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Zhao J, Xiao C. Oncologic Safety of One-Stage Implant-Based Breast Reconstruction in Breast Cancer Patients With Positive Sentinel Lymph Nodes: A Single-Center Retrospective Study Using Propensity Score Matching. Clin Breast Cancer 2024; 24:e1-e8. [PMID: 37775348 DOI: 10.1016/j.clbc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the oncologic safety of one-stage implant-based breast reconstruction (OIBR) following mastectomy in breast cancer patients with positive sentinel lymph nodes (SLNs). METHODS We collected clinical and pathological data from breast cancer patients with positive SLNs who underwent OIBR or not after mastectomy between January 2015 and December 2018. A total of 194 patients were included, with 130 patients undergoing mastectomy alone (MA) and 64 patients receiving OIBR after mastectomy. The clinical and pathological features, as well as the postoperative oncologic outcomes, of the 2 groups were retrospectively analyzed. Propensity score matching (PSM) was employed to mitigate the effects of data bias and confounding factors. RESULTS The median follow-up time was 66 months for the OIBR group and 64 months for the MA group after PSM. The majority of reconstructive surgeries use an approach of prosthetic implantation (52.0%). This is followed by prosthetic implantation combined with a latissimus dorsi (LD) flap (32.0%), and acellular dermal matrix (ADM)-assisted implant placement (16.0%). During the follow-up period, a local recurrence was observed in 1 case, regional recurrence in 3 cases, and distant metastasis leading to death in 3 cases among the OIBR group patients. No significant difference was found between the OIBR and MA groups in disease-free survival (DFS) (P = .66), distant metastasis-free survival (DMFS) (P = .91), locoregional recurrence-free survival (LRRFS) (P = .44), and overall survival (OS) (P = .57). CONCLUSION OIBR is a safe option for breast cancer patients with positive SLNs and does not negatively impact cancer recurrence or overall survival.
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Affiliation(s)
- Jingjing Zhao
- The First Department of Breast Cancer, Tianjin Medical University, Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Chunhua Xiao
- The First Department of Breast Cancer, Tianjin Medical University, Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
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2
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Demicheli R, Biganzoli E. Clinical Tumor Dormancy. Methods Mol Biol 2024; 2811:1-26. [PMID: 39037646 DOI: 10.1007/978-1-0716-3882-8_1] [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] [Indexed: 07/23/2024]
Abstract
This chapter summarizes clinical evidence on tumor dormancy, with a special focus on our research supporting the role of dormancy both in local and distant recurrence of breast cancer following mastectomy. Starting from these premises, we propose a model of neoplastic development that allows us to elucidate several relevant clinical phenomena, including the mammographic paradox, the significance of ipsilateral breast tumor recurrence after conservative surgery, and the effect of surgeries performed after the removal of the primary. We will discuss the biological implications of the dormancy-based model, which are at odds with Somatic Mutation Theory. We will then review new models, alternatives to the Somatic Mutation Theory, for cancer development, with special emphasis on the Dynamic System Theory and the originality of its conceptual approach. Finally, we will put particular emphasis on the view of cancer development as a tissue-level process. We believe that this will help harmonize the molecular biology research with the new conceptual approach and bridge the knowledge gap on dormancy between bench and bedside.
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Affiliation(s)
- Romano Demicheli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences, IBIC & DSRC, Ospedale "L. Sacco," LITA Campus, Università degli Studi di Milano, Milan, Italy.
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Epidemiology, Department of Biomedical and Clinical Sciences, IBIC & DSRC, Ospedale "L. Sacco," LITA Campus, Università degli Studi di Milano, Milan, Italy
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3
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Guo XY, Sun GY, Wang HM, Liu M, Zhang YJ, Zhang N, Tang Y, Zhao XR, Jing H, Fang H, Wen G, Guo QS, Wu HF, Wang XH, Ma CY, Li YX, Cheng J, Shi M, Wang SL. Effect of postmastectomy radiotherapy on pT 1-2N 1 breast cancer patients with different molecular subtypes. Breast 2021; 61:108-117. [PMID: 34942430 PMCID: PMC8695355 DOI: 10.1016/j.breast.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/28/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To clarify the effect of postmastectomy radiotherapy (PMRT) on pT1-2N1 breast cancer patients with different molecular subtypes. Methods We retrospectively analyzed the data of 5442 patients with pT1-2N1 breast cancer treated using modified radical mastectomy in 11 hospitals in China. Univariate, multivariate, and propensity score matching (PSM) analyses were used to evaluate the effect of PMRT on locoregional recurrence (LRR). Results With a median follow-up duration of 63.8 months, the 5-year LRR rates were 4.0% and 7.7% among patients treated with and without PMRT, respectively (p < 0.001). PMRT was independently associated with reduced LRR after adjustments for confounders (p < 0.001). After grouping the patients according to the molecular subtype of cancer and conducting PSM, we found that the 5-year LRR rates among patients treated with and without PMRT (in that order) were as follows: luminal HER2-negative cancer, 1.9% and 6.5% (p < 0.001); luminal HER2-positive cancer, 3.8% and 13.7% (p = 0.041); HER2-overexpressing cancer, 10.2% and 15.5% (p = 0.236); and triple-negative cancer, 4.6% and 15.9% (p = 0.002). Among patients with HER2-overexpressing and triple-negative cancers, the LRR hazard rate displayed a dominant early peak, and was extremely low after 5 years. However, patients with luminal cancer continued to have a long-lasting high annual LRR hazard rate during follow-up. Conclusion PMRT significantly reduced the LRR risk in patients with pT1-2N1 luminal and triple-negative breast cancers, but had no effect on the LRR risk in patients with HER2-overexpressing cancer. Patients with different molecular subtypes displayed different annual LRR patterns, and the late recurrence of the luminal subtype suggests the necessity of long-term follow-up to evaluate the efficacy of PMRT. PMRT reduces LRR of pT1-2N1 luminal and triple-negative breast cancers. PMRT has no effect on the LRR of HER2-overexpressing breast cancer. Different molecular subtypes display different annual LRR patterns. Late LRR beyond 5 years is observed in luminal breast cancers.
