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Liu K, Chen GP, Chen XQ, Wu SG. Tumor grade and progesterone receptor status in predicting benefit of chemotherapy in high genomic risk breast cancer. Expert Rev Anticancer Ther 2024; 24:1021-1028. [PMID: 39152692 DOI: 10.1080/14737140.2024.2393749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/27/2024] [Accepted: 08/10/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Not all eligible breast cancer (BC) patients could afford the expensive test of 21-gene recurrence score (RS) assay. This study aimed to identify clinicopathological factors associated with high-risk RS and examine whether these factors correlate with the benefit of chemotherapy. RESEARCH DESIGN AND METHODS Patients diagnosed with early-stage BC, node-negative, and estrogen receptor-positive disease were identified from the Surveillance, Epidemiology, and End Results Oncotype DX database. RESULT We included 74,605 patients. Those with higher grade (p < 0.001) and progesterone receptor-negative (PR Neg) (p < 0.001) had the highest odds of a high-risk RS. Among them, 3.2%, 10.1%, 39.1%, 18.6%, 41.6%, and 80.1% had high-risk RS tumors in PR-positive (PR Pos)/well-differentiated (G1), PR Pos/moderately differentiated (G2), PR Pos/poorly and/or undifferentiated (G3), PR Neg/G1, PR Neg/G2, and PR Neg/G3 groups, respectively. Receipt of chemotherapy was associated with improved breast cancer-specific survival (p = 0.010) and overall survival (p < 0.001) in high-risk RS cohort. However, there were no survival benefits from chemotherapy in patients with PR Neg/G3 disease and other groups after stratification by grade and PR status (all p ≥ 0.05). CONCLUSION Our study aids in refining patient selection for the RS testing, which is crucial given its economic implications. However, 21-gene RS remains pivotal for treatment decision-making.
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Affiliation(s)
- Ke Liu
- Xiamen Key Laboratory of Clinical Efficacy and Evidence Studies of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - Gui-Ping Chen
- Department of Radiation Oncology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, People's Republic of China
| | - Xue-Qin Chen
- Xiamen Key Laboratory of Clinical Efficacy and Evidence Studies of Traditional Chinese Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China
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Matikas A, Bergh J. Breast cancer during pregnancy-The oncologist's point of view. Acta Obstet Gynecol Scand 2024; 103:775-778. [PMID: 37983830 PMCID: PMC10993346 DOI: 10.1111/aogs.14729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
Breast cancer is the most common malignancy diagnosed during or directly after pregnancy. Differences in pathogenesis and prognosis identify two distinct patient groups, those with breast cancer during pregnancy and those with postpartum breast cancer which, for reasons not completely understood, is associated with worse outcomes. Compared with breast cancer in the non-pregnant patient, several limitations in terms of both local and systemic therapy are applied to limit fetal harm. Treatment is nevertheless delivered with curative intent, therefore avoiding harmful delays in therapy initiation, unnecessary therapy de-escalation or chemotherapy dose modifications is strongly recommended. In this short commentary, we briefly review current evidence and treatment guidelines and provide recommendations for optimal oncologic management of pregnancy-related breast cancer.
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Affiliation(s)
- Alexios Matikas
- Oncology/Pathology DepartmentKarolinska InstitutetStockholmSweden
- Breast Center, Karolinska Comprehensive Cancer Center and Karolinska University HospitalStockholmSweden
| | - Jonas Bergh
- Oncology/Pathology DepartmentKarolinska InstitutetStockholmSweden
- Breast Center, Karolinska Comprehensive Cancer Center and Karolinska University HospitalStockholmSweden
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3
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Coradini D. Impact of De Novo Cholesterol Biosynthesis on the Initiation and Progression of Breast Cancer. Biomolecules 2024; 14:64. [PMID: 38254664 PMCID: PMC10813427 DOI: 10.3390/biom14010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 01/24/2024] Open
Abstract
Cholesterol (CHOL) is a multifaceted lipid molecule. It is an essential structural component of cell membranes, where it cooperates in regulating the intracellular trafficking and signaling pathways. Additionally, it serves as a precursor for vital biomolecules, including steroid hormones, isoprenoids, vitamin D, and bile acids. Although CHOL is normally uptaken from the bloodstream, cells can synthesize it de novo in response to an increased requirement due to physiological tissue remodeling or abnormal proliferation, such as in cancer. Cumulating evidence indicated that increased CHOL biosynthesis is a common feature of breast cancer and is associated with the neoplastic transformation of normal mammary epithelial cells. After an overview of the multiple biological activities of CHOL and its derivatives, this review will address the impact of de novo CHOL production on the promotion of breast cancer with a focus on mammary stem cells. The review will also discuss the effect of de novo CHOL production on in situ and invasive carcinoma and its impact on the response to adjuvant treatment. Finally, the review will discuss the present and future therapeutic strategies to normalize CHOL biosynthesis.
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Affiliation(s)
- Danila Coradini
- Laboratory of Medical Statistics and Biometry, "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Campus Cascina Rosa, 20133 Milan, Italy
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Chiru ED, Oseledchyk A, Schoetzau A, Kurzeder C, Mosimann R, Vetter M, Grašič Kuhar C. Application of a 21-Gene Recurrence Score in a Swiss Single-Center Breast Cancer Population: A Comparative Analysis of Treatment Administration before and after TAILORx. Diagnostics (Basel) 2023; 14:97. [PMID: 38201405 PMCID: PMC10795714 DOI: 10.3390/diagnostics14010097] [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: 11/03/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
In patients with hormone receptor positive, human epidermal receptor 2 negative (HR+/HER2-) negative breast cancer (BC), the TAILORx study showed the benefit of adding chemotherapy (CHT) to endocrine therapy (ET) in a subgroup of patients under 50 years with an intermediate Oncotype DX recurrence score (RS 11-25). The aim of the present study was to determine if the TAILORx findings, including the changes in the RS categories, impacted CHT use in the intermediate RS (11-25) group in daily practice, as well as to identify the main factors for CHT decisions. We conducted a retrospective study on 326 BC patients (59% node-negative), of which 165 had a BC diagnosis before TAILORx (Cohort A) and 161 after TAILORx publication (Cohort B). Changes in the RS categories led to shifts in patient population distribution, thereby leading to a 40% drop in the low RS (from 60% to 20%), which represented a doubling in the intermediate RS (from 30% to 60%) and an increase of 5% in the high RS (from 8-10% to 15%). The overall CHT recommendation and application did not differ significantly between cohort B when compared with A (19% vs. 22%, resp., p = 0.763). In the intermediate RS (11-25), CHT use decreased by 5%, while in the high-risk RS category (>25), there was an increase of 13%. The tumor board recommended CHT for 90% of the patients according to the new RS guidelines in cohort A and for 85% in cohort B. The decision for CHT recommendation was based on age (OR 0.93, 95% CI 0.08-0.97, p = 0.001), nodal stage (OR 4.77, 95% CI 2.03-11.22, p < 0.001), and RS categories (RS 11-25 vs. RS 0-10: OR 0.06 (95% CI 0.02-0.17), p < 0.001; RS > 26 vs. RS 11-25: OR 618.18 95% CI 91.64-4169.91, p < 0.001), but did not depend on the cohort. In conclusion, while the tumor board recommendation for CHT decreased in the intermediate RS category, there was an increase being reported in the high RS category, thus leading to overall minor changes in CHT application. As expected, among the younger women with intermediate RS and unfavorable histopathological factors, CHT use increased.
