and the proliferation rate (Ki-67) are used to determine a surrogate (molecular-like) subtype. Within luminal(-like) IBC, no special subtype and invasive lobular breast carcinoma are the most common histological subtypes. Other rare histological subtypes (e.g., tubular carcinoma) should be recognized due to their distinct clinical and pathological features.
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Affiliation(s)
- Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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37
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Tasdemir N, Ding K, Savariau L, Levine KM, Du T, Elangovan A, Bossart EA, Lee AV, Davidson NE, Oesterreich S. Proteomic and transcriptomic profiling identifies mediators of anchorage-independent growth and roles of inhibitor of differentiation proteins in invasive lobular carcinoma. Sci Rep 2020; 10:11487. [PMID: 32661241 PMCID: PMC7359337 DOI: 10.1038/s41598-020-68141-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022] Open
Abstract
Invasive lobular carcinoma (ILC) is a histological subtype of breast cancer with distinct molecular and clinical features from the more common subtype invasive ductal carcinoma (IDC). ILC cells exhibit anchorage-independent growth in ultra-low attachment (ULA) suspension cultures, which is largely attributed to the loss of E-cadherin. In addition to anoikis resistance, herein we show that human ILC cell lines exhibit enhanced cell proliferation in ULA cultures as compared to IDC cells. Proteomic comparison of ILC and IDC cell lines identified induction of PI3K/Akt and p90-RSK pathways specifically in ULA culture in ILC cells. Further transcriptional profiling uncovered unique upregulation of the inhibitors of differentiation family transcription factors ID1 and ID3 in ILC ULA culture, the knockdown of which diminished the anchorage-independent growth of ILC cell lines through cell cycle arrest. We find that ID1 and ID3 expression is higher in human ILC tumors as compared to IDC, correlated with worse prognosis uniquely in patients with ILC and associated with upregulation of angiogenesis and matrisome-related genes. Altogether, our comprehensive study of anchorage independence in human ILC cell lines provides mechanistic insights and clinical implications for metastatic dissemination of ILC and implicates ID1 and ID3 as novel drivers and therapeutic targets for lobular breast cancer.
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Affiliation(s)
- Nilgun Tasdemir
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Kai Ding
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Integrative Systems Biology Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura Savariau
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, 15261, USA
| | - Kevin M Levine
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Tian Du
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Ashuvinee Elangovan
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Molecular Genetics and Developmental Biology Graduate Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Emily A Bossart
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Adrian V Lee
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Nancy E Davidson
- Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- University of Washington, Seattle, WA, 98195, USA
| | - Steffi Oesterreich
- Women's Cancer Research Center, University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HCC), Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA, 15213, USA.
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
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Blohmer M, Zhu L, Atkinson JM, Beriwal S, Rodríguez-López JL, Rosenzweig M, Brufsky AM, Tseng G, Lucas PC, Lee AV, Oesterreich S, Jankowitz RC. Patient treatment and outcome after breast cancer orbital and periorbital metastases: a comprehensive case series including analysis of lobular versus ductal tumor histology. Breast Cancer Res 2020; 22:70. [PMID: 32586354 PMCID: PMC7318761 DOI: 10.1186/s13058-020-01309-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/10/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy to spread to the orbit and periorbit, and the invasive lobular carcinoma (ILC) histologic subtype of breast cancer has been reported to form these ophthalmic metastases (OM) more frequently than invasive ductal carcinomas (IDC). We herein report our single academic institution experience with breast cancer OM with respect to anatomical presentation, histology (lobular vs. ductal), treatment, and survival. METHODS We employed the natural language processing platform, TIES (Text Information Extraction System), to search 2.3 million de-identified patient pathology and radiology records at our institution in order to identify patients with OM secondary to breast cancer. We then compared the resultant cohort, the "OM cohort," to two other representative metastatic breast cancer patient (MBC) databases from our institution. Histological analysis of selected patients was performed. RESULTS Our TIES search and manual refinement ultimately identified 28 patients who were diagnosed with breast cancer between 1995 and 2016 that subsequently developed OM. Median age at diagnosis was 54 (range 28-77) years of age. ER, PR, and