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Affiliation(s)
- Xin-Yuan Guo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Guang-Yi Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Mei Wang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Liu
- Department of Radiation Oncology, First Hospital of Jilin University, Changchun, China
| | - Yu-Jing Zhang
- Department of Radiation Oncology, Sun Yat-sen University Affiliated Tumor Hospital, Guangzhou, China
| | - Na Zhang
- Department of Radiation Oncology, Liaoning Cancer Hospital, Shenyang, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu-Ran Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Wen
- Department of Radiation Oncology, Sun Yat-sen University Affiliated Tumor Hospital, Guangzhou, China; Department of Radiation Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi-Shuai Guo
- Department of Radiation Oncology, Affiliated Cancer Hospital of Chongqing University, Chongqing, China
| | - Hong-Fen Wu
- Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, China
| | - Xiao-Hu Wang
- Department of Radiation Oncology, Gansu Cancer Hospital, Lanzhou, China
| | - Chang-Ying Ma
- Department of Radiation Oncology, Qiqihaer First Hospital, Qiqihaer, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Cheng
- Department of Breast Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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4
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Hammer J, Servaes M, Berners A, Deconinck C, Pirson G, Fosseprez P. Oncologic Safety of Immediate Breast Reconstruction: A Single-Center Retrospective Review of 138 Patients. Ann Plast Surg 2021; 87:623-627. [PMID: 34818286 DOI: 10.1097/sap.0000000000002869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the oncologic safety of mastectomies associated with immediate breast reconstruction (IBR) in terms of recurrence and survival. METHODS A retrospective review was conducted at a single center (CHU UCL Namur, Belgium). We analyzed the oncologic safety of IBR for patients with invasive and in situ breast cancer who underwent mastectomy associated with IBR. Patients who underwent palliative surgery and those with a diagnosis of breast sarcoma were excluded. RESULTS We retrospectively analyzed 138 patients who underwent mastectomy and IBR between January 2012 and December 2019. Most reconstruction procedures used deep inferior epigastric perforator free flaps (55.1%). The reconstructive failure rate was 8.7%. Among the patients included, 5 cases of local cancer recurrence, 1 case of local cancer recurrence associated with distant metastasis, and 2 cases of systemic recurrence were identified during a mean follow-up of 49.3 months (range, 8-104 months) after surgery. Overall survival was 97.8%, and disease-free survival was 94.2%. CONCLUSIONS Patients had a low incidence of cancer recurrence in this review. Immediate breast reconstruction after mastectomy had no negative impact on recurrence or patient survival, even in patients with advanced disease. The study findings suggest that mastectomy associated with IBR can be a safe surgical option for patients with invasive and noninvasive breast cancers. Longer follow-ups are needed to confirm these preliminary results.
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Affiliation(s)
- Jennifer Hammer
- From the Department of Plastic Surgery, CHU UCL Namur, Namur, Belgium
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5
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Sun GY, Jing H, Wang SL, Song YW, Jin J, Fang H, Liu YP, Ren H, Tang Y, Zhao XR, Song YC, Chen SY, Yang ZB, Chen B, Tang Y, Li N, Lu NN, Qi SN, Yang Y, Li YX. Trastuzumab Provides a Comparable Prognosis in Patients With HER2-Positive Breast Cancer to Those With HER2-Negative Breast Cancer: Post Hoc Analyses of a Randomized Controlled Trial of Post-Mastectomy Hypofractionated Radiotherapy. Front Oncol 2021; 10:605750. [PMID: 33575216 PMCID: PMC7871908 DOI: 10.3389/fonc.2020.605750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE We investigated the locoregional effect of trastuzumab, and determined whether patients with human epidermal growth factor receptor (HER)2-positive breast cancer (BC) treated with trastuzumab could achieve comparable efficacy to that of patients with HER2-negative BC. MATERIALS AND METHODS This was post hoc analyses of data of 793 BC patients from a randomized controlled trial comparing post-mastectomy hypofractionated radiotherapy with conventional fractionated radiotherapy. Survival rates were analyzed by the Kaplan-Meier method and compared by the log-rank test. RESULTS Patients were classified into three groups: HER2-negative (HER2-; n = 547), HER2-positve with trastuzumab (HER2+ + T; n = 136), and HER2-positive without trastuzumab (HER2+ - T; n = 110). The HER2+ + T group had significantly lower locoregional recurrence (LRR, 6.0% vs. 13.9%), distant metastasis (DM, 17.4% vs. 33.8%) and higher disease-free survival (DFS, 81.2% vs. 61.9%) at 5 years than that of the HER2+ - T group (P <.05). The HER2- group had significantly lower LRR (6.8% vs. 13.9%), DM (22.4% vs. 33.8%) and higher DFS (76.1% vs. 61.9%) at 5 years than that of the HER2+ - T group (P <.05). The difference in LRR, DM and DFS at 5 years was not significant between the HER2+ + T group and HER2- group (P >.05). Different annual LRR patterns was found among groups according to HR status. CONCLUSION Trastuzumab reduces LRR in patients with locally advanced HER2-positive BC who have received post-mastectomy radiotherapy. It provides comparable DFS to that with patients with HER2-negative BC.
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Affiliation(s)
| | | | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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6
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Riggio AI, Varley KE, Welm AL. The lingering mysteries of metastatic recurrence in breast cancer. Br J Cancer 2021; 124:13-26. [PMID: 33239679 PMCID: PMC7782773 DOI: 10.1038/s41416-020-01161-4] [Citation(s) in RCA: 253] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
Despite being the hallmark of cancer that is responsible for the highest number of deaths, very little is known about the biology of metastasis. Metastatic disease typically manifests after a protracted period of undetectable disease following surgery or systemic therapy, owing to relapse or recurrence. In the case of breast cancer, metastatic relapse can occur months to decades after initial diagnosis and treatment. In this review, we provide an overview of the known key factors that influence metastatic recurrence, with the goal of highlighting the critical unanswered questions that still need to be addressed to make a difference in the mortality of breast cancer patients.
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Affiliation(s)
- Alessandra I Riggio
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Katherine E Varley
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Alana L Welm
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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7
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Kim S, Lee S, Bae Y, Lee S. Nipple-sparing mastectomy for breast cancer close to the nipple: a single institution's 11-year experience. Breast Cancer 2020; 27:999-1006. [PMID: 32372321 DOI: 10.1007/s12282-020-01104-0] [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: 01/23/2019] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to analyze our 11-year experience using NSM with immediate breast reconstruction in breast cancer. METHODS Between January 2007 and December 2015, 251 NSMs were performed on 251 women with breast cancer for therapeutic purpose at Pusan National University Hospital. RESULTS The clinical and pathologic mean tumor size was 3.1 cm. Based on preoperative imaging, mean distance between tumor and nipple was 2.5 cm. Among 251 tumors, 119 cases (47.4%) and 69 cases (27.5%) with a distances ≤ 2 cm and ≤ 1 cm, respectively, were detected. There were 11 patients (4.4%) with locoregional recurrences during the mean follow-up period of 68.0 months. Of these 11 cases, one (0.4%) had local recurrence in the retained NAC, and the others had recurrence in the chest wall or skin. CONCLUSION Unless clinical and histological evidence of nipple involvement, NSM can be an oncologically safe surgical option for breast cancer, even if the tumor is located close to the nipple.