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Affiliation(s)
- Elena Diana Chiru
- Medical Oncology, Basel University Hospital, 4051 Basel, Switzerland; (A.O.); (M.V.)
- Center of Oncology and Hematology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
| | - Anton Oseledchyk
- Medical Oncology, Basel University Hospital, 4051 Basel, Switzerland; (A.O.); (M.V.)
| | - Andreas Schoetzau
- Department of Biomedicine, Basel University, 4051 Basel, Switzerland;
| | | | - Raphael Mosimann
- Faculty of Medicine, Basel Medical University, 4051 Basel, Switzerland;
| | - Marcus Vetter
- Medical Oncology, Basel University Hospital, 4051 Basel, Switzerland; (A.O.); (M.V.)
- Center of Oncology and Hematology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland
- Department of Gynecologic Oncology, Basel University Hospital, 4051 Basel, Switzerland;
| | - Cvetka Grašič Kuhar
- Department of Gynecologic Oncology, Basel University Hospital, 4051 Basel, Switzerland;
- Medical Oncology Department, Institute of Oncology Ljubljana, SI-1000 Ljubljana, Slovenia
- Faculty of Medicine Ljubljana, Korytkova 2, SI-1000 Ljubljana, Slovenia
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Kay C, Martinez-Perez C, Dixon JM, Turnbull AK. The Role of Nodes and Nodal Assessment in Diagnosis, Treatment and Prediction in ER+, Node-Positive Breast Cancer. J Pers Med 2023; 13:1476. [PMID: 37888087 PMCID: PMC10608445 DOI: 10.3390/jpm13101476] [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: 08/29/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023] Open
Abstract
The majority of breast cancers are oestrogen receptor-positive (ER+). In ER+ cancers, oestrogen acts as a disease driver, so these tumours are likely to be susceptible to endocrine therapy (ET). ET works by blocking the hormone's synthesis or effect. A significant number of patients diagnosed with breast cancer will have the spread of tumour cells into regional lymph nodes either at the time of diagnosis, or as a recurrence some years later. Patients with node-positive disease have a poorer prognosis and can respond less well to ET. The nodal metastases may be genomically similar or, as is becoming more evident, may differ from the primary tumour. However, nodal metastatic disease is often not assessed, and treatment decisions are almost always based on biomarkers evaluated in the primary tumour. This review will summarise the evidence in the field on ER+, node-positive breast cancer, including diagnosis, treatment, prognosis and predictive tools.
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Affiliation(s)
- Charlene Kay
- Translational Oncology Research Group, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Carlos Martinez-Perez
- Translational Oncology Research Group, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, NHS Lothian, Edinburgh Eh4 2XU, UK
| | - Arran K Turnbull
- Translational Oncology Research Group, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh EH4 2XU, UK
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Ding W, Ye D, Zhu H, Lin Y, Li Z, Ruan G. Survival Benefit of Adjuvant Chemotherapy in Node-Positive Breast Cancer With a 21-Gene Recurrence Score of 14 to 25: A Real-World Study Based on the Inverse Probability of Treatment Weighting Method. Clin Breast Cancer 2023; 23:e441-e450. [PMID: 37500355 DOI: 10.1016/j.clbc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/28/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The role of recurrence score in predicting the benefits of adjuvant chemotherapy for lymph-node-positive breast cancer remains uncertain. We studied chemotherapy usage in patients with 1 to 3 positive lymph nodes and a recurrence score (RS) of 25 or lower to assess changes in clinical practice based on the RxPONDER trial. METHODS A retrospective study using the SEER database identified female patients diagnosed with ER-positive, HER2-negative breast cancer, 1 to 3 positive lymph nodes, and an RS of 25 or lower between 2010 and 2015. Patients were divided into nonchemotherapy and chemotherapy groups, with propensity score weighting to balance clinicopathologic factors. RESULTS Among 7965 patients, 5774 (72.5%) were in the nonchemotherapy group, while 2191 (27.5%) were in the chemotherapy group. Median follow-up was 39 months. Breast cancer accounted for 67 deaths, while 128 deaths were due to other causes. The weighted 5-year overall survival (OS) rates were 95.7% for the nonchemotherapy group and 97.2% for the chemotherapy group. For high-risk patients, the weighted 5-year OS rates were 95.2% and 97.0% for the nonchemotherapy and chemotherapy groups, respectively, with a significant absolute difference of 1.8% (P = .014). Multivariate analysis showed a significant difference in weighted hazard ratios for OS between the nonchemotherapy and chemotherapy groups in high-risk patients (hazard ratio: 0.64; 95% CI: 0.48-0.86). However, there were no significant differences in weighted hazard ratios for lower-risk patients, and similar results were observed for breast cancer-specific survival (BCSS). CONCLUSION Patients with ER-positive, HER2-negative breast cancer and 1 to 3 positive lymph nodes, assessed by a 21-gene RS of 0 to 25, exhibited heterogeneous prognosis. Adjuvant chemotherapy provided a significant survival benefit, especially for patients with RS of 14 to 25, particularly those with invasive ductal carcinoma (IDC) and 2 to 3 positive lymph nodes.
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Affiliation(s)
- Wu Ding
- Department of oncological surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China; Department of Clinical Medicine, Shaoxing University School of Medicine, Shaoxing, Zhejiang Province, China
| | - Dengfeng Ye
- Department of oncological surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China
| | - Hongjuan Zhu
- Department of oncological surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China
| | - Yingli Lin
- Department of Early Childhood Education, Shaoxing Vocational & Technical College, Shaoxing, Zhejiang Province, China
| | - Zhian Li
- Department of oncological surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China
| | - Guodong Ruan
- Department of oncological surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang Province, China.
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7
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Diederiks N, Ravensbergen CJ, Treep M, van Wezel M, Kuruc M, Renee Ruhaak L, Tollenaar RA, Cobbaert CM, van der Burgt YE, Mesker WE. Development of Tier 2 LC-MRM-MS protein quantification methods for liquid biopsies. J Mass Spectrom Adv Clin Lab 2022; 27:49-55. [PMID: 36619217 PMCID: PMC9811211 DOI: 10.1016/j.jmsacl.2022.12.007] [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: 07/08/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
In the pursuit of personalized diagnostics and tailored treatments, quantitative protein tests contribute to a more precise definition of health and disease. The development of new quantitative protein tests should be driven by an unmet clinical need and performed in a collaborative effort that involves all stakeholders. With regard to the analytical part, mass spectrometry (MS)-based platforms are an excellent tool for quantification of specific proteins in body fluids, for example focused on cancer. The obtained readouts have great potential in determining tumor aggressiveness to facilitate treatment decisions, and can furthermore be used to monitor patient response. Internationally standardized TNM classifications of malignant tumors are beneficial for diagnosis, however treatment outcome and survival of cancer patients is poorly predicted. To this end, the importance of the tumor microenvironment has endorsed the introduction of the tumor-stroma ratio as a prognostic parameter in solid primary tumor types. Currently, the stromal content of tumor tissues is determined via routine diagnostic pathology slides. With the development of liquid chromatography (LC)-MS methods we aim at quantification of tumor-stroma specific proteins in body fluids. In this mini-review the analytical aspect of this developmental trajectory is further detailed.
