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Guerra E, Trerotola M, Relli V, Lattanzio R, Boujnah K, Travali N, Moschella A, Todaro P, Pierdomenico L, Di Pietro R, Tinari N, Alberti S. Phylogenetic conservation of Trop-2 across species-rodent and primate genomics model anti-Trop-2 therapy for pre-clinical benchmarks. Front Genet 2024; 14:1297367. [PMID: 38250577 PMCID: PMC10797630 DOI: 10.3389/fgene.2023.1297367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/23/2023] [Indexed: 01/23/2024] Open
Abstract
A phylogenetic conservation analysis of Trop-2 across vertebrate species showed a high degree of sequence conservation, permitting to explore multiple models as pre-clinical benchmarks. Sequence divergence and incomplete conservation of expression patterns were observed in mouse and rat. Primate Trop-2 sequences were found to be 95%-100% identical to the human sequence. Comparative three-dimension primate Trop-2 structures were obtained with AlphaFold and homology modeling. This revealed high structure conservation of Trop-2 (0.66 ProMod3 GMQE, 0.80-0.86 ± 0.05 QMEANDisCo scores), with conservative amino acid changes at variant sites. Primate TACSTD2/TROP2 cDNAs were cloned and transfectants for individual ORF were shown to be efficiently recognized by humanized anti-Trop-2 monoclonal antibodies (Hu2G10, Hu2EF). Immunohistochemistry analysis of Macaca mulatta (rhesus monkey) tissues showed Trop-2 expression patterns that closely followed those in human tissues. This led us to test Trop-2 targeting in vivo in Macaca fascicularis (cynomolgus monkey). Intravenously injected Hu2G10 and Hu2EF were well tolerated from 5 to 10 mg/kg. Neither neurological, respiratory, digestive, urinary symptoms, nor biochemical or hematological toxicities were detected during 28-day observation. Blood serum pharmacokinetic (PK) studies were conducted utilizing anti-idiotypic antibodies in capture-ELISA assays. Hu2G10 (t1/2 = 6.5 days) and Hu2EF (t1/2 = 5.5 days) were stable in plasma, and were detectable in the circulation up to 3 weeks after the infusion. These findings validate primates as reliable models for Hu2G10 and Hu2EF toxicity and PK, and support the use of these antibodies as next-generation anti-Trop-2 immunotherapy tools.
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Affiliation(s)
- Emanuela Guerra
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Marco Trerotola
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Valeria Relli
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Rossano Lattanzio
- Laboratory of Cancer Pathology, Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Khouloud Boujnah
- Unit of Medical Genetics, Department of Biomedical Sciences—BIOMORF, University of Messina, Messina, Italy
| | - Nicole Travali
- Unit of Medical Genetics, Department of Biomedical Sciences—BIOMORF, University of Messina, Messina, Italy
| | - Antonino Moschella
- Unit of Medical Genetics, Department of Biomedical Sciences—BIOMORF, University of Messina, Messina, Italy
| | - Paolo Todaro
- Department of Human Pathology “Gaetano Barresi”, Section of Cytopathology, University of Messina, Azienda Ospedaliera Universitaria “Gaetano Martino”, Messina, Italy
| | - Laura Pierdomenico
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technologies (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Roberta Di Pietro
- Department of Medicine and Aging Sciences, Section of Biomorphology, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, United States
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Saverio Alberti
- Unit of Medical Genetics, Department of Biomedical Sciences—BIOMORF, University of Messina, Messina, Italy
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Thorny ground, rocky soil: Tissue-specific mechanisms of tumor dormancy and relapse. Semin Cancer Biol 2022; 78:104-123. [PMID: 33979673 PMCID: PMC9595433 DOI: 10.1016/j.semcancer.2021.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
Disseminated tumor cells (DTCs) spread systemically yet distinct patterns of metastasis indicate a range of tissue susceptibility to metastatic colonization. Distinctions between permissive and suppressive tissues are still being elucidated at cellular and molecular levels. Although there is a growing appreciation for the role of the microenvironment in regulating metastatic success, we have a limited understanding of how diverse tissues regulate DTC dormancy, the state of reversible quiescence and subsequent awakening thought to contribute to delayed relapse. Several themes of microenvironmental regulation of dormancy are beginning to emerge, including vascular association, co-option of pre-existing niches, metabolic adaptation, and immune evasion, with tissue-specific nuances. Conversely, DTC awakening is often associated with injury or inflammation-induced activation of the stroma, promoting a proliferative environment with DTCs following suit. We review what is known about tissue-specific regulation of tumor dormancy on a tissue-by-tissue basis, profiling major metastatic organs including the bone, lung, brain, liver, and lymph node. An aerial view of the barriers to metastatic growth may reveal common targets and dependencies to inform the therapeutic prevention of relapse.