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Affiliation(s)
- Sunhyun Kim
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea
| | - Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea.
| | - Youngtae Bae
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea
| | - Seungju Lee
- Department of Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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8
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Sommer AK, Hermawan A, Mickler FM, Ljepoja B, Knyazev P, Bräuchle C, Ullrich A, Wagner E, Roidl A. Salinomycin co-treatment enhances tamoxifen cytotoxicity in luminal A breast tumor cells by facilitating lysosomal degradation of receptor tyrosine kinases. Oncotarget 2018; 7:50461-50476. [PMID: 27409163 PMCID: PMC5226596 DOI: 10.18632/oncotarget.10459] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/17/2016] [Indexed: 11/25/2022] Open
Abstract
Luminal A breast cancer is the most common breast cancer subtype which is usually treated with selective estrogen receptor modulators (SERMS) like tamoxifen. Nevertheless, one third of estrogen receptor positive breast cancer patients initially do not respond to endocrine therapy and about 40% of luminal A breast tumors recur in five years. In this study, we investigated an alternative treatment approach by combining tamoxifen and salinomycin in luminal A breast cancer cell lines. We have found that salinomycin induces an additional cytotoxic effect by inhibiting the ligand independent activation of ERα. Thereby salinomycin increases the intracellular calcium level. This leads to a premature fusion of endosomes with lysosomes and thus to the degradation of Egfr family members. Since this process is essential for luminal A breast cancer cells to circumvent tamoxifen treatment, the combination of both drugs induces cytotoxicity in tamoxifen sensitive as well as resistant luminal A breast cancer cell lines.
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Affiliation(s)
- Ann-Katrin Sommer
- Pharmaceutical Biotechnology, Department of Pharmacy, Ludwig-Maximilians-Universität München, 81377 Munich, Germany.,Department of Molecular Biology, Max-Planck-Institute of Biochemistry, 82152 Martinsried, Germany
| | - Adam Hermawan
- Pharmaceutical Biotechnology, Department of Pharmacy, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Frauke Martina Mickler
- Physical Chemistry, Department of Chemistry, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Bojan Ljepoja
- Pharmaceutical Biotechnology, Department of Pharmacy, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Pjotr Knyazev
- Department of Molecular Biology, Max-Planck-Institute of Biochemistry, 82152 Martinsried, Germany
| | - Christoph Bräuchle
- Physical Chemistry, Department of Chemistry, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Axel Ullrich
- Department of Molecular Biology, Max-Planck-Institute of Biochemistry, 82152 Martinsried, Germany
| | - Ernst Wagner
- Pharmaceutical Biotechnology, Department of Pharmacy, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Andreas Roidl
- Pharmaceutical Biotechnology, Department of Pharmacy, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
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9
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Esserman LJ, Yau C, Thompson CK, van 't Veer LJ, Borowsky AD, Hoadley KA, Tobin NP, Nordenskjöld B, Fornander T, Stål O, Benz CC, Lindström LS. Use of Molecular Tools to Identify Patients With Indolent Breast Cancers With Ultralow Risk Over 2 Decades. JAMA Oncol 2017; 3:1503-1510. [PMID: 28662222 DOI: 10.1001/jamaoncol.2017.1261] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance The frequency of cancers with indolent behavior has increased with screening. Better tools to identify indolent tumors are needed to avoid overtreatment. Objective To determine if a multigene classifier is associated with indolent behavior of invasive breast cancers in women followed for 2 decades. Design, Setting, and Participants This is a secondary analysis of a randomized clinical trial of tamoxifen vs no systemic therapy, with more than 20-year follow-up. An indolent threshold (ultralow risk) of the US Food and Drug Administration-cleared MammaPrint 70-gene expression score was established above which no breast cancer deaths occurred after 15 years in the absence of systemic therapy. Immunohistochemical markers (n = 727 women) and Agilent microarrays, for MammaPrint risk scoring (n = 652 women), were performed from formalin-fixed paraffin-embedded primary tumor blocks. Participants were postmenopausal women with clinically detected node-negative breast cancers treated with mastectomy or lumpectomy and radiation enrolled in the Stockholm tamoxifen (STO-3) trial, 1976 to 1990. Exposures After 2 years of tamoxifen vs no systemic therapy, regardless of hormone receptor status, patients without relapse who reconsented were further randomized to 3 additional years or none. Main Outcomes and Measures Breast cancer-specific survival assessed by Kaplan-Meier analyses and multivariate Cox proportional hazard modeling, adjusted for treatment, patient age, year of diagnosis, tumor size, grade, hormone receptors, and ERBB2/HER2 and Ki67 status. Results In this secondary analysis of node-negative postmenopausal women, conducted in the era before mammography screening, among the 652 women with MammaPrint scoring available (median age, 62.8 years of age), 377 (58%) and 275 (42%) were MammaPrint low and high risk, respectively, while 98 (15%) were ultralow risk. At 20 years, women with 70-gene high and low tumors but not ultralow tumors had a significantly higher risk of disease-specific death compared with ultralow-risk patients by Cox analysis (hazard ratios, 4.73 [95% CI, 1.38-16.22] and 4.54 [95% CI, 1.40-14.80], respectively). There were no deaths in the ultralow-risk tamoxifen-treated arm at 15 years, and these patients had a 20-year disease-specific survival rate of 97%, whereas for untreated patients the survival rate was 94%. Recursive partitioning identified ultralow risk as the most significant predictor of good outcome. In tumors "not ultralow risk," tumor size greater than 2 cm was the most predictive of outcome. Conclusions and Relevance The ultralow-risk threshold of the 70-gene MammaPrint assay can identify patients whose long-term systemic risk of death from breast cancer after surgery alone is exceedingly low.