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Affiliation(s)
- Nina Diederiks
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Cor J. Ravensbergen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Maxim Treep
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Madelein van Wezel
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Matt Kuruc
- Biotech Support Group LLC, 1 Deer Park Drive, Suite M, Monmouth Junction, NJ 08852, USA
| | - L. Renee Ruhaak
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Rob A.E.M. Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Christa M. Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Yuri E.M. van der Burgt
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Corresponding author.
| | - Wilma E. Mesker
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Understanding Breast Cancers through Spatial and High-Resolution Visualization Using Imaging Technologies. Cancers (Basel) 2022; 14:cancers14174080. [PMID: 36077616 PMCID: PMC9454728 DOI: 10.3390/cancers14174080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Breast cancer is the most common cancer affecting women worldwide. Although many analyses and treatments have traditionally targeted the breast cancer cells themselves, recent studies have focused on investigating entire cancer tissues, including breast cancer cells. To understand the structure of breast cancer tissues, including breast cancer cells, it is necessary to investigate the three-dimensional location of the cells and/or proteins comprising the tissues and to clarify the relationship between the three-dimensional structure and malignant transformation or metastasis of breast cancers. In this review, we aim to summarize the methods for analyzing the three-dimensional structure of breast cancer tissue, paying particular attention to the recent technological advances in the combination of the tissue-clearing method and optical three-dimensional imaging. We also aimed to identify the latest methods for exploring the relationship between the three-dimensional cell arrangement in breast cancer tissues and the gene expression of each cell. Finally, we aimed to describe the three-dimensional imaging features of breast cancer tissues using noninvasive photoacoustic imaging methods.
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Kjällquist U, Acs B, Margolin S, Karlsson E, Kessler LE, Garcia Hernandez S, Ekholm M, Lundgren C, Olsson E, Lindman H, Foukakis T, Matikas A, Hartman J. Real World Evaluation of the Prosigna/PAM50 Test in a Node-Negative Postmenopausal Swedish Population: A Multicenter Study. Cancers (Basel) 2022; 14:2615. [PMID: 35681597 PMCID: PMC9179899 DOI: 10.3390/cancers14112615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022] Open
Abstract
Molecular signatures to guide decisions for adjuvant chemotherapy are recommended in early ER-positive, HER2-negative breast cancer. The objective of this study was to assess what impact gene-expression-based risk testing has had following its recommendation by Swedish national guidelines. Postmenopausal women with ER-positive, HER2-negative and node negative breast cancer at intermediate clinical risk and eligible for chemotherapy were identified retrospectively from five Swedish hospitals. Tumor characteristics, results from Prosigna® test and final treatment decision were available for all patients. Treatment recommendations were compared with the last version of regional guidelines before the introduction of routine risk signature testing. Among the 360 included patients, 41% (n = 148) had a change in decision for adjuvant treatment based on Prosigna® test result. Out of the patients with clinical indication for adjuvant chemotherapy, 52% (n = 118) could avoid treatment based on results from Prosigna® test. On the contrary, 23% (n = 30) of the patients with no indication were escalated to receive adjuvant chemotherapy after testing. Ki67 could not distinguish between the Prosigna® risk groups or intrinsic subtypes and did not significantly differ between patients in which decision for adjuvant therapy was changed based on the test results. In conclusion, we report the first real-world data from implementation of gene-expression-based risk assessment in a Swedish context, which may facilitate the optimization of future versions of the national guidelines.
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Affiliation(s)
- Una Kjällquist
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Breast Center, Theme Cancer, Karolinska University Hospital, Solna, 17167 Stockholm, Sweden
| | - Balazs Acs
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Sara Margolin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden;
- Department of Oncology, Södersjukhuset, 11828 Stockholm, Sweden
| | - Emelie Karlsson
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
| | - Luisa Edman Kessler
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Breast Center, Capio St:Göran’s Hospital, 11235 Stockholm, Sweden;
| | | | - Maria Ekholm
- Department of Oncology, Jönköping County, 55185 Jönköping, Sweden; (M.E.); (C.L.)
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Christine Lundgren
- Department of Oncology, Jönköping County, 55185 Jönköping, Sweden; (M.E.); (C.L.)
- Department of Oncology and Pathology, Institute of Clinical Sciences, Lund University, 22184 Lund, Sweden
| | - Erik Olsson
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden; (E.O.); (H.L.)
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden; (E.O.); (H.L.)
| | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Breast Center, Theme Cancer, Karolinska University Hospital, Solna, 17167 Stockholm, Sweden
| | - Alexios Matikas
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Breast Center, Theme Cancer, Karolinska University Hospital, Solna, 17167 Stockholm, Sweden
| | - Johan Hartman
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 17176 Stockholm, Sweden
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Leinert E, Schwentner L, Janni W, Wöckel A, Herbert SL, Herr D, Kühn T, Flock F, Felberbaum R, Kreienberg R, Fink V, Dayan D, Ernst K, Singer S. Outcome analysis of primary breast cancer patients who declined adjuvant chemotherapy-results from the prospective multi-center BRENDA II study. Breast Cancer 2022; 29:429-436. [PMID: 35178667 PMCID: PMC9021155 DOI: 10.1007/s12282-021-01321-1] [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: 05/31/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND This study examined 5-year overall, recurrence and distant metastasis-free survival (OS, RFS, MFS) of high- and intermediate-risk breast cancer (BC) patients who declined guideline-recommended adjuvant chemotherapy (CHT). METHODS In the prospective multicenter cohort study BRENDA II, patients with primary BC were sampled over a period of four years (2009-2012). A multi-professional team (tumorboard) discussed recommendation for adjuvant CHT according to the German guideline. Potential differences in 5 year survival were analyzed using Kaplan-Meier curves and Cox regression. The hazard ratios (HR) were adjusted for age, Charlson Comorbidity Score, American Society of Anesthesiologist (ASA) physical status classification, and endocrine therapy. RESULTS A total of 759 patients were enrolled of which 688 could receive CHT according to the guidelines (n = 219 had a clear indication, in n = 304 it was possible). For 360 patients, the tumorboard advised to perform CHT, for 304 it advised against and in 24 cases, no decision was documented. Of those with a positive suggestion, 83% received CHT. Until 5 years after diagnosis, 57 patients were deceased, 41 had at least one distant metastasis and 29 a recurrence. There was no evidence for differences in OS and MFS in patients who declined CHT despite tumorboard recommendation (HR 3.5, 95% CI 0.8-15.1 for OS, HR 1.9, 95% 0.6-6.6 for MFS). Patients who received CHT had significantly better 5-year RFS compared to those who declined (HR 0.3, 95% CI 0.1-0.9, p = 0.03). There was no evidence for different survival in those who had no CHT because of comorbidity and those who declined actively, neither for OS, MFS nor RFS. CONCLUSION The prospective BRENDA II study demonstrates benefit in RFS by guideline adherence in adjuvant breast cancer treatment, indicating prospectively the value of internationally validated guidelines in breast cancer care.