HER2 status from the 28 patients with OM did not differ from other patients with MBC from our institution. The relative proportion of patients with ILC was significantly higher in the OM cohort (32.1%) than in other MBC patients in our institution (11.3%, p = 0.007). Median time to first OM in the OM cohort was 46.7 months, and OM were the second most frequent first metastases after bony metastases. After diagnosis of the first distant metastasis of any kind, median survival of patients with ILC (21.4 months) was significantly shorter than that of patients with IDC (55.3 months, p = 0.03). Nine patients developed bilateral OM. We observed a significant co-occurrence of OM and central nervous system metastases (p = 0.0053). The histological analysis revealed an interesting case in which the primary tumor was of a mixed ILC/IDC subtype, while only ILC was present in the OM. CONCLUSIONS OM from breast cancer are illustrative of the difference in metastatic behavior of ILC versus IDC and should be considered when treating patients with ILC, especially in those with complaints of visual acuity changes.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/radiotherapy
- Female
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Middle Aged
- Orbital Neoplasms/metabolism
- Orbital Neoplasms/radiotherapy
- Orbital Neoplasms/secondary
- Prognosis
- Radiotherapy, Intensity-Modulated
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Martin Blohmer
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Li Zhu
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer M Atkinson
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Sushil Beriwal
- University of Pittsburgh School of Medicine, Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Joshua L Rodríguez-López
- University of Pittsburgh School of Medicine, Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Margaret Rosenzweig
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam M Brufsky
- University of Pittsburgh School of Medicine, Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - George Tseng
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Peter C Lucas
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adrian V Lee
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Steffi Oesterreich
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee Women's Research Institute, Pittsburgh, PA, USA
| | - Rachel C Jankowitz
- University of Pittsburgh School of Medicine, Department of Medicine, Division of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
- Rena Rowan Breast Center, Perelman Center for Advanced Medicine and the Abramson Cancer Center, 3rd Floor, West Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
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Sanges F, Floris M, Cossu-Rocca P, Muroni MR, Pira G, Urru SAM, Barrocu R, Gallus S, Bosetti C, D'Incalci M, Manca A, Uras MG, Medda R, Sollai E, Murgia A, Palmas D, Atzori F, Zinellu A, Cambosu F, Moi T, Ghiani M, Marras V, Santona MC, Canu L, Valle E, Sarobba MG, Onnis D, Asunis A, Cossu S, Orrù S, De Miglio MR. Histologic subtyping affecting outcome of triple negative breast cancer: a large Sardinian population-based analysis. BMC Cancer 2020; 20:491. [PMID: 32487046 PMCID: PMC7268380 DOI: 10.1186/s12885-020-06998-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Triple Negative breast cancer (TNBC) includes a heterogeneous group of tumors with different clinico-pathological features, molecular alterations and treatment responsivity. Our aim was to evaluate the clinico-pathological heterogeneity and prognostic significance of TNBC histologic variants, comparing "special types" to high-grade invasive breast carcinomas of no special type (IBC-NST). METHODS This study was performed on data obtained from TNBC Database, including pathological features and clinical records of 1009 TNBCs patients diagnosed between 1994 and 2015 in the four most important Oncology Units located in different hospitals in Sardinia, Italy. Kaplan-Meier analysis, log-rank test and multivariate Cox proportional-hazards regression were applied for overall survival (OS) and disease free survival (DFS) according to TNBC histologic types. RESULTS TNBC "special types" showed significant differences for several clinico-pathological features when compared to IBC-NST. We observed that in apocrine carcinomas as tumor size increased, the number of metastatic lymph nodes manifestly increased. Adenoid cystic carcinoma showed the smallest tumor size relative to IBC-NST. At five-year follow-up, OS was 92.1, 100.0, and 94.5% for patients with apocrine, adenoid cystic and medullary carcinoma, respectively; patients with lobular and metaplastic carcinoma showed the worst OS, with 79.7 and 84.3%, respectively. At ten-years, patients with adenoid cystic (100.0%) and medullary (94.5%) carcinoma showed a favourable prognosis, whereas patients with lobular carcinoma showed the worst prognosis (73.8%). TNBC medullary type was an independent prognostic factor for DFS compared to IBC-NST. CONCLUSIONS Our study confirms that an accurate and reliable histopathologic definition of TNBC subtypes has a significant clinical utility and is effective in the therapeutic decision-making process, with the aim to develop innovative and personalized treatments.