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Affiliation(s)
- Laura J Esserman
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco
| | - Christina Yau
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco.,Buck Institute for Research on Aging, Novato, California
| | - Carlie K Thompson
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco
| | - Laura J van 't Veer
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco
| | | | - Katherine A Hoadley
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Nicholas P Tobin
- Department of Oncology-Pathology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Bo Nordenskjöld
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Oncology, Linköping University, Linköping, Sweden
| | - Tommy Fornander
- Department of Oncology-Pathology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Olle Stål
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Oncology, Linköping University, Linköping, Sweden
| | - Christopher C Benz
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco.,Buck Institute for Research on Aging, Novato, California
| | - Linda S Lindström
- Department of Biosciences and Nutrition, Karolinska Institutet and University Hospital, Stockholm, Sweden
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10
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Long non-coding RNA00544 serves as a potential novel predictive and prognostic marker for HR+ HER2- subtype breast cancer. Sci Rep 2017; 7:12382. [PMID: 28959047 PMCID: PMC5620366 DOI: 10.1038/s41598-017-11066-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/28/2017] [Indexed: 12/31/2022] Open
Abstract
Luminal breast cancers (BC) account for majority of breast cancer. Due to its heterogeneity and the development of treatment resistance, luminal BC patients can vary substantially. Long noncoding RNAs (lncRNAs), as we known, is involved in breast cancer progression. Here, we aim to identify the lncRNAs which are involved in the particular type luminal BC progression. By Gene Chips analysis, we found a novel lncRNA00544, which was highly expressed in the metastatic axillary nodes compared with corresponding luminal BC tissues (fold change = 2.26, P = 0.043). This result was confirmed in luminal BC cell lines (p = 0.0113) and 49 paired breast cancer samples compared with in corresponding controls (p = 0.011). Furthermore, Kaplan-Meier survival curves of 373 breast cancer patients indicated that disease-free survival was significantly poor in breast cancer patients with high lncRNA00544 expression (p < 0.001). Univariate and multivariate Cox regression analyses showed that lncRNA00544 was a significant independent prognostic biomarker in luminal BC patients. Further analysis showed that the prognosis of high lncRNA00544 expression in breast cancer patients was actually related to HR + HER2- subtype. Together, our studies indicate that lncRNA00544 may represent a novel predictive and prognostic indicator in luminal BC patients.
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11
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Mejía-Rangel J, Córdova E, Orozco L, Ventura-Gallegos JL, Mitre-Aguilar I, Escalona-Guzmán A, Vadillo F, Vázquez-Prado J, Gariglio P, Zentella-Dehesa A. Pro-adhesive phenotype of normal endothelial cells responding to metastatic breast cancer cell conditioned medium is linked to NFκB-mediated transcriptomic regulation. Int J Oncol 2016; 49:2173-2185. [DOI: 10.3892/ijo.2016.3705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/26/2016] [Indexed: 11/06/2022] Open
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12
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Cao L, Cai G, Xu F, Yang ZZ, Yu XL, Ma JL, Zhang Q, Wu J, Guo XM, Chen JY. Trastuzumab improves locoregional control in HER2-positive breast cancer patients following adjuvant radiotherapy. Medicine (Baltimore) 2016; 95:e4230. [PMID: 27512838 PMCID: PMC4985293 DOI: 10.1097/md.0000000000004230] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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
The benefit of adjuvant trastuzumab in disease-free and overall survival for human epidermal receptor 2-positive (HER2+) breast cancer patients is well established. However, the effect of trastuzumab on locoregional control remains unclear, particularly in patients treated with adjuvant radiotherapy (RT). In this study, we investigated the locoregional benefit of trastuzumab in patients with HER2+ breast cancer after adjuvant RT.Using a single institutional database, we identified 278 patients with stage II/III invasive HER2+ breast tumors receiving adjuvant RT between January 2008 and July 2011. We compared the locoregional outcomes of 134 patients who received trastuzumab to 144 patients without trastuzumab within the same period. Clinical and biological factors that might impact on the locoregional benefit of trastuzumab were also assessed.At the median follow-up of 45 months, trastuzumab significantly lowered the risk of locoregional recurrence (LRR) with a 3-year LRR rate of 2.4% versus 7.5% for the cohort with and without trastuzumab (P = 0.019). Trastuzumab was associated with a more significant locoregional benefit in the hormone receptor-positive (HR+)/HER2+ subgroup, with a 3-year LRR of 0% versus 6.7% in the cohort with and without trastuzumab (P = 0.027). For HR-/HER2+ breast tumor patients, the 3-year LRR rate was still lower for the cohort with trastuzumab (4.7% vs 8.6%). However, statistical significance was not found (P = 0.179). Both univariate and multivariate analyses confirmed that trastuzumab treatment was the only significant predictive factor for LRR (hazard ratio, 4.05; 95% confidence interval, 1.07-15.35; P = 0.039).Adjuvant trastuzumab in addition to RT is associated with significant reduced LRR risk in HER2+ breast cancer.
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Affiliation(s)
- Lu Cao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine
| | - Gang Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine
| | - Fei Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
| | - Zhao-Zhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
| | - Xiao-Li Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
| | - Jin-Li Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
| | - Qian Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiao-Mao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
| | - Jia-Yi Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine
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Frey JD, Alperovich M, Kim JC, Axelrod DM, Shapiro RL, Choi M, Schnabel FR, Karp NS, Guth AA. Oncologic outcomes after nipple-sparing mastectomy: A single-institution experience. J Surg Oncol 2015; 113:8-11. [DOI: 10.1002/jso.24097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/04/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Jordan D. Frey
- Department of Plastic Surgery; NYU Langone Medical Center; New York New York
| | - Michael Alperovich
- Department of Plastic Surgery; NYU Langone Medical Center; New York New York
| | - Jennifer Chun Kim
- Department of Surgery; NYU Langone Medical Center; New York New York
| | | | | | - Mihye Choi
- Department of Plastic Surgery; NYU Langone Medical Center; New York New York
| | - Freya R. Schnabel
- Department of Surgery; NYU Langone Medical Center; New York New York
| | - Nolan S. Karp
- Department of Plastic Surgery; NYU Langone Medical Center; New York New York
| | - Amber A. Guth
- Department of Surgery; NYU Langone Medical Center; New York New York
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Circulating microRNAs for the prediction of metastasis in breast cancer patients diagnosed with early stage disease. Breast 2015; 24:364-9. [PMID: 25957467 DOI: 10.1016/j.breast.2015.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 12/27/2022] Open
Abstract
Breast cancer is the second most common malignancy diagnosed in women worldwide. The greatest cause of breast cancer mortality is development of metastasis. For many women metastasis is an early event in breast cancer which goes undetected until its presentation, thus there is an urgent need for the development of biomarkers to predict those patients at greatest risk. The expression of a group of small non-coding RNAs, termed microRNAs, has been shown to be altered in tumours. Furthermore, microRNAs identified as being highly expressed in breast cancer tumours can also be detected in the circulation. Circulating microRNAs are an emerging field of biomarker research which have the benefit of being able to be obtained non-invasively and analysed rapidly and relatively cheaply. Here the potential use of circulating miRNAs to detect metastasis in discussed and the current barriers to their progression to the clinic.