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Smith J, Leonard C, Carter DL, Tole S. Does the Presence of Cytokeratin Positive Individual Tumor Cells (N 0(I+)) in Sentinel Lymph Nodes Affect Clinical Outcomes in Breast Cancer Patients Treated with Accelerated Partial Breast Irradiation. BREAST CANCER-TARGETS AND THERAPY 2021; 13:513-517. [PMID: 34512014 PMCID: PMC8413089 DOI: 10.2147/bctt.s318197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
Purpose To report a primary objective clinical outcome of ipsilateral breast cancer recurrence following accelerated partial breast irradiation (APBI) with N0(i+) (single tumor cells or clusters <2mm) in sentinel lymph nodes. The secondary objective was to observe any incidence of ipsilateral breast failure. Patients and Methods Between March 2004 and April 2016, a total of 747 patients were enrolled in one of two APBI (Accelerated Partial Breast Irradiation) breast protocols (Phase II NCT01185145 and Phase III NCT01185132). Nineteen patients with N0(i+) disease were treated between February 2005 and December 2015. Patient eligibility included a primary invasive or DCIS tumor size <3 cm, N0(i+) disease, and margin width of >2 mm. All enrolled patients presented in this report had sentinel lymph node examinations. Clinical outcomes of ipsilateral breast, axillary and combined regional (breast or axillary) recurrences were analyzed. Results Median follow-up for all patients was 5 years (1–8 years). No patient experienced either ipsilateral breast or axillary recurrence. Conclusion There has been scarce information/reporting of the treatment of patients with cytokeratin positive individual tumor cells N0(i+) with APBI. The authors have presented data which suggest that the successful outcomes of these patients might warrant further study.
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Affiliation(s)
- Jamie Smith
- Rocky Mountain Cancer Centers Littleton, Denver, CO, USA
| | | | | | - Shannon Tole
- Rocky Mountain Cancer Centers Littleton, Denver, CO, USA
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Wang G, Zhang S, Wang M, Liu L, Liu Y, Tang L, Bai H, Zhao H. Prognostic significance of occult lymph node metastases in breast cancer: a meta-analysis. BMC Cancer 2021; 21:875. [PMID: 34330233 PMCID: PMC8325175 DOI: 10.1186/s12885-021-08582-1] [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: 03/17/2021] [Accepted: 07/10/2021] [Indexed: 12/01/2022] Open
Abstract
Background Occult metastases in axillary lymph nodes have been reported to be associated with poor prognosis in patients with breast cancer. However, studies on the prognostic value of occult metastases have shown controversial results. This meta-analysis aimed to evaluate the prognostic significance of occult lymph node metastases in breast cancer. Methods Studies published until May, 2020, which retrospectively examined negative lymph nodes by stepsectioning and/or immunohistochemistry, were retrieved from MEDLINE, EMBASE, CNKI, and Cochrane Library databases. The pooled Relative Risk (RR) with 95% confidence interval (95% CI) for overall survival (OS) and disease-free survival (DFS) were calculated to examine the associations between occult metastases and prognosis. Results Patients with occult metastases in axillary lymph nodes had poorer five-year DFS (RR = 0.930; 95% CI = 0.907–0.954) and OS (RR = 0.972; 95% CI = 0.954–0.990). Furthermore, the DFS (RR = 0.887; 95% CI = 0.810–0.972) and OS (RR = 0.896; 95% CI = 0.856–0.939) of patients with occult metastases were significantly lower after a ten-year follow-up. Conclusions Occult metastases in the axillary lymph nodes are associated with poorer DFS andOS of patients with breast cancer. Occult metastases might serve as a predictive factor of survival outcomes in patients with breast cancer.