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Affiliation(s)
- Elena Leinert
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
| | - Lukas Schwentner
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Achim Wöckel
- Department of Gynaecology and Obstetrics, University of Würzburg, Würzburg, Germany
| | - Saskia-L Herbert
- Department of Gynaecology and Obstetrics, University of Würzburg, Würzburg, Germany
| | - Daniel Herr
- Department of Gynaecology and Obstetrics, University of Würzburg, Würzburg, Germany
| | - Thorsten Kühn
- Department of Gynaecology and Obstetrics, Hospital Esslingen, Esslingen, Germany
| | - Felix Flock
- Department of Gynaecology and Obstetrics, Hospital Memmingen, Memmingen, Germany
| | - Ricardo Felberbaum
- Department of Gynaecology and Obstetrics, Hospital Kempten, Kempten, Germany
| | - Rolf Kreienberg
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Visnja Fink
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Davut Dayan
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Kristina Ernst
- Department of Gynaecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
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Immediate Skin Replacement Allows for Nipple-sparing, Direct-to-implant Reconstruction in Patients with Advanced Breast Cancers. Plast Reconstr Surg Glob Open 2022; 10:e4098. [PMID: 35186640 PMCID: PMC8846285 DOI: 10.1097/gox.0000000000004098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
Mastectomy has evolved from approaches that involved extensive skin resection to nipple-sparing mastectomy (NSM). However, patients with advanced breast cancers who require extensive skin resection usually also have their nipple areola complexes (NACs) removed, even if they are distant from the cancer. Implant reconstruction in these patients is challenging as they require tissue expansion and, typically, radiotherapy with additional surgeries to complete their reconstruction. The aesthetic results of this approach are inferior to NSM and direct-to-implant reconstruction. In patients who require significant skin resection but whose NACs are free of tumor, we have found that immediate skin replacement using a muscle-sparing latissimus dorsi flap allows for NSM and direct-to-implant reconstruction, obviating the need for tissue expansion, delayed implant placement, and NAC reconstruction. Here, we report on 12 patients in whom this approach is utilized.
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12
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Cancer Grade Model: a multi-gene machine learning-based risk classification for improving prognosis in breast cancer. Br J Cancer 2021; 125:748-758. [PMID: 34131308 PMCID: PMC8405688 DOI: 10.1038/s41416-021-01455-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/29/2021] [Accepted: 05/28/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Prognostic stratification of breast cancers remains a challenge to improve clinical decision making. We employ machine learning on breast cancer transcriptomics from multiple studies to link the expression of specific genes to histological grade and classify tumours into a more or less aggressive prognostic type. MATERIALS AND METHODS Microarray data of 5031 untreated breast tumours spanning 33 published datasets and corresponding clinical data were integrated. A machine learning model based on gradient boosted trees was trained on histological grade-1 and grade-3 samples. The resulting predictive model (Cancer Grade Model, CGM) was applied on samples of grade-2 and unknown-grade (3029) for prognostic risk classification. RESULTS A 70-gene signature for assessing clinical risk was identified and was shown to be 90% accurate when tested on known histological-grade samples. The predictive framework was validated through survival analysis and showed robust prognostic performance. CGM was cross-referenced with existing genomic tests and demonstrated the competitive predictive power of tumour risk. CONCLUSIONS CGM is able to classify tumours into better-defined prognostic categories without employing information on tumour size, stage, or subgroups. The model offers means to improve prognosis and support the clinical decision and precision treatments, thereby potentially contributing to preventing underdiagnosis of high-risk tumours and minimising over-treatment of low-risk disease.
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13
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Gagnet S, Diorio C, Provencher L, Mbuya-Bienge C, Lapointe J, Morin C, Lemieux J, Nabi H. Identifying Clinicopathological Factors Associated with Oncotype DX ® 21-Gene Recurrence Score: A Real-World Retrospective Cohort Study of Breast Cancer Patients in Quebec City, Canada. J Pers Med 2021; 11:858. [PMID: 34575635 PMCID: PMC8471231 DOI: 10.3390/jpm11090858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/26/2021] [Indexed: 12/22/2022] Open
Abstract
Gene expression profiling tests such as the Oncotype DX (ODX) 21-gene recurrence score (RS) assay is increasingly used in clinical practice to predict the risk of recurrence and support treatment planning for early-stage breast cancer (BC). However, this test has some disadvantages such as a high cost and a long turnaround time to get results, which may lead to disparities in access. We aim to identify clinicopathological factors associated with ODX RS in women with early-stage BC. We conducted a retrospective cohort study of women identified in the medical database of the Deschênes-Fabia Breast Disease Center of Quebec City University, Canada. Our sample consists of 425 women diagnosed with early-stage BC who have obtained an ODX RS between January 2011 and April 2015. The ODX RS has been categorized into three levels as originally defined: low (0-17), intermediate (18-30), and high (>30). The mean RS was 17.8 (SD = 9.2). Univariate analyses and multinomial logistic regressions were performed to identify factors associated with intermediate and high RS compared with low RS. A total of 237 (55.8%) patients had low RS, 148 (34.8%) had intermediate RS, and 40 (9.4%) had high RS. Women with progesterone receptor (PR)-negative (ORs ranging from 3.51 to 10.34) and histologic grade II (ORs ranging from 3.16 to 23.04) tumors were consistently more likely to have intermediate or high RS than low RS. Similar patterns of associations were observed when the RS was categorised using redefined thresholds from (i.e., from the TAILORx study or dichotomized). This study provides evidence suggesting that histologic grade and PR status are predictive factors for intermediate or high RS in women with early-stage BC. If these results are confirmed in future studies, considering these clinicopathological factors could spare women the need to get such a test before the beginning of a possible adjuvant therapy. This option could be considered in settings where the cost of testing is an issue.
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Affiliation(s)
- Simon Gagnet
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
| | - Caroline Diorio
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche sur le Cancer, Université Laval, Québec, QC G1V 0A6, Canada
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Université Laval, Québec, QC G1S 4L8, Canada;
| | - Louise Provencher
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Université Laval, Québec, QC G1S 4L8, Canada;
| | - Cynthia Mbuya-Bienge
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Julie Lapointe
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
| | - Claudya Morin
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Université Laval, Québec, QC G1S 4L8, Canada;
| | - Julie Lemieux
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Centre des Maladies du Sein Deschênes-Fabia, CHU de Québec-Université Laval, Québec, QC G1S 4L8, Canada;
| | - Hermann Nabi
- Axe Oncologie, Centre de Recherche du CHU de Québec-Université Laval, Québec, QC G1R 3S3, Canada; (S.G.); (C.D.); (L.P.); (C.M.-B.); (J.L.); (J.L.)