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15
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Ogba N, Manning NG, Bliesner BS, Ambler SK, Haughian JM, Pinto MP, Jedlicka P, Joensuu K, Heikkilä P, Horwitz KB. Luminal breast cancer metastases and tumor arousal from dormancy are promoted by direct actions of estradiol and progesterone on the malignant cells. Breast Cancer Res 2014; 16:489. [PMID: 25475897 PMCID: PMC4303198 DOI: 10.1186/s13058-014-0489-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 11/19/2014] [Indexed: 12/14/2022] Open
Abstract
Introduction Luminal, estrogen receptor-positive (ER+) breast cancers can metastasize but lie dormant for years before recurrences prove lethal. Understanding the roles of estrogen (E) or progestin (P) in development of luminal metastases or in arousal from dormancy is hindered by few preclinical models. We have developed such models. Methods Immunocompromised, ovariectomized (ovx’d) mice were intracardiac-injected with luminal or basal human breast cancer cells. Four lines were tested: luminal ER+PR+ cytokeratin 5-negative (CK5−) E3 and MCF-7 cells, basal ER−PR−CK5+ estrogen withdrawn-line 8 (EWD8) cells, and basal ER−PR−CK5− MDA-MB-231 cells. Development of micrometastases or macrometastases was quantified in ovx’d mice and in mice supplemented with E or P or both. Metastatic deposits were analyzed by immunohistochemistry for luminal, basal, and proliferation markers. Results ER−PR− cells generated macrometastases in multiple organs in the absence or presence of hormones. By contrast, ovx’d mice injected with ER+PR+ cells appeared to be metastases-free until they were supplemented with E or E+P. Furthermore, unlike parental ER+PR+CK5− cells, luminal metastases were heterogeneous, containing a significant (6% to 30%) proportion of non-proliferative ER−PR−CK5+ cells that would be chemotherapy-resistant. Additionally, because these cells lack receptors, they would also be endocrine therapy-resistant. With regard to ovx’d control mice injected with ER+PR+ cells that appeared to be metastases-free, systematic pathologic analysis of organs showed that some harbor a reservoir of dormant micrometastases that are ER+ but PR−. Such cells may also be endocrine therapy- and chemotherapy-resistant. Their emergence as macrometastases can be triggered by E or E+P restoration. Conclusions We conclude that hormones promote development of multi-organ macrometastases in luminal disease. The metastases display a disturbing heterogeneity, containing newly emergent ER−PR− subpopulations that would be resistant to endocrine therapy and chemotherapy. Similar cells are found in luminal metastases of patients. Furthermore, lack of hormones is not protective. While no overt metastases form in ovx’d mice, luminal tumor cells can seed distant organs, where they remain dormant as micrometastases and sheltered from therapies but arousable by hormone repletion. This has implications for breast cancer survivors or women with occult disease who are prescribed hormones for contraception or replacement purposes. Electronic supplementary material The online version of this article (doi:10.1186/s13058-014-0489-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ndiya Ogba
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA.
| | - Nicole G Manning
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA.
| | - Brian S Bliesner
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA.
| | - S Kelly Ambler
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA.
| | - James M Haughian
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA.
| | - Mauricio P Pinto
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA.
| | - Paul Jedlicka
- Department of Pathology, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA.
| | - Kristiina Joensuu
- Department of Pathology, University of Helsinki, 12801 E. 7th Avenue, Helsinki, 00014, Finland.
| | - Päivi Heikkilä
- Department of Pathology, University of Helsinki, 12801 E. 7th Avenue, Helsinki, 00014, Finland.
| | - Kathryn B Horwitz
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA. .,Department of Pathology, University of Colorado Anschutz Medical Campus, 12801 E. 7th Avenue, Aurora, CO, 80045, USA.
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Demicheli R, Ambrogi F. Comparative benefit from small tumour size and adjuvant chemotherapy: clues for explaining breast cancer mortality decline. BMC Cancer 2014; 14:702. [PMID: 25249290 PMCID: PMC4194359 DOI: 10.1186/1471-2407-14-702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022] Open
Abstract
Background Breast cancer mortality steadily declined from the 1990s and this has been attributed to early detection and/or to improvements in therapy. Which of those two has had the greater impact is a subject of contention. Methods A database of 386 patients, enrolled in a randomized clinical trial on the effect of adjuvant chemotherapy (CMF), was analysed. The probabilities of recurrence and death were estimated by the Fine and Gray’s model and by the Cox model. Time dependent covariate and interaction effects were investigated by additive models. Absolute risk reductions (ARR) related to adjuvant treatment or to tumour size [diameter ≤ 2 cm (T1) or >2 cm (T2/T3)] were estimated. Results CMF-related reduction in recurrence emerges early, reaches a maximum level at 3 years and persists at a constant level thereafter. Tumour-size-related recurrence reduction, after a maximum at 3 years, displays a progressive regular reduction approaching zero. Patients with any tumour size, when given CMF, exhibit mortality reduction that displays an early regular increase and continues to a persistent plateau. In contrast, tumour-size-related mortality reduction reaches a maximum at 5–7 years and then regularly drops to very low values for patients of both trial arms. Conclusions Findings reveal that there is a different time-dependent benefit from chemotherapy and from smaller tumour size at diagnosis. The benefit from adjuvant chemotherapy is long-lasting for patients with any tumour size while the early benefit of diagnosing smaller tumours substantially decreases afterwards. Treatment improvements have probably had greater impact on the mortality reduction than mammography screening.
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Affiliation(s)
- Romano Demicheli
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133 Milano, Italy.
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17
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Differences in metastatic patterns in relation to time between primary surgery and first relapse from breast cancer suggest synchronized growth of dormant micrometastases. Breast Cancer Res Treat 2014; 146:627-36. [PMID: 25038878 PMCID: PMC4112046 DOI: 10.1007/s10549-014-3057-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/07/2014] [Indexed: 01/05/2023]
Abstract
A significant variation in the metastatic pattern among breast cancer patients exists. Clinical observations suggest that these differences are related to time to recurrence (TTR), thus suggesting a common systemic growth signal at the time of surgery. Our goal was to identify a marker for synchronized growth of micrometastases. To quantify the metastatic pattern at first relapse, 180 patients with metastatic breast cancer were studied. Standard deviation (SD) of lesions size and lesion number was calculated and served as a marker for variation. Patients with low SD (multiple/similar sized lesions) were assumed to have synchronized growth, whereas patients with high SD were assumed to have unsynchronized growth. Patients were grouped according to TTR; early (< 3 years-) or late (> 3 years- after surgery). In patients not receiving systemic adjuvant treatment, median SD was significantly lower in the early group (2.5 mm) compared with 6.4 mm in the late group (p = 0.005). In node negative patients, median SD was significantly lower in the early group (3.0 mm) when compared with the late group (5.7 mm, p = 0.02). An additional drop in SD was observed immediately after end of adjuvant endocrine therapy. Our results identify SD as a marker of synchronized metastatic growth in breast cancer. A metastatic phenotype characterized by multiple similar sized metastases, suggesting synchronized onset of growth of micrometastases was predominantly found in patients recurring early after surgery and was counteracted by adjuvant treatment. Systemic growth signals caused by surgery might be antagonized during the time window following surgery.