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Affiliation(s)
- Francesca Sanges
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Matteo Floris
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
| | - Paolo Cossu-Rocca
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy.
- Department of Diagnostic Services, "Giovanni Paolo II" Hospital, ASSL Olbia-ATS Sardegna, Olbia, Italy.
| | - Maria R Muroni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy
| | - Giovanna Pira
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Silvana Anna Maria Urru
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
- School of Hospital Pharmacy, University of Sassari, Sassari, Italy
| | - Renata Barrocu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio D'Incalci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Maria Gabriela Uras
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy
| | - Ricardo Medda
- Biomedicine Sector, Center for Advanced Studies, Research and Development in Sardinia Technology Park Polaris, Cagliari, Italy
| | - Elisabetta Sollai
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Alma Murgia
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Dolores Palmas
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Francesca Cambosu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Tiziana Moi
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Massimo Ghiani
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | | | - Luisa Canu
- Department of Pathology, ASSL Nuoro, Nuoro, Italy
| | - Enrichetta Valle
- Department of Medical Oncology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | | | - Daniela Onnis
- Department of Pathology, Brotzu Hospital, Cagliari, Italy
| | - Anna Asunis
- Department of Pathology, Brotzu Hospital, Cagliari, Italy
| | - Sergio Cossu
- Department of Pathology, ASSL Nuoro, Nuoro, Italy
| | - Sandra Orrù
- Department of Pathology, "A. Businco" Oncologic Hospital, ASL Cagliari, Cagliari, Italy
| | - Maria Rosaria De Miglio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Via P. Manzella, 4, 07100, Sassari, Italy.
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Kanbayti IH, Rae WID, McEntee MF, Al-Foheidi M, Ashour S, Turson SA, Ekpo EU. Is mammographic density a marker of breast cancer phenotypes? Cancer Causes Control 2020; 31:749-765. [PMID: 32410205 DOI: 10.1007/s10552-020-01316-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the association between mammographic density (MD) phenotypes and both clinicopathologic features of breast cancer (BC) and tumor location. METHODS MD was measured for 297 BC-affected females using qualitative (visual method) and quantitative (fully automated area-based method) approaches. Radiologists' description, visible external markers, and surgical scar were used to establish the location of tumors. Binary logistic regression models were used to assess the association between MD phenotypes and BC clinicopathologic features. RESULTS Categorical and numerical MD measures showed no association with clinicopathologic features of BC (p > 0.05). Participants with higher BI-RADS scores [(51-75% glandular) and (> 75% glandular)] (p < 0.001), and percent density (PD) categories [PD (21-49%) and PD ≥ 50%] (p = 0.01) were more likely to have tumors emanating from dense areas. Additionally, tumors were commonly found in dense regions of the breast among patients with higher medians of PD (p = 0.001), dense area (DA) (p = 0.02), and lower medians of non-dense area (NDA) (p < 0.001). Adjusted logistic regression models showed that high BI-RADS density (> 75% glandular) has an almost fivefold increased odds of tumors developing within dense areas (OR 4.99, 95% CI 0.93-25.9; p = 0.05. PD (OR 1.02, 95% CI 1-1.03, p = 0.002) and NDA (OR 0.99, 95% CI 0.991-0.997, p < 0.001) had very small effect on tumor location. Compared to tumors within non-dense areas, tumors in dense areas tended to exhibit human epidermal growth factor receptor 2 positive (p = 0.05) and carcinoma in situ (p = 0.01) characteristics. CONCLUSION MD shows no significant association with clinicopathologic features of BC. However, BC was more likely to originate from dense tissue, with tumors in dense regions having human epidermal growth receptor 2 positive and carcinoma in situ characteristics.