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
- Centre de Recherche sur le Cancer, Université Laval, Québec, QC G1V 0A6, Canada
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Kuo WL, Tseng LL, Chang CC, Chen CJ, Cheng ML, Cheng HH, Wu MJ, Chen YL, Chang RT, Tang HY, Hsu YC, Lin WJ, Kao CY, Hsieh WP, Kung HJ, Wang WC. Prognostic Significance of O-GlcNAc and PKM2 in Hormone Receptor-Positive and HER2-Nonenriched Breast Cancer. Diagnostics (Basel) 2021; 11:diagnostics11081460. [PMID: 34441396 PMCID: PMC8392504 DOI: 10.3390/diagnostics11081460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022] Open
Abstract
Predictive metabolic biomarkers for the recurrent luminal breast cancer (BC) with hormone receptor (HR)-positive and human epidermal growth factor receptor type 2 (HER2)-negative are lacking. High levels of O-GlcNAcylation (O-GlcNAc) and pyruvate kinase isoenzyme M2 (PKM2) are associated with malignancy in BC; however, the association with the recurrence risk remains unclear. We first conduct survival analysis by using the METABRIC dataset to assess the correlation of PKM2 expression with BC clinical outcomes. Next, patients with HR+/HER2- luminal BC were recruited for PKM2/O-GlcNAc testing. Logistic regression and receiver operating characteristic curve analysis were performed to evaluate the 10-year DFS predicted outcome. Survival analysis of the METABRIC dataset revealed that high expression of PKM2 was significantly associated with worse overall survival in luminal BC. The high expression of O-GlcNAc or PKM2 was a significant independent marker for poor 10-year DFS using immunohistochemical analysis. The PKM2 or O-GlcNAc status was a significant predictor of DFS, with the combination of PKM2–O-GlcNAc status and T stage greatly enhancing the predictive outcome potential. In summary, O-GlcNAc, PKM2, and T stage serve as good prognostic discriminators in HR+/HER2− luminal BC.
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Affiliation(s)
- Wen-Ling Kuo
- Division of Breast Surgery, General Surgery, Department of Surgery, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City 33305, Taiwan;
| | - Lin-Lu Tseng
- Institute of Molecular and Cellular Biology and Department of Life Sciences, National Tsing-Hua University, Hsinchu City 30013, Taiwan; (L.-L.T.); (H.-H.C.); (M.-J.W.); (Y.-L.C.)
| | - Che-Chang Chang
- The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei City 11031, Taiwan; (C.-C.C.); (R.-T.C.)
| | - Chih-Jung Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (C.-J.C.); (Y.-C.H.)
- School of Medicine, Chung Shan Medical University, Taichung City 40201, Taiwan
| | - Mei-Ling Cheng
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan;
- Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan City 33302, Taiwan;
| | - Hsin-Hung Cheng
- Institute of Molecular and Cellular Biology and Department of Life Sciences, National Tsing-Hua University, Hsinchu City 30013, Taiwan; (L.-L.T.); (H.-H.C.); (M.-J.W.); (Y.-L.C.)
| | - Meng-Jen Wu
- Institute of Molecular and Cellular Biology and Department of Life Sciences, National Tsing-Hua University, Hsinchu City 30013, Taiwan; (L.-L.T.); (H.-H.C.); (M.-J.W.); (Y.-L.C.)
| | - Yu-Lun Chen
- Institute of Molecular and Cellular Biology and Department of Life Sciences, National Tsing-Hua University, Hsinchu City 30013, Taiwan; (L.-L.T.); (H.-H.C.); (M.-J.W.); (Y.-L.C.)
| | - Ruei-Ting Chang
- The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei City 11031, Taiwan; (C.-C.C.); (R.-T.C.)
| | - Hsiang-Yu Tang
- Metabolomics Core Laboratory, Healthy Aging Research Center, Chang Gung University, Taoyuan City 33302, Taiwan;
| | - Yong-Chen Hsu
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (C.-J.C.); (Y.-C.H.)
| | - Wen-Jye Lin
- Immunology Research Center, National Health Research Institutes, Miaoli County 35053, Taiwan; (W.-J.L.); (C.-Y.K.)
| | - Cheng-Yuan Kao
- Immunology Research Center, National Health Research Institutes, Miaoli County 35053, Taiwan; (W.-J.L.); (C.-Y.K.)
| | - Wen-Ping Hsieh
- Institute of Statistics, National Tsing Hua University, Hsinchu City 30013, Taiwan;
| | - Hsing-Jien Kung
- Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei City 11031, Taiwan;
- Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine, University of California Davis Cancer Centre, Sacramento, CA 95817, USA
| | - Wen-Ching Wang
- Institute of Molecular and Cellular Biology and Department of Life Sciences, National Tsing-Hua University, Hsinchu City 30013, Taiwan; (L.-L.T.); (H.-H.C.); (M.-J.W.); (Y.-L.C.)
- Correspondence: ; Tel.: +886-35742766
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15
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The Influence of Hormone Therapy on secondary diabetes mellitus in Breast Cancer: A Meta-analysis. Clin Breast Cancer 2021; 22:e48-e58. [PMID: 34429242 DOI: 10.1016/j.clbc.2021.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 04/13/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Growing evidences have implied that patients with primary breast cancer (BC) were at increased risks of developing diabetes mellitus (DM). However, as a major adjuvant treatment, the influence of hormone therapy (HT) on secondary DM in primary BC remains controversial; we conducted a meta-analysis of existing studies to evaluate the association of hormone therapy and secondary DM. METHODS We searched online databases (PubMed, EMBASE, the Cochrane library, Scopus, and Google Scholar) for studies exploring the influence of hormone therapy on secondary DM in BC. The summarized effect sizes (ES) and 95% confidence interval (95% CI) are calculated by STATA software utilizing fixed-effect or random-effect models, depending on the heterogeneity of the eligible studies. RESULTS Ultimately, 7 retrospective publications including a total of 44,524 primary BC patients are eligible in present meta-analysis. HT use significantly increased the risk of developing DM in primary BC patients, whenever compared with NON-HT BC patients (pooled adjusted HR 1.30, 95% CI: 1.19-1.43) or NORMAL participants (HR 1.19, 95% CI: 1.14-1.25). As to specific HT medications, our sub-analysis demonstrates the risk for DM in tamoxifen (TAM) users elevates by 30% than NON-TAM use BC patients (pooled HR 1.30, 95% CI: 1.20-1.40) and by 18% than NORMAL participants (pooled HR 1.18, 95% CI: 1.12-1.24). However, for aromatase inhibitors (AIs) users, the risks for DM do not elevate significantly. Funnel plots and Egger's tests are used to evaluate publication bias and no apparent bias is detected in all analysis. CONCLUSION The present study is the first meta-analysis which thoroughly reveals that adjuvant HT is a risk factor of secondary DM in primary female BC patients. As to specific HT medications, TAM use significantly enhances the incidence of secondary DM, while AIs use does not influence the DM incidence significantly. Our results can help clinicians to tailor more appropriate strategies for the therapy and follow-up of primary BC patients.