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Affiliation(s)
- Guixin Wang
- General Surgery Department, Dalian University Affiliated Xinhua Hospital, Dalian, 116000, China.,Breast Surgery Department, The Second Hospital of Dalian Medical University, Dalian, 116000, China
| | - Shuhao Zhang
- Cardiology Department, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, China
| | - Meiling Wang
- Breast Surgery Department, The Second Hospital of Dalian Medical University, Dalian, 116000, China
| | - Lin Liu
- General Surgery Department, Dalian University Affiliated Xinhua Hospital, Dalian, 116000, China
| | - Yaqian Liu
- Breast Surgery Department, The Second Hospital of Dalian Medical University, Dalian, 116000, China
| | - Lianjun Tang
- General Surgery Department, Dalian Jinzhou First People's Hospital, Dalian, 116000, China
| | - He Bai
- General Surgery Department, Dalian University Affiliated Xinhua Hospital, Dalian, 116000, China
| | - Haidong Zhao
- Breast Surgery Department, The Second Hospital of Dalian Medical University, Dalian, 116000, China.
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Li Y, Zhang H, Zhang W, Ren Y, Qiao Y, Li K, Chen H, Pu S, He J, Zhou C. A Competing Risk Analysis Model to Determine the Prognostic Value of Isolated Tumor Cells in Axillary Lymph Nodes for T1N0M0 Breast Cancer Patients Based on the Surveillance, Epidemiology, and End Results Database. Front Oncol 2020; 10:572316. [PMID: 33072606 PMCID: PMC7531361 DOI: 10.3389/fonc.2020.572316] [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: 06/13/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Knowledge of the association between isolated tumor cells (ITCs) in breast cancer patients and the outcome is very limited. We aimed to determine the prognostic value of axillary lymph node ITCs for T1N0M0 female breast cancer (FBC) patients. Methods Data for T1N0M0 FBC patients staged ITCs negative [pN0(i−)] and positive [pN0(i+)] were extracted from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. Prognostic predictors were identified by Kaplan–Meier analysis, competing risk model, and Fine–Gray multivariable regression model. Results A total of 94,599 subjects were included, 88,632 of whom were staged at pN0(i−) and 5,967 were pN0(i+). Patients staged pN0(i+) had worse breast cancer-specific survival (BCSS) [hazard ratio (HR): 1.298, 95% CI = 1.069–1.576, P = 0.003] and higher breast cancer-specific death (BCSD) rate (Gray’s test, P = 0.002) than pN0(i−) group. In the Fine–Gray multivariable regression analysis, the pN0(i+) group had higher BCSD rate (HR: 1.321, 95% CI = 1.109–1.575, P = 0.002) than pN0(i−) group. In subgroup analyses, no significant difference in BCSD was shown between the chemotherapy and non-chemotherapy subgroup (Gray’s test, P = 0.069) or radiotherapy and non-radiotherapy subgroup (Gray’s test, P = 0.096). Conclusion ITC was independently related to the increase of the BCSD rate and could be identified as a reliable survival predictor for T1N0M0 FBC patients.