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18
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Demicheli R, Retsky MW. A dormancy-based model for breast cancer: new findings and possible extension to other sites. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Romano Demicheli
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori di Milano, 20133 Milano, Italy
| | - Michael W Retsky
- Harvard School of Public Health, Building I, Room 1311, 665 Huntington, Avenue, Boston, MA 02115, USA
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19
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Demicheli R, Fornili M, Biganzoli E. Bimodal mortality dynamics for uveal melanoma: a cue for metastasis development traits? BMC Cancer 2014; 14:392. [PMID: 24890689 PMCID: PMC4047778 DOI: 10.1186/1471-2407-14-392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/19/2014] [Indexed: 01/24/2023] Open
Abstract
Background The study estimates mortality dynamics (event-specific hazard rates over a follow-up time interval) for uveal melanoma. Methods Three thousands six hundred seventy two patients undergoing radical or conservative treatment for unilateral uveal melanoma, whose yearly follow-up data were reported in three published datasets, were analysed. Mortality dynamics was studied by estimating with the life-table method the discrete hazard rate for death. Smoothed curves were obtained by a Kernel-like smoothing procedure and a piecewise exponential regression model. The ratio deaths/patients at risk per year was the main outcome measure. Results The three explored hazard rate curves display a common bimodal pattern, with a sudden increase peaking at about three years, followed by reduction until the sixth-seventh year and a second surge peaking at about nine years after treatment. Conclusions The bimodal pattern of mortality indicates that uveal melanoma metastatic development cannot be explained by a continuous growth model. Similar metastasis dynamics have been reported for other tumours, including early breast cancer, for which it supported a paradigm shift to an interrupted growth model, the implications of which are episodes of ‘tumour dormancy’. We propose that the concepts of tumour homeostasis, tumour dormancy and enhancement of metastasis growth related to primary tumour removal, convincingly explaining the clinical behaviour of breast cancer, may be used for uveal melanoma as well. To confirm this proposition, a careful analysis of uveal melanoma metastasis dynamics is strongly warranted.
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Affiliation(s)
- Romano Demicheli
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milano 20133, Italy.
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Pérez-Rivas LG, Jerez JM, Carmona R, de Luque V, Vicioso L, Claros MG, Viguera E, Pajares B, Sánchez A, Ribelles N, Alba E, Lozano J. A microRNA signature associated with early recurrence in breast cancer. PLoS One 2014; 9:e91884. [PMID: 24632820 PMCID: PMC3954835 DOI: 10.1371/journal.pone.0091884] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/14/2014] [Indexed: 12/20/2022] Open
Abstract
Recurrent breast cancer occurring after the initial treatment is associated with poor outcome. A bimodal relapse pattern after surgery for primary tumor has been described with peaks of early and late recurrence occurring at about 2 and 5 years, respectively. Although several clinical and pathological features have been used to discriminate between low- and high-risk patients, the identification of molecular biomarkers with prognostic value remains an unmet need in the current management of breast cancer. Using microarray-based technology, we have performed a microRNA expression analysis in 71 primary breast tumors from patients that either remained disease-free at 5 years post-surgery (group A) or developed early (group B) or late (group C) recurrence. Unsupervised hierarchical clustering of microRNA expression data segregated tumors in two groups, mainly corresponding to patients with early recurrence and those with no recurrence. Microarray data analysis and RT-qPCR validation led to the identification of a set of 5 microRNAs (the 5-miRNA signature) differentially expressed between these two groups: miR-149, miR-10a, miR-20b, miR-30a-3p and miR-342-5p. All five microRNAs were down-regulated in tumors from patients with early recurrence. We show here that the 5-miRNA signature defines a high-risk group of patients with shorter relapse-free survival and has predictive value to discriminate non-relapsing versus early-relapsing patients (AUC = 0.993, p-value<0.05). Network analysis based on miRNA-target interactions curated by public databases suggests that down-regulation of the 5-miRNA signature in the subset of early-relapsing tumors would result in an overall increased proliferative and angiogenic capacity. In summary, we have identified a set of recurrence-related microRNAs with potential prognostic value to identify patients who will likely develop metastasis early after primary breast surgery.
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Affiliation(s)
- Luis G Pérez-Rivas
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José M Jerez
- Departamento de Lenguajes y Ciencias de la Computación, Universidad de Málaga, Málaga, Spain
| | - Rosario Carmona
- Plataforma Andaluza de Bioinformática, Universidad de Málaga, Málaga, Spain
| | - Vanessa de Luque
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Luis Vicioso
- Servicio de Anatomía Patológica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - M Gonzalo Claros
- Plataforma Andaluza de Bioinformática, Universidad de Málaga, Málaga, Spain; Departmento de Biología Molecular y Bioquímica, Universidad de Málaga, Málaga, Spain
| | - Enrique Viguera
- Departmento of Biología Celular, Genética y Fisiología Animal, Universidad de Málaga, Málaga, Spain
| | - Bella Pajares
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Alfonso Sánchez
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Nuria Ribelles
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Emilio Alba
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José Lozano
- Laboratorio de Oncología Molecular, Servicio de Oncología Médica, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain; Departmento de Biología Molecular y Bioquímica, Universidad de Málaga, Málaga, Spain
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FDG avidity at PET/CT during adjuvant hormonal therapy in patients with breast cancer. Clin Nucl Med 2014; 39:e135-41. [PMID: 24398430 DOI: 10.1097/rlu.0b013e318287353e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aim to retrospectively evaluate the impact of hormone therapy (HT) on FDG avidity of metastatic lesions in patients with breast cancer (BC) undergoing PET/CT. PATIENTS AND METHODS Three hundred eight patients with BC were scanned with PET/CT at 2 Italian institutions (mean time from diagnosis 4 yrs, range: 1-24 yrs). Main indications for PET/CT were elevation of tumor markers (34.4%) and clinical or radiological suspicion of relapse (65.6%). The diagnostic accuracy of FDG PET/CT was computed according to the standard method. Student t test was used to assess the mean differences between the study groups, whereas categorical data were compared with chi-square test. Significance was set at P <0.05. RESULTS Two hundred sixty-four patients with positive estrogen receptor and who had received adjuvant HT were included in the analysis. At the time of PET/CT scan, HT was ongoing in 176 patients (66.7%) and 88 (33.3%) had completed adjuvant HT. Ninety-eight (55.7%) patients on HT and 59 (67%) off HT had a positive PET/CT; therefore, the scan resulted negative in the remaining 107 patients, 78 and 29 on and off HT, 44.3% and 33%, respectively (P < 0.001). At a median follow-up of 7 months (range 1-48 mos), disease recurrence was confirmed in either clinical or radiological examinations in 126 (47.7%) patients; 72 (40.9%) versus 54 (61.4%) patients on and off HT, respectively (P < 0.005). True-positive PET/CT results were found in 82% and 91% of patients on and off HT, respectively, whereas it failed to identify disease relapse in 13 (18%) and 5 (9%) patients on and off HT, respectively. CONCLUSIONS In our series, FDG PET/CT shows a similar diagnostic accuracy in detecting disease relapse between patients with BC on adjuvant HT versus those who have completed therapy. These preliminary results suggest that the glucose metabolism is not altered by hormonal suppression at the time of the scan.