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16
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Prognostic Cancer Gene Expression Signatures: Current Status and Challenges. Cells 2021; 10:cells10030648. [PMID: 33804045 PMCID: PMC8000474 DOI: 10.3390/cells10030648] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/27/2022] Open
Abstract
Current staging systems of cancer are mainly based on the anatomical extent of disease. They need refinement by biological parameters to improve stratification of patients for tumor therapy or surveillance strategies. Thanks to developments in genomic, transcriptomic, and big-data technologies, we are now able to explore molecular characteristics of tumors in detail and determine their clinical relevance. This has led to numerous prognostic and predictive gene expression signatures that have the potential to establish a classification of tumor subgroups by biological determinants. However, only a few gene signatures have reached the stage of clinical implementation so far. In this review article, we summarize the current status, and present and future challenges of prognostic gene signatures in three relevant cancer entities: breast cancer, colorectal cancer, and hepatocellular carcinoma.
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Bou Zerdan M, Ibrahim M, El Nakib C, Hajjar R, Assi HI. Genomic Assays in Node Positive Breast Cancer Patients: A Review. Front Oncol 2021; 10:609100. [PMID: 33665165 PMCID: PMC7921691 DOI: 10.3389/fonc.2020.609100] [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: 09/22/2020] [Accepted: 12/30/2020] [Indexed: 01/16/2023] Open
Abstract
In recent years, developments in breast cancer have allowed yet another realization of individualized medicine in the field of oncology. One of these advances is genomic assays, which are considered elements of standard clinical practice in the management of breast cancer. These assays are widely used today not only to measure recurrence risk in breast cancer patients at an early stage but also to tailor treatment as well and minimize avoidable treatment side effects. At present, genomic tests are applied extensively in node negative disease. In this article, we review the use of these tests in node positive disease, explore their ramifications on neoadjuvant chemotherapy decisions, highlight sufficiently powered recent studies emphasizing their use and review the most recent guidelines.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maryam Ibrahim
- Division of Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Clara El Nakib
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Hajjar
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hazem I. Assi
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
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18
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Zhu X, Dent S, Paquet L, Zhang T, Tesolin D, Graham N, Aseyev O, Song X. How Canadian Oncologists Use Oncotype DX for Treatment of Breast Cancer Patients. ACTA ACUST UNITED AC 2021; 28:800-812. [PMID: 33557029 PMCID: PMC7985759 DOI: 10.3390/curroncol28010077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/20/2022]
Abstract
Background: The literature suggests that medical oncologists differ on how they use the Oncotype DX (ODX) genomic assay for making decisions about systemic therapy in breast cancer patients. Given the emergence of data supporting the use of genomic profiling for the prognosis and predicting benefit of chemotherapy, we surveyed medical oncologists in Canada to assess their usage and perception of the ODX assay. Methods: A 34-item survey was distributed to Canadian medical oncologists via the Canadian Association of Medical Oncologists. Data was collected on physician demographics, ODX usage patterns, and physicians’ perception of the impact clinical and pathologic characteristics make on ODX utilization. Results: Response rate was 20.6% with 47 responses received from 228 survey sent. Forty-five responses were eligible for analysis. Sixty-two percent (28/45) of respondents treated predominantly breast cancer, and 60% (27/45) have been in practice for at least 10 years. The most cited reason for using ODX was to avoid giving patients unnecessary chemotherapy (64%; 29/45). Sixty-seven percent (30/45) deferred making treatment decisions until ODX testing was completed. Factors most strongly impacting ODX utilization included: patient request, medical comorbidities and tumor grade. In clinical scenarios, ODX was more frequently selected for patients aged 40–65 (vs. <40 or >65), grade 2 tumors (vs. grade 1 or 3), and Ki-67 index of 10–20% (vs. <10% or >20%). Conclusions: This survey demonstrated that Canadian medical oncologists are preferentially using ODX to avoid giving patients unnecessary chemotherapy. The utilization of ODX is mainly in patients with intermediate clinical and pathologic features.
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Affiliation(s)
- Xiaofu Zhu
- The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (X.Z.); (S.D.); (N.G.); (X.S.)
| | - Susan Dent
- The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (X.Z.); (S.D.); (N.G.); (X.S.)
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
| | - Lise Paquet
- Department of Psychology, Carleton University, Ottawa, ON K1S 5B6, Canada;
| | - Tinghua Zhang
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada;
| | - Daniel Tesolin
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON P3E 2C6, Canada;
| | - Nadine Graham
- The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (X.Z.); (S.D.); (N.G.); (X.S.)
| | - Olexiy Aseyev
- Regional Cancer Care Northwest, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON P7B 6V4, Canada
- Correspondence:
| | - Xinni Song
- The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (X.Z.); (S.D.); (N.G.); (X.S.)
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Sengupta AK, Gunda A, Malpani S, Serkad CPV, Basavaraj C, Bapat A, Bakre MM. Comparison of breast cancer prognostic tests CanAssist Breast and Oncotype DX. Cancer Med 2020; 9:7810-7818. [PMID: 33027559 PMCID: PMC7643688 DOI: 10.1002/cam4.3495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/08/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND CanAssist Breast (CAB) is a prognostic test for early stage hormone receptor-positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) breast cancer patients, validated on Indian and Caucasian patients. The 21-gene signature Oncotype DX (ODX) is the most widely used commercially available breast cancer prognostic test. In the current study, risk stratification of CAB is compared with that done with ODX along with the respective outcomes of these patients. METHODS A cohort of 109 early stage breast cancer patients who had previously taken the ODX test were retested with CAB, and the results respectively compared with old cut-offs of ODX as well as cut-offs suggested by TAILORx, a prospective randomized trial of ODX. Distant metastasis-free survival after 5 years was taken as the end point. RESULTS CanAssist Breast stratified 83.5% of the cohort into low-risk and 16.5% into high-risk. With the TAILORx cut-offs, ODX stratified the cohort into 89.9% low-risk and 10.1% into high-risk. The low, intermediate, and high-risk groups with ODX old cut-offs were 62.4%, 31.2%, and 6.4%, respectively. The overall concordance of CAB with ODX using both cut-offs is 75%-76%, with ~82%-83% concordance in the low-risk category of these tests. The NPV of the low-risk category of CAB was 93.4%, and of ODX with TAILORx cut-offs was 91.8% and 89.7% with old cut-offs. CONCLUSIONS Compared to the concordance reported for other tests, CAB shows high concordance with ODX, and in addition shows comparable performance in the patient outcomes in this cohort. CAB is thus an excellent and cost-effective alternative to ODX.