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Affiliation(s)
- Yijun Li
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Huimin Zhang
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Zhang
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yu Ren
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Qiao
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kunlong Li
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Heyan Chen
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Shengyu Pu
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Jianjun He
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Can Zhou
- Department of Breast Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Wang X, Yin Z, Wang D, Zhang J, Wang S, Zhao J, Wang Q, Zhao L, Zhu L, Xu L, Wang P. Greater negative lymph node count predicts favorable survival of patients with breast cancer in the setting of neoadjuvant chemotherapy and mastectomy. Future Oncol 2019; 15:3701-3709. [DOI: 10.2217/fon-2019-0439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: Adequate lymph node evaluation is recommended in patients with malignant tumors. However, the role of negative lymph nodes (NLNs) remains unclear in breast cancer (BC), especially in patients who have received neoadjuvant chemotherapy and mastectomy. Materials & methods: A total of 435 patients were included in the analysis. On multivariate analysis, NLN count was an independent predictor of 5 year disease-free survival and 5 year overall survival. Results: Patients with NLN count <10 showed significantly worse 5 year disease-free survival than those with NLN count ≥10 (34.8 and 78.2%; p = 0.000); the corresponding 5 year overall survival rates were also significantly different (52.0 and 82.7%; p = 0.000). Conclusion: This is the first study that confirms the relationship between NLN count and prognosis of patients in the setting of neoadjuvant chemotherapy and mastectomy. More NLNs imply better prognosis.
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Affiliation(s)
- Xin Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Zhenzhen Yin
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Daquan Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Jiaqi Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Shuai Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Jinlin Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
- Tianjin Key Laboratory of Radiation Medicine & Molecular Nuclear Medicine, Tianjin, PR China
| | - Qi Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
- Tianjin Key Laboratory of Radiation Medicine & Molecular Nuclear Medicine, Tianjin, PR China
| | - Li Zhu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Liming Xu
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key laboratory of Cancer Prevention & Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Key laboratory of Breast Cancer, Prevention & Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, PR China
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Demicheli R, Fornili M, Querzoli P, Pedriali M, Alberti S, Desmedt C, Biganzoli E. Microscopic tumor foci in axillary lymph nodes may reveal the recurrence dynamics of breast cancer. Cancer Commun (Lond) 2019; 39:35. [PMID: 31217037 PMCID: PMC6582468 DOI: 10.1186/s40880-019-0381-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Romano Demicheli
- Unit of Medical Statistics, Biometry and Bioinformatics, Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori, Laboratory of Medical Statistics and Epidemiology, "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133, Milan, Italy
| | - Marco Fornili
- Laboratory of Medical Statistics and Epidemiology, "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133, Milan, Italy
| | - Patrizia Querzoli
- Section of Surgical Pathology, Department of Morphology, Surgical and Experimental Medicine, University of Ferrara, 44121, Ferrara, Italy
| | - Massimo Pedriali
- Operative Unit of Surgical Pathology, Azienda Ospedaliera - Universitaria, University of Ferrara, 44121, Ferrara, Italy
| | - Saverio Alberti
- Section of Medical Genetics, Department of Biomedical and Odontoiatric Sciences, Morphological and Functional Imaging, University of Messina, 98125, Messina, Italy
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, Katholieke Universiteit Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Bioinformatics, Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori, Laboratory of Medical Statistics and Epidemiology, "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133, Milan, Italy.
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Crisafulli C, Romeo PD, Calabrò M, Epasto LM, Alberti S. Pharmacogenetic and pharmacogenomic discovery strategies. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2019; 2:225-241. [PMID: 35582724 PMCID: PMC8992635 DOI: 10.20517/cdr.2018.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 11/12/2022]
Abstract
Genetic/genomic profiling at a single-patient level is expected to provide critical information for determining inter-individual drug toxicity and potential efficacy in cancer therapy. A better definition of cancer subtypes at a molecular level, may correspondingly complement such pharmacogenetic and pharmacogenomic approaches, for more effective personalized treatments. Current pharmacogenetic/pharmacogenomic strategies are largely based on the identification of known polymorphisms, thus limiting the discovery of novel or rarer genetic variants. Recent improvements in cost and throughput of next generation sequencing (NGS) are now making whole-genome profiling a plausible alternative for clinical procedures. Beyond classical pharmacogenetic/pharmacogenomic traits for drug metabolism, NGS screening programs of cancer genomes may lead to the identification of novel cancer-driving mutations. These may not only constitute novel therapeutic targets, but also effector determinants for metabolic pathways linked to drug metabolism. An additional advantage is that cancer NGS profiling is now leading to discovering targetable mutations, e.g., in glioblastomas and pancreatic cancers, which were originally discovered in other tumor types, thus allowing for effective repurposing of active drugs already on the market.