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Affiliation(s)
- Ibrahem H Kanbayti
- Diagnostic Radiography Technology Department, Faculty of Applied Medical Sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia. .,Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. .,Faculty of Health Science, University of Sydney, Cumberland Campus C42
- 75 East Street, Lidcombe, NSW, 2141, Australia.
| | - William I D Rae
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark F McEntee
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Medicine Roinn na Sláinte, UG 12 Áras Watson
- Brookfield Health Sciences, Cork, T12 AK54, Ireland
| | - Meteb Al-Foheidi
- King Saud Bin Abdulaziz University for Health Science-National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Sawsan Ashour
- Radiology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Smeera A Turson
- Radiology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ernest U Ekpo
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
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41
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Hu G, Hu G, Zhang C, Lin X, Shan M, Yu Y, Lu Y, Niu R, Ye H, Wang C, Xu C. Adjuvant chemotherapy could not bring survival benefit to HR-positive, HER2-negative, pT1b-c/N0-1/M0 invasive lobular carcinoma of the breast: a propensity score matching study based on SEER database. BMC Cancer 2020; 20:136. [PMID: 32085753 PMCID: PMC7035707 DOI: 10.1186/s12885-020-6614-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/07/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The benefit of adjuvant chemotherapy in invasive lobular carcinoma (ILC) is still unclear. The objective of the current study was to elucidate the effectiveness of adjuvant chemotherapy in hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, pT1b-c/N0-1/M0 ILC. METHODS Based on Surveillance, Epidemiology, and End-Results (SEER) database, we identified original 12,334 HR-positive, HER2-negative, pT1b-c/N0-1/M0 ILC patients, who were then divided into adjuvant chemotherapy group and control group. End-points were overall survival (OS) and breast cancer-specific mortality (BCSM). Aiming to minimize the selection bias of baseline characteristics, Propensity Score Matching (PSM) method was used. RESULTS In a total of 12,334 patients with HR-positive, HER2-negative, pT1b-c/N0-1/M0 ILC, 1785 patients (14.5%) were allocated into adjuvant chemotherapy group and 10,549 (85.5%) into control group. Used PSM, the 1785 patients in adjuvant chemotherapy group matched to the 1785 patients in control group. By Kaplan-Meier survival analyses, we observed no beneficial effect of adjuvant chemotherapy on OS in both original samples (P = 0.639) and matched samples (P = 0.962), however, ineffective or even contrary results of adjuvant chemotherapy on BCSM both in original samples (P = 0.001) and in matched samples (P = 0.002). In both original and matched multivariate Cox models, we observed ineffectiveness of adjuvant chemotherapy on OS (hazard ratio (HR) for overall survival = 0.82, 95% confidence interval (CI) [0.62-1.09]; P = 0.172 and HR = 0.90, 95%CI [0.65-1.26]; P = 0.553, respectively), unexpectedly promoting effect of adjuvant chemotherapy on BCSM (HR = 2.33, 95%CI [1.47-3.67]; P = 0.001 and HR = 2.41, 95%CI [1.32-4.39]; P = 0.004, respectively). Standard surgery was beneficial to the survival of patients. Lymph node metastasis was detrimental to survival and radiotherapy brought survival benefit in original samples, but two issues had unobvious effect in matched samples. CONCLUSION In this study, adjuvant chemotherapy did not improve survival for patients with HR-positive, HER2-negative pT1b-c/N0-1/M0 ILC.