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20
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Shaker H, Mahate Z, Dabritz G, Absar MS. Axillary Clearance Following Positive Sentinel Lymph Node Biopsy in Symptomatic Breast Cancer. In Vivo 2020; 34:3503-3509. [PMID: 33144460 PMCID: PMC7811626 DOI: 10.21873/invivo.12191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM Symptomatic cancers display a different biological behaviour from screen-detected cancers, which may impact the management of axillary metastases. We aimed to determine the role of unselected axillary nodal clearance (ANC) in symptomatic patients with positive sentinel node biopsies (SNBs). PATIENTS AND METHODS A case-note review was performed on 95 symptomatic breast cancer patients who underwent ANC following positive SNB. RESULTS Thirty-eight (40%) patients were treated with a mastectomy and 57 (60%) with breast-conserving surgery. At ANC, 25 patients (26.3%) showed evidence of further lymph node metastases, with 15 (60%) having two or fewer macrometastases. The presence of more than 2 SNB macrometastases was associated with further ANC metastases (p<0.001). The presence of further metastases at ANC was not associated with either reduced overall survival or disease-free survival. CONCLUSION A number of symptomatic breast cancer patients with positive SNBs may be overtreated. Ongoing trials examining the management of low volume SNB macrometastases need to consider the symptomatic subgroup in their conclusions.
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Affiliation(s)
- Hudhaifah Shaker
- Department of Breast Surgery, Pennine Acute Hospitals NHS Trust, Manchester, U.K
| | - Zeinab Mahate
- Department of Breast Surgery, Pennine Acute Hospitals NHS Trust, Manchester, U.K
| | - Grit Dabritz
- Department of Breast Surgery, Pennine Acute Hospitals NHS Trust, Manchester, U.K
| | - Mohammed S Absar
- Department of Breast Surgery, Pennine Acute Hospitals NHS Trust, Manchester, U.K.
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Weiser R, Haque W, Polychronopoulou E, Hatch SS, Kuo YF, Gradishar WJ, Klimberg VS. The 21-gene recurrence score in node-positive, hormone receptor-positive, HER2-negative breast cancer: a cautionary tale from an NCDB analysis. Breast Cancer Res Treat 2020; 185:667-676. [PMID: 33070279 DOI: 10.1007/s10549-020-05971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The 21-gene recurrence score assay (RS) has not been prospectively validated to predict adjuvant chemotherapy benefit in hormone receptor-positive (HR+), HER2-negative (HER2-), node-positive breast cancer patients. Nevertheless, de-escalation based on RS has been demonstrated and partially advocated by retrospective data. The purpose of this study was to identify subgroups of node-positive patients with low to intermediate RS who still benefit from adjuvant chemotherapy. METHODS The National Cancer Database was used to identify 28,591 women with stage I-III, T1-T3, N1, HR+, HER2- breast cancer and a RS ≤ 25 between 2010 and 2016. Univariate and multivariate analyses were used to identify variables correlating with chemotherapy use and 5-year survival. Subgroup analysis was performed to discern patients in whom the use of adjuvant chemotherapy correlated with better survival. RESULTS A 35% decline in chemotherapy use was observed from 2010 to 2016. Patients with younger age, higher RS, larger tumors and more positive lymph nodes, and those treated by mastectomy, axillary lymph node dissection and radiation, were more likely to receive chemotherapy. Chemotherapy use was associated with an improved 5-year survival (HR = 1.63, 95% CI 1.28-2.07). Upon subgroup analysis, this association was lost in patients > 70 years and those with a RS ≤ 11, while patients ≤ 70 with a RS of 12-25 treated with chemotherapy had an absolute 5-year survival advantage of 3.0% (HR = 1.91, 95% CI 1.42-2.57). CONCLUSION Clinicians should be cautious when considering omission of adjuvant chemotherapy in patients ≤ 70 years, with HR+, HER2-, N1 tumors and a RS 12-25, at least until the results of the anticipated RxPONDER trial become available.
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Affiliation(s)
- Roi Weiser
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Efstathia Polychronopoulou
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Sandra S Hatch
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - William J Gradishar
- Department of Medicine & Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - V Suzanne Klimberg
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.
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22
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Song Y, Zhang M, Lu MM, Qu LY, Xu SG, Li YZ, Wang MY, Zhu HF, Zhang ZY, He GY, Yuan ZQ, Li N. EPAS1 targeting by miR-152-3p in Paclitaxel-resistant Breast Cancer. J Cancer 2020; 11:5822-5830. [PMID: 32913475 PMCID: PMC7477434 DOI: 10.7150/jca.46898] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/09/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Paclitaxel plays a pivotal role in the chemotherapy of breast cancer, but resistance to this drug is an important obstacle in the treatment. It is reported that microRNA-152-3p (miR-152-3p) is involved in tamoxifen resistance in breast cancer, but whether it is involved in paclitaxel resistance in breast cancer remains unknown. Materials and methods: We examined the expression of miR-152-3p in breast cancer tissues and cells by qRT-PCR. After transfecting paclitaxel-resistant MCF-7/TAX cells with miR-152-3p mimics, we analyzed the function of miR-152-3p in these cells by MTT assay and flow cytometry. We screened the target gene, endothelial PAS domain-containing protein 1 (EPAS1), using bioinformatics analysis and verified it with the dual luciferase reporter gene experiment. The relationship between EPAS1 and miR-152-3p and their roles in paclitaxel resistance of breast cancer were further investigated using RNA interference and transfection techniques. Results: The expression of miR-152-3p in normal breast tissues and cells was markedly higher than that in breast cancer. Overexpression of miR-152-3p decreased the survival rate and increased the apoptosis rate and sensitivity of MCF-7/TAX cells to paclitaxel. We confirmed that EPAS1 is the target of miR-152-3p and is negatively regulated by this miRNA. Moreover, transfection with EPAS1 siRNA enhanced the susceptibility and apoptosis rate of MCF-7/TAX cells to paclitaxel. Co-transfection of miR-152-3p mimics and EPAS1 increased paclitaxel sensitivity and apoptosis induced by the drug. Conclusion: miR-152-3p inhibits the survival of MCF-7/TAX cells and promotes their apoptosis by targeting the expression of EPAS1, thereby, enhancing the sensitivity of these breast cancer cells to paclitaxel.