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Affiliation(s)
- Concetta Crisafulli
- Department of Biomedical Sciences - BIOMORF, University of Messina, via Consolare Valeria, 98125 Messina, Italy
| | | | - Marco Calabrò
- Department of Biomedical Sciences - BIOMORF, University of Messina, via Consolare Valeria, 98125 Messina, Italy
| | - Ludovica Martina Epasto
- Unit of Medical Genetics, University of Messina, via Consolare Valeria, 98125 Messina, Italy
| | - Saverio Alberti
- Department of Biomedical Sciences - BIOMORF, University of Messina, via Consolare Valeria, 98125 Messina, Italy.,Unit of Medical Genetics, University of Messina, via Consolare Valeria, 98125 Messina, Italy.,Correspondence Address: Prof. Saverio Alberti, Unit of Medical Genetics, BIOMORF Department of Biomedical Sciences, University of Messina, via Consolare Valeria, 98125 Messina, Italy. E-mail:
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Prognostic value of isolated tumour cells in sentinel lymph nodes in early-stage breast cancer: a prospective study. Br J Cancer 2018; 118:1529-1535. [PMID: 29686324 PMCID: PMC5988733 DOI: 10.1038/s41416-018-0052-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/01/2018] [Accepted: 02/14/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The prognostic significance of isolated tumour cells (ITCs) in the sentinel nodes (SNs) is controversial in early breast cancer, and some centres have abandoned immunohistochemistry to detect ITCs. METHODS Patients with unilateral pT1N0 breast cancer, operated between February 2001 and August 2005 at a university hospital were included in this prospective, population-based cohort study. Survival of 936 patients with or without isolated tumour cells (ITC) in their SNs were compared with the log-rank test and Cox regression analysis. RESULTS Eight hundred sixty one (92.0%) patients were ITC-negative (pN0i-) and 75 (8.0%) ITC-positive (pN0i+). Patients with ITC-positive cancer received more frequently adjuvant systemic therapies than those with ITC-negative cancer. The median follow-up time was 9.5 years. Ten-year distant disease-free survival was 95.3% in the pN0i- group and 88.8% in the pN0i+ group (P = 0.013). ITCs were an independent prognostic factor in a Cox regression model (HR = 2.34, 95% CI 1.09-5.04; P = 0.029), together with tumour Ki-67 proliferation index and diameter. ITCs were associated with unfavourable overall survival (P = 0.005) and breast cancer-specific survival (P = 0.001). CONCLUSIONS We conclude that presence of ITCs in the SNs is an adverse prognostic factor in early small node-negative breast cancer, and may be considered in the decision-making for adjuvant therapy.
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Zhao X, Wei J, Li X, Yang H, Wang P, Cao S. Increasing negative lymph node count predicts favorable OS and DSS in breast cancer with different lymph node-positive subgroups. PLoS One 2018; 13:e0193784. [PMID: 29554092 PMCID: PMC5858777 DOI: 10.1371/journal.pone.0193784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/16/2018] [Indexed: 11/18/2022] Open
Abstract
Adequate lymph node evaluation is recommended for optimal staging in patients with malignant neoplasms including breast cancer. However, the role of negative lymph nodes (LNs) remains unclear in breast cancer according to N substage (N1, N2, and N3). In this study, for the first time, we analyzed the prognostic significance of negative LNs in breast cancer patients. A critical relationship was observed between negative LN count and survival, independent of patient characteristics and other related molecular variables including estrogen receptor (PR) status, progesterone receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, depth of tumor invasion and degree of differentiation. This research is of great importance in providing more information about the prognosis of breast cancer by statistical analysis of negative lymph nodes and can serve as a useful supplement to the current pathological system.