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Affiliation(s)
- Guangfu Hu
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangxia Hu
- Department of Pathology, Binzhong People's Hospital, Affiliated to First Shandong Medical University, Binzhong, China
| | - Chengjiao Zhang
- Department of Psychological Measurement, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyan Lin
- Department of Breast Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Shan
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanmin Yu
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongwei Lu
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijie Niu
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Ye
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng Wang
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Cheng Xu
- Department of Breast Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
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Schnitt SJ, Brogi E, Chen YY, King TA, Lakhani SR. American Registry of Pathology Expert Opinions: The Spectrum of Lobular Carcinoma in Situ: Diagnostic Features and Clinical Implications. Ann Diagn Pathol 2020; 45:151481. [PMID: 32120324 DOI: 10.1016/j.anndiagpath.2020.151481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This review reflects a collaboration between the American Registry of Pathology (the publisher of the Armed Forces Institute of Pathology Fascicles) and Annals of Diagnostic Pathology. It is part of a series of expert recommendations on topics encountered in daily practice. The authors, 4 pathologists with expertise in breast pathology and a breast surgeon with a clinical and research interest in lobular carcinoma in situ (LCIS), met by conference call in September 2019 to develop recommendations for evaluating and reporting LCIS. Herein, we summarize the diagnostic criteria of classic LCIS and LCIS subtypes according to the most recent WHO criteria, discuss how best to distinguish LCIS from ductal carcinoma in situ in problematic cases (including the uses and limitations of E-cadherin immunohistochemistry), and review outcome and management issues for patients with LCIS.
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Affiliation(s)
- Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Dana-Farber Cancer Institute, Boston, MA, United States of America; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, United States of America.
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Yunn-Yi Chen
- Department of Pathology, University of California San Francisco School of Medicine, San Francisco, CA, United States of America
| | - Tari A King
- Division of Breast Surgery, Brigham and Women's Hospital; Dana-Farber Cancer Institute, Boston, MA, United States of America; Dana-Farber Cancer Institute, Boston, MA, United States of America; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, United States of America
| | - Sunil R Lakhani
- University of Queensland and Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Australia
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Corona SP, Bortul M, Scomersi S, Bigal C, Bottin C, Zanconati F, Fox SB, Giudici F, Generali D. Management of the axilla in breast cancer: outcome analysis in a series of ductal versus lobular invasive cancers. Breast Cancer Res Treat 2020; 180:735-745. [PMID: 32060782 DOI: 10.1007/s10549-020-05565-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/03/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Axillary lymph node dissection (ALND) has been considered essential for the staging of breast cancer (BC). As the impact of tumor biology on clinical outcomes is recognized, a surgical de-escalation approach is being implemented. We performed a retrospective study focused on surgical management of the axilla in invasive lobular carcinoma (ILC) versus invasive ductal carcinoma (IDC). MATERIALS AND METHODS 1151 newly diagnosed BCs, IDCs (79.6%) or ILCs (20.4%), were selected among patients treated at our Breast Cancer Unit from 2012 to 2018. Tumor characteristics and clinical information were collected and predictors of further metastasis after positive sentinel lymph node biopsy (SLNB) analyzed in relation to disease-free survival (DFS) and overall survival (OS). RESULTS 27.5% of patients with ILC had ≥ 3 metastatic lymph nodes at ALND after positive SLNB versus 11.48% of IDCs (p = 0.04). Risk predictors of further metastasis at ALND were the presence of > 2 positive lymph nodes at SLNB (OR = 4.72, 95% CI 1.15-19.5 p = 0.03), T3-T4 tumors (OR = 4.93, 95% CI 1.10-22.2, p = 0.03) and Non-Luminal BC (OR = 2.74, 95% CI 1.16-6.50, p = 0.02). The lobular histotype was not associated with the risk of further metastasis at ALND (OR = 1.62, 95% CI 0.77-3.41, p = 0.20). CONCLUSIONS ILC histology is not associated with higher risk of further metastasis at ALND in our analysis. However, surgical management decisions should be taken considering tumor histotype, biology and expected sensitivity to adjuvant therapies.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Axilla
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Disease Management
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision/mortality
- Mastectomy/mortality
- Middle Aged
- Neoplasm Invasiveness
- Prognosis
- Retrospective Studies
- Sentinel Lymph Node Biopsy/mortality
- Survival Rate
- Young Adult
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Affiliation(s)
- S P Corona
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital 447, 34129, Trieste, Italy.