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Demicheli R, Ardoino I, Ambrogi F, Agresti R, Biganzoli E. Significance of ipsilateral breast tumor recurrence after breast conserving treatment: role of surgical removal. Chin J Cancer Res 2013; 25:22-31. [PMID: 23372338 DOI: 10.3978/j.issn.1000-9604.2013.01.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 08/09/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To analyze the pattern over time (dynamics) of further recurrence and death after ipsilateral breast tumor recurrence (IBTR) in breast cancer patients undergoing breast conserving treatment (BCT). METHODS A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT. The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment. RESULTS In a time frame with the time origin at the surgical treatment for IBTR, the hazard rate for further recurrence displays a bimodal pattern (peaks at the second and at the sixth year). Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive (N+) patients receiving mastectomy as primary surgery, apart from the first two-three years, when IBTR patients do worse. If the patients with time to IBTR longer than 2.5 years are considered, differences disappear. CONCLUSIONS The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal. In particular, patients with time to IBTR in excess of 2.5 years behave like N+ patients following primary tumor removal. Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which, as suggested by the systemic model of breast cancer, would have reached the clinical level according to their own dynamics.
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Affiliation(s)
- Romano Demicheli
- Scientific Directorate, IRCCS National Cancer Institute, 20133 Milan, Italy
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23
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Ribelles N, Perez-Villa L, Jerez JM, Pajares B, Vicioso L, Jimenez B, de Luque V, Franco L, Gallego E, Marquez A, Alvarez M, Sanchez-Muñoz A, Perez-Rivas L, Alba E. Pattern of recurrence of early breast cancer is different according to intrinsic subtype and proliferation index. Breast Cancer Res 2013; 15:R98. [PMID: 24148581 PMCID: PMC3978680 DOI: 10.1186/bcr3559] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/07/2013] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Recurrence risk in breast cancer varies throughout the follow-up time. We examined if these changes are related to the level of expression of the proliferation pathway and intrinsic subtypes. METHODS Expression of estrogen and progesterone receptor, Ki-67, human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) was performed on tissue-microarrays constructed from a large and uniformly managed series of early breast cancer patients (N = 1,249). Subtype definitions by four biomarkers were as follows: luminal A (ER + and/or PR+, HER2−, Ki-67 <14), luminal B (ER + and/or PR+, HER2−, Ki-67 ≥14), HER2-enriched (any ER, any PR, HER2+, any Ki-67), triple-negative (ER−, PR−, HER2−, any Ki-67). Subtype definitions by six biomarkers were as follows: luminal A (ER + and/or PR+, HER2−, Ki-67 <14, any CK 5/6, any EGFR), luminal B (ER + and/or PR+, HER2−, Ki-67 ≥14, any CK 5/6, any EGFR), HER2-enriched (ER−, PR−, HER2+, any Ki-67, any CK 5/6, any EGFR), Luminal-HER2 (ER + and/or PR+, HER2+, any Ki-67, any CK 5/6, any EGFR), Basal-like (ER−, PR−, HER2−, any Ki-67, CK5/6+ and/or EGFR+), triple-negative nonbasal (ER−, PR−, HER2−, any Ki-67, CK 5/6−, EGFR−). Each four- or six-marker defined intrinsic subtype was divided in two groups, with Ki-67 <14% or with Ki-67 ≥14%. Recurrence hazard rate function was determined for each intrinsic subtype as a whole and according to Ki-67 value. RESULTS Luminal A displayed a slow risk increase, reaching its maximum after three years and then remained steady. Luminal B presented most of its relapses during the first five years. HER2-enriched tumors show a peak of recurrence nearly twenty months post-surgery, with a greater risk in Ki-67 ≥14%. However a second peak occurred at 72 months but the risk magnitude was greater in Ki-67 <14%. Triple negative tumors with low proliferation rate display a smooth risk curve, but with Ki-67 ≥14% show sharp peak at nearly 18 months. CONCLUSIONS Each intrinsic subtype has a particular pattern of relapses over time which change depending on the level of activation of the proliferation pathway assessed by Ki-67. These findings could have clinical implications both on adjuvant treatment trial design and on the recommendations concerning the surveillance of patients.
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Affiliation(s)
- Nuria Ribelles
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Lidia Perez-Villa
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Jose Manuel Jerez
- Department of Languages and Computer Science, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Bella Pajares
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Luis Vicioso
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Begoña Jimenez
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Vanessa de Luque
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Leonardo Franco
- Department of Languages and Computer Science, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Elena Gallego
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Antonia Marquez
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Martina Alvarez
- Department of Pathology, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Alfonso Sanchez-Muñoz
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Luis Perez-Rivas
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Emilio Alba
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
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Giskeødegård GF, Lundgren S, Sitter B, Fjøsne HE, Postma G, Buydens LMC, Gribbestad IS, Bathen TF. Lactate and glycine-potential MR biomarkers of prognosis in estrogen receptor-positive breast cancers. NMR IN BIOMEDICINE 2012; 25:1271-1279. [PMID: 22407957 DOI: 10.1002/nbm.2798] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/06/2012] [Accepted: 02/12/2012] [Indexed: 05/31/2023]
Abstract
Breast cancer is a heterogeneous disease with a variable prognosis. Clinical factors provide some information about the prognosis of patients with breast cancer; however, there is a need for additional information to stratify patients for improved and more individualized treatment. The aim of this study was to examine the relationship between the metabolite profiles of breast cancer tissue and 5-year survival. Biopsies from breast cancer patients (n=98) were excised during surgery and analyzed by high-resolution magic angle spinning MRS. The data were analyzed by multivariate principal component analysis and partial least-squares discriminant analysis, and the findings of important metabolites were confirmed by spectral integration of the metabolite peaks. Predictions of 5-year survival using metabolite profiles were compared with predictions using clinical parameters. Based on the metabolite profiles, patients with estrogen receptor (ER)-positive breast cancer (n=71) were separated into two groups with significantly different survival rates (p=0.024). Higher levels of glycine and lactate were found to be associated with lower survival rates by both multivariate analyses and spectral integration, and are suggested as biomarkers for breast cancer prognosis. Similar metabolic differences were not observed for ER-negative patients, where survivors could not be separated from nonsurvivors. Predictions of 5-year survival of ER-positive patients using metabolite profiles gave better and more robust results than those using traditional clinical parameters. The results imply that the metabolic state of a tumor may provide additional information concerning breast cancer prognosis. Further studies should be conducted in order to evaluate the role of MR metabolomics as an additional clinical tool for determining the prognosis of patients with breast cancer.