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Affiliation(s)
- Ying Song
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Mo Zhang
- Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Man Man Lu
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Li Yuan Qu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Si Guang Xu
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Yong Zhen Li
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Ming Yong Wang
- School of Laboratory Medicine, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
- Xinxiang Key Laboratory of Immunoregulation and Molecular Diagnostics, Xinxiang, Henan 453003, P.R. China
| | - Hui Fang Zhu
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Zhe Ying Zhang
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Guo Yang He
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Zhi Qing Yuan
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Na Li
- Department of Pathology, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
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23
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Jones B, Thomas G, Westreich J, Nofech-Mozes S, Vitkin A, Khorasani M. Novel quantitative signature of tumor stromal architecture: polarized light imaging differentiates between myxoid and sclerotic human breast cancer stroma. BIOMEDICAL OPTICS EXPRESS 2020; 11:3246-3262. [PMID: 32637252 PMCID: PMC7316019 DOI: 10.1364/boe.392722] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 05/02/2023]
Abstract
As a leading cause of death in women, breast cancer is a global health concern for which personalized therapy remains largely unrealized, resulting in over- or under-treatment. Recently, tumor stroma has been shown to carry important prognostic information, both in its relative abundance and morphology, but its current assessment methods are few and suboptimal. Herein, we present a novel stromal architecture signature (SAS) methodology based on polarized light imaging that quantifies patterns of tumor connective tissue. We demonstrate its ability to differentiate between myxoid and sclerotic stroma, two pathology-derived categories associated with significantly different patient outcomes. The results demonstrate a 97% sensitivity and 88% specificity for myxoid stroma identification in a pilot study of 102 regions of interest from human invasive ductal carcinoma breast cancer surgical specimens (20 patients). Additionally, the SAS numerical score is indicative of the wide range of stromal characteristics within these binary classes and highlights ambiguous mixed-morphology regions prone to misclassification. The enabling polarized light microscopy technique is inexpensive, fast, fully automatable, applicable to fresh or embedded tissue without the need for staining and thus potentially translatable into research and/or clinical settings. The SAS metric yields quantifiable and objective stromal characterization with promise for prognosis in many types of cancers beyond breast carcinoma, enabling researchers and clinicians to further investigate the emerging and important role of stromal architectural patterns in solid tumors.
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Affiliation(s)
- Blake Jones
- Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, ON M5G 1L7, Canada
- Authors contributed equally
| | - Georgia Thomas
- Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, ON M5G 1L7, Canada
- Authors contributed equally
| | - Jared Westreich
- Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, ON M5G 1L7, Canada
| | - Sharon Nofech-Mozes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8, Canada
| | - Alex Vitkin
- Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, ON M5G 1L7, Canada
- Division of Biophysics and Bioimaging, Princess Margaret Cancer Center, University Health Network, 610 University Ave, Toronto, ON M5G 2C1, Canada
- Department of Radiation Oncology, University of Toronto, Stewart building, 149 College St Suite 504, Toronto, ON M5 T 1P5, Canada
- Co-senior authors
| | - Mohammadali Khorasani
- Department of Surgical Oncology, University of Toronto, Princess Margaret Cancer Center, OPG Wing, 6th floor, 610 University Avenue Toronto, ON M5G 2M9, Canada
- Co-senior authors
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24
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Bhattacharyya GS, Doval DC, Desai CJ, Chaturvedi H, Sharma S, Somashekhar S. Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective. JCO Glob Oncol 2020; 6:789-798. [PMID: 32511068 PMCID: PMC7328098 DOI: 10.1200/go.20.00033] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
The prevalence and mortality of breast cancer is increasing in Asian countries, including India. With advances in medical technology leading to better detection and characterization of the disease, it has been possible to classify breast cancer into various subtypes using markers, which helps predict the risk of distant recurrence, response to therapy, and prognosis using a combination of molecular and clinical parameters. Breast cancer and its therapy, mainly surgery, systemic therapy (anticancer chemotherapy, hormonal therapy, targeted therapy, and immunotherapy), and radiation therapy, are associated with significant adverse influences on physical and mental health, quality of life, and the economic status of the patient and her family. The fear of recurrence and its devastating effects often leads to overtreatment, with a toxic cost to the patient financially and physically in cases in which this is not required. This article discusses some aspects of a breast cancer diagnosis and its impact on the various facets of the life of the patient and her family. It further elucidates the role of prognostic factors, the currently available biomarkers and prognostic signatures, and the importance of ethnically validating biomarkers and prognostic signatures.
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Affiliation(s)
| | - Dinesh C. Doval
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Chirag J. Desai
- Vedanta Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | | | - Sanjay Sharma
- Asian Cancer Institute, Somaiya Ayurvihar, Mumbai, Maharashtra, India
| | - S.P. Somashekhar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
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25
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Cho WCS, Chan LWC, Wong CSC. Editorial: Role of RNA in Molecular Diagnostics of Cancer. Front Genet 2020; 11:435. [PMID: 32435261 PMCID: PMC7218120 DOI: 10.3389/fgene.2020.00435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/08/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- William C S Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Lawrence W C Chan
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, Hong kong Polytechnic University, Hong Kong, China
| | - Cesar S C Wong
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, Hong kong Polytechnic University, Hong Kong, China
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26
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Zerdes I, Sifakis EG, Matikas A, Chrétien S, Tobin NP, Hartman J, Rassidakis GZ, Bergh J, Foukakis T. Programmed death-ligand 1 gene expression is a prognostic marker in early breast cancer and provides additional prognostic value to 21-gene and 70-gene signatures in estrogen receptor-positive disease. Mol Oncol 2020; 14:951-963. [PMID: 32115850 PMCID: PMC7191187 DOI: 10.1002/1878-0261.12654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/04/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
Gene and protein expression of programmed death‐ligand 1 (PD‐L1) are prognostic in early breast cancer (BC), but their prognostic information is inconsistent at least in some biological subgroups. The validated prognostic gene signatures (GS) in BC are mainly based on proliferation and estrogen receptor (ER)‐related genes. Here, we aimed to explore the prognostic capacity of PD‐L1 expression at the protein vs mRNA levels and to investigate the prognostic information that PD‐L1 can potentially add to routinely used GS. Gene expression data were derived from two early BC cohorts (cohort 1: 562 patients; cohort 2: 1081 patients). Tissue microarrays from cohort 1 were immunohistochemically (IHC) stained for PD‐L1 using the SP263 clone. GS scores (21‐gene, 70‐gene) were calculated, and likelihood‐ratio (LR) tests and concordance indices were used to evaluate the additional prognostic information for each signature. The immune cell composition was also evaluated using the CIBERSORT in silico tool. PD‐L1 gene and protein expressions were independently associated with better prognosis. In ER+/HER2− patients, PD‐L1 gene expression provided significant additional prognostic information beyond that of both 21‐GS [LR‐Δχ2 = 15.289 and LR‐Δχ2 = 8.812, P < 0.01 for distant metastasis‐free interval (DMFI) in cohorts 1 and 2, respectively] and 70‐GS score alone (LR‐Δχ2 = 18.198 and LR‐Δχ2 = 8.467, P < 0.01 for DMFI in cohorts 1 and 2, respectively). PD‐L1 expression was correlated with IHC‐determined CD3+ cells (r = 0.41, P < 0.001) and with CD8+ (r = 0.62, P < 0.001) and CD4+ memory activated (r = 0.66, P < 0.001) but not with memory resting (r = −0.063, P = 0.14) or regulatory (r = −0.12, P < 0.01) T cells in silico. PD‐L1 gene expression represents a promising favorable prognostic marker and can provide additional prognostic value to 21‐ and 70‐gene scores in ER+/HER2− BC.
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Affiliation(s)
- Ioannis Zerdes
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Alexios Matikas
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Sebastian Chrétien
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Nicholas P Tobin
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Johan Hartman
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - George Z Rassidakis
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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