| | - M Bortul
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital 447, 34129, Trieste, Italy
| | - S Scomersi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital 447, 34129, Trieste, Italy
| | - C Bigal
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital 447, 34129, Trieste, Italy
| | - C Bottin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital 447, 34129, Trieste, Italy
| | - F Zanconati
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital 447, 34129, Trieste, Italy
| | - S B Fox
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
- Department of Clinical Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - F Giudici
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital 447, 34129, Trieste, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Loredan, 18, Padua, 35131, Italy
| | - D Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Cattinara Hospital 447, 34129, Trieste, Italy
- U.O. Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, Azienda Socio-Sanitaria Territoriale di Cremona, viale Concordia 1, Cremona, 26100, Italy
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Bergeron A, Desmoulins I, Beltjens F, Causeret S, Charon-Barra C, Martin E, Richard C, Boidot R, Arnould L. An exceptional metaplastic lobular breast carcinoma diagnosed through exome sequencing. J Clin Pathol 2020; 73:597-601. [PMID: 31980561 DOI: 10.1136/jclinpath-2019-205783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 12/31/2022]
Abstract
Metaplastic breast carcinoma is a rare subtype of breast cancer. This subtype is mostly found in association with poorly differentiated ductal breast carcinomas and rarely with other breast carcinoma types. We report the case of a 69-year-old woman with an exceptional invasive lobular breast carcinoma associated with metaplastic squamous cell bone metastasis occurring 2 years after the initial breast cancer diagnosis. Whole-exome sequencing and subsequent immunohistochemistry of the lesions were used to link the squamous cell bone metastasis of unknown origin to the primary breast carcinoma initially diagnosed. Searching for primary carcinoma when metastatic lesions of unknown origin occur can be complex. Current molecular biology techniques may help pathologists in associating metastasis with the primary carcinoma by identifying shared specific gene mutations, even when different morphological and immunohistochemical profiles are observed between the tumours.
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Affiliation(s)
- Anthony Bergeron
- Department of Tumor Biology and Pathology, Pathology Unit, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | - Isabelle Desmoulins
- Department of Clinical Oncology, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | - Francoise Beltjens
- Department of Tumor Biology and Pathology, Pathology Unit, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | - Sylvain Causeret
- Department of Surgery, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | - Celine Charon-Barra
- Department of Tumor Biology and Pathology, Pathology Unit, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | - Etienne Martin
- Department of Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | - Corentin Richard
- Department of Tumor Biology and Pathology, Molecular Biology Unit, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | - Romain Boidot
- Department of Tumor Biology and Pathology, Molecular Biology Unit, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
| | - Laurent Arnould
- Department of Tumor Biology and Pathology, Pathology Unit, Centre Georges-Francois Leclerc, Dijon, Bourgogne, France
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Mamtani A, Morrow M. ASO Author Reflections: Early-Stage Lobular Breast Cancer: Axillary Treatment in the Z0011 Era. Ann Surg Oncol 2019; 26:715-716. [PMID: 31468221 DOI: 10.1245/s10434-019-07769-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Anita Mamtani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Mamtani A, Zabor EC, Rosenberger LH, Stempel M, Gemignani ML, Morrow M. Was Reexcision Less Frequent for Patients with Lobular Breast Cancer After Publication of the SSO-ASTRO Margin Guidelines? Ann Surg Oncol 2019; 26:3856-3862. [PMID: 31456094 DOI: 10.1245/s10434-019-07751-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Society of Surgical Oncology and American Society