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Affiliation(s)
- Guro F Giskeødegård
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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25
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Histological type is not an independent prognostic factor for the risk pattern of breast cancer recurrences. Breast Cancer Res Treat 2012; 135:271-80. [DOI: 10.1007/s10549-012-2160-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/03/2012] [Indexed: 01/30/2023]
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26
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Ardoino I, Biganzoli EM, Bajdik C, Lisboa PJ, Boracchi P, Ambrogi F. Flexible parametric modelling of the hazard function in breast cancer studies. J Appl Stat 2012. [DOI: 10.1080/02664763.2011.650685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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27
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Galmarini D, Galmarini CM, Galmarini FC. Cancer chemotherapy: a critical analysis of its 60 years of history. Crit Rev Oncol Hematol 2012; 84:181-99. [PMID: 22542531 DOI: 10.1016/j.critrevonc.2012.03.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/10/2012] [Accepted: 03/07/2012] [Indexed: 02/07/2023] Open
Abstract
Chemotherapy has already proven widely effective in the treatment of cancer, occupying a prominent place in the current therapeutic arsenal. However, in recent years, there has been a plateau in the evolution of the clinical results obtained with this modality treatment. In some cases, the limitations of chemotherapy observed during the early days still apply. These facts forced us to do a thorough analysis of what happened in the past 60years. We have observed that each major advance obtained in this field was based on empirical clinical observations. We thus believe that the current results of old or new agents can only be improved by understanding the natural history of each specific cancer subtype at the clinical level and by overcoming the physiological barriers involved in chemotherapy failure. This strategy will surely allow us to enlarge the list of curable cancers by chemotherapy.
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Affiliation(s)
- Darío Galmarini
- Fundación Marcel Dargent - Escuela Sudamericana de Oncología, Buenos Aires, Argentina
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28
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Recurrence Dynamics for Non–Small-Cell Lung Cancer: Effect of Surgery on the Development of Metastases. J Thorac Oncol 2012; 7:723-30. [DOI: 10.1097/jto.0b013e31824a9022] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Cheng L, Swartz MD, Zhao H, Kapadia AS, Lai D, Rowan PJ, Buchholz TA, Giordano SH. Hazard of Recurrence among Women after Primary Breast Cancer Treatment—A 10-Year Follow-up Using Data from SEER-Medicare. Cancer Epidemiol Biomarkers Prev 2012; 21:800-9. [PMID: 22426147 DOI: 10.1158/1055-9965.epi-11-1089] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Lee Cheng
- Department of Clinical Effectiveness, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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30
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Demicheli R, Coradini D. Gene regulatory networks: a new conceptual framework to analyse breast cancer behaviour. Ann Oncol 2011; 22:1259-1265. [PMID: 21109571 DOI: 10.1093/annonc/mdq546] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- R Demicheli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori.
| | - D Coradini
- Institute of Medical Statistics and Biometry, Università di Milano, Milano, Italy
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31
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Demicheli R, Ardoino I, Boracchi P, Coradini D, Agresti R, Ferraris C, Gennaro M, Hrushesky WJM, Biganzoli E. Recurrence and mortality according to estrogen receptor status for breast cancer patients undergoing conservative surgery. Ipsilateral breast tumour recurrence dynamics provides clues for tumour biology within the residual breast. BMC Cancer 2010; 10:656. [PMID: 21118508 PMCID: PMC3002930 DOI: 10.1186/1471-2407-10-656] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 11/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was designed to determine how tumour hormone receptor status affects the subsequent pattern over time (dynamics) of breast cancer recurrence and death following conservative primary breast cancer resection. METHODS Time span from primary resection until both first recurrence and death were considered among 2825 patients undergoing conservative surgery with or without breast radiotherapy. The hazard rates for ipsilateral breast tumour recurrence (IBTR), distant metastasis (DM) and mortality throughout 10 years of follow-up were assessed. RESULTS DM dynamics displays the same bimodal pattern (first early peak at about 24 months, second late peak at the sixth-seventh year) for both estrogen receptor (ER) positive (P) and negative (N) tumours and for all local treatments and metastatic sites. The hazard rates for IBTR maintain the bimodal pattern for ERP and ERN tumours; however, each IBTR recurrence peak for ERP tumours is delayed in comparison to the corresponding timing of recurrence peaks for ERN tumours. Mortality dynamics is markedly different for ERP and ERN tumours with more early deaths among patients with ERN than among patients with ERP primary tumours. CONCLUSION DM dynamics is not influenced by the extent of conservative primary tumour resection and is similar for both ER phenotypes across different metastatic sites, suggesting similar mechanisms for tumour development at distant sites despite apparently different microenvironments. The IBTR risk peak delay observed in ERP tumours is an exception to the common recurrence risk rhythm. This suggests that the microenvironment within the residual breast tissue may enforce more stringent constraints upon ERP breast tumour cell growth than other tissues, prolonging the latency of IBTR. This local environment is, however, apparently less constraining to ERN cells, as IBTR dynamics is similar to the corresponding recurrence dynamics among other distant tissues.
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Affiliation(s)
- Romano Demicheli
- Scientific Direction, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Ilaria Ardoino
- Medical Statistics and Biometry, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Patrizia Boracchi
- Medical Statistics and Biometry, Università di Milano, Milano, Italy
| | - Danila Coradini
- Medical Statistics and Biometry, Università di Milano, Milano, Italy
| | - Roberto Agresti
- Breast Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Cristina Ferraris
- Breast Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | | | | | - Elia Biganzoli
- Medical Statistics and Biometry, Università di Milano e Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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