for Radiation Oncology consensus guidelines defined a negative margin for breast-conserving surgery (BCS) as no ink on tumor, and implementation has reduced rates of additional surgery for patients with invasive ductal cancer (IDC). The outcomes for invasive lobular cancer (ILC) patients are uncertain. METHODS This study identified patients who had stage 1 or 2 ILC treated with BCS from January 2010 to February 2018. The guidelines were adopted 1 January 2014. Clinicopathologic characteristics, margin status, and reexcisions were compared before and after adoption of the guidelines and with those of IDC patients treated from May 2013 to February 2015. RESULTS Among 745 early-stage ILC patients undergoing BCT, 312 (42%) were treated before the guidelines and 433 (58%) after the guidelines. Most clinicopathologic characteristics were similar between the two groups, with differences in lobular carcinoma in situ, lymphovascular invasion, and node-positivity rates. The overall rates of additional surgery declined significantly after the guidelines (31.4 to 23.1%; p = 0.01), but the difference did not reach significance for reexcisions (19.9 to 15.2%; p = 0.12) or conversions to mastectomy (11.5 to 7.9%; p = 0.099) individually. Between eras, no difference in incidence or number of tumor on ink or ≤ 2 mm margins was observed (all p = 0.2). Larger tumors, younger age, and pre-guideline era were independently associated with additional surgery. Only younger age was predictive of mastectomy. Among 431 pre-guideline and 601 post-guideline IDC patients, reexcisions declined from 21.3 to 14.8% (p = 0.008), and conversion to mastectomy was rare (0.6%). The magnitude of reduction in any additional surgery (interaction, p = 0.92) and reexcisions (interaction, p = 0.56) was similar between ILC and IDC. CONCLUSIONS Despite differences in growth pattern and conspicuity, guideline adoption significantly reduced additional surgery among ILC patients, with a magnitude of benefit similar to that among IDC patients.
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Affiliation(s)
- Anita Mamtani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Mamtani A, Zabor EC, Stempel M, Morrow M. Lobular Histology Does Not Predict the Need for Axillary Dissection Among ACOSOG Z0011-Eligible Breast Cancers. Ann Surg Oncol 2019; 26:3269-3274. [PMID: 31342363 DOI: 10.1245/s10434-019-07536-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated that axillary lymph node dissection (ALND) may be omitted for women with two or fewer positive sentinel nodes (SLNs) undergoing breast-conservation therapy (BCT). Lobular histology comprises a minority of patients, and applicability to these discohesive cancers has been questioned. METHODS From August 2010 to March 2017, patients undergoing BCT for cT1-2N0 cancer with positive SLNs were prospectively managed with ALND for three or more positive SLNs or gross extracapsular extension (ECE). In this study, clinicopathologic characteristics and nodal burden were compared between pure/mixed invasive lobular cancer (ILC) and invasive ductal cancer (IDC) patients. RESULTS Among 813 consecutive patients, 104 (12.8%) had ILC and 709 (87.2%) had IDC. ILC was more often multifocal and low grade, and less frequently had lymphovascular invasion (all p < 0.001). ILC more often had SLN macrometastases (81.7% ILC vs. 69.4% IDC; p = 0.01) and more than 2 mm of ECE (30.8% ILC vs. 19.5% IDC; p = 0.03), but the proportions of cases with three or more positive SLNs were similar in the two groups (14.4% ILC vs. 9.9% IDC; p = 0.2). The ALND procedure was performed for 20 ILC patients (19.2%) compared with 97 IDC patients (13.7%) (p = 0.2). Additional positive nodes were found in 80% of the ILC patients versus 56.7% of the IDC patients (p = 0.09). The ALND and nodal burden rates were similar in the estrogen receptor-positive (ER+) subset analysis. In the multivariable analysis, lobular histology (p = 0.03) and larger tumors (p = 0.03) were associated with additional positive nodes. During a median follow-up period of 42 months, there were no isolated axillary recurrences. CONCLUSIONS Despite a higher proportion of SLN macrometastases and association with more positive nodes at ALND, lobular histology does not predict the need for ALND. ALND is not indicated on the basis of histology among patients otherwise meeting Z0011 criteria.
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Affiliation(s)
- Anita Mamtani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.
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Gogia A, Raina V, Deo SVS, Shukla NK, Mathur S, Mohanti BK, Sharma DN. Clinico-pathological characteristics and treatment outcome in invasive lobular carcinoma of the breast: An Indian experience. Indian J Cancer 2019; 55:344-347. [PMID: 30829268 DOI: 10.4103/ijc.ijc_428_18] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) is the second most common histologic subtype of breast cancer and accounts for 10%-15% of all breast cancers in the west. There is a scarcity of data on ILC from the Indian subcontinent. This report intends to present the patterns of care, survival outcomes, and prognostic factors of ILC treated in a tertiary care institute. MATERIALS AND METHODS This retrospective analysis included consecutive patients diagnosed with ILC and registered at our Institute between 2009 and 2016. RESULTS We included 97 patients with a median age of 53 years (range 28-80). American Joint Committee on Cancer (7th edition) stage distribution was stage I-8.24%, stage II-45.36%, stage III- 34.10%, and stage IV-12.30%. Bilateral breast cancer was seen in 8 cases. Estrogen receptor, progesterone receptor, and HER 2/neu positivity was 90%, 85%, and 9%, respectively. Triple-negative breast cancer constituted 5% of cases. Twenty-nine events were recorded (systemic and locoregional relapse) with a median follow-up of 3.5 years. Three years relapse-free survival (RFS) and overall survival were 80% and 60%, respectively. Bones were the most common site of metastasis. Age <45 years [HR-1.4 (0.8-2.1), P < 0.001] and advanced clinical tumor stage [T4, HR-2.1 (1.1-3.8), P = 0.001] were associated with poor RFS. CONCLUSION ILC constituted 2.5% of breast cancer cases at our institute. Triple negativity and HER-2/neu positivity were seen in 9% and 5% of cases, respectively. Age <45 years and advanced clinical tumor stage were associated with poor RFS.
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Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | | | - Nootan Kumar Shukla
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Chen XH, Zhang WW, Wang J, Sun JY, Li FY, He ZY, Wu SG. 21-gene recurrence score and adjuvant chemotherapy decisions in patients with invasive lobular breast cancer. Biomark Med 2019; 13:83-93. [PMID: 30565472 DOI: 10.2217/bmm-2018-0396] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: To determine the effect of the 21-gene recurrence score (RS) on outcome and chemotherapy decision in breast invasive lobular carcinoma (ILC). Materials & methods: We included 6467 patients with early stage and estrogen receptor–positive ILC from the Surveillance, epidemiology, and end results database. Results: A total of 9.1, 31.4, and 70.1% of patients with low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. A higher RS was independently associated with poor breast cancer-specific survival, and receipt of chemotherapy was not related to better breast cancer-specific survival in low-, intermediate-, or high-risk RS groups. Conclusion: The 21-gene RS could impact chemotherapy decision making in early-stage ILC. However, adjuvant chemotherapy does not appear to improve outcome in high-risk RS cohort.
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Affiliation(s)
- Xiang-Hong Chen
- Department of Breast Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Jun Wang
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
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Kalinowski L, Saunus JM, McCart Reed AE, Lakhani SR. Breast Cancer Heterogeneity in Primary and Metastatic Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1152:75-104. [DOI: 10.1007/978-3-030-20301-6_6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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