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Affiliation(s)
- Xin Zhao
- Department of General Surgery, Tianjin First Central Hospital,Tianjin,China
| | - Jing Wei
- Department of Thoracic Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Xiaoxin Li
- Department of Pathology, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Haochang Yang
- College of Clinical Medicine, Binzhou Medical University, Yantai, China
| | - Pei Wang
- Department of Breast Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University,Xuzhou, China
- * E-mail: (SC); (PW)
| | - Susheng Cao
- Department of Breast Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University,Xuzhou, China
- * E-mail: (SC); (PW)
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11
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Rahimzadeh M, Pourhoseingholi MA, Kavehie B. Survival Rates for Breast Cancer in Iranian Patients: a Meta- Analysis. Asian Pac J Cancer Prev 2017; 17:2223-7. [PMID: 27221922 DOI: 10.7314/apjcp.2016.17.4.2223] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer among Iranian women. Since development of the disease in Iranian women occurs relatively early, the survival rate matters considerably. In different countries, survival of breast cancer patients varies considerably. Therefore, the one-year, three-year, five-year, and ten- year survival rates for breast cancer in Iran were assessed using a meta-analysis. MATERIALS AND METHODS This systematic review and meta-analysis was based on valid Iranian sources including SID, MAGIRAN and IRANMEDEX, along with reliable English databases, namely, PUBMED and SCOPUS. In domestic databases, a search was conducted based on key words of breast cancer and survival rate, and in international databases, with "breast cancer" and the equivalent of "neoplasm" of Mesh Word, "survival rate" and "Iran. " Then all reviewed papers and theses which met the inclusion criteria were selected for investigation. To conduct the analysis STATA 11.2 software and random-effects models were used. RESULTS In 24 studies, 22,745 participants were included. The one-year, three-year, five-year and ten-year survival rates were 0.956, 0.808, 0.695 and 0.559, respectively. The minimum and maximum survival rates for 5-years were 0.48 and 0.87. The average age of the onset of the disease was 48.3. CONCLUSIONS As in Iran, since the onset of the disease is at low age, in spite of the relatively high survival rate as compared to other cancers, prevention and screening programs at early age for early stage diagnosis seems necessary.
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12
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Iqbal J, Ginsburg O, Giannakeas V, Rochon PA, Semple JL, Narod SA. The impact of nodal micrometastasis on mortality among women with early-stage breast cancer. Breast Cancer Res Treat 2016; 161:103-115. [PMID: 27796715 DOI: 10.1007/s10549-016-4015-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/08/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The clinical significance of nodal micrometastasis is debated. Our primary objective was to determine whether, among women with early-stage breast cancer, regional lymph node micrometastasis is an independent risk factor for mortality. The secondary objective was to identify subgroups of women who have the highest risk of death from early-stage breast cancer with micrometastases. METHODS 206,625 women diagnosed with early-stage breast cancer (IA, IB, and IIA) from 2004 to 2012 were identified in the Surveillance, epidemiology, and end results database. Nodal status was classified as node-negative, isolated-tumor cells, micrometastases, and macrometastases. Women were classified into eight ethnic groups. Logistic regression was performed to estimate the odds ratio of being diagnosed with micrometastases. The Cox proportional hazard model was used to estimate the hazard ratio (HR) of breast cancer-specific death associated with micrometastases for each ethnic group. RESULTS The 8-year breast cancer-specific survival was 96.6 % for women with node-negative breast cancers and was 94.6 % for women with micrometastases (adjusted HR 1.49; 95 % CI 1.31-1.69; P < .001). Among women with micrometastases, the 8-year breast cancer-specific survival was 95.1 % for white women and was 90.6 % for black women (HR 1.80; 95 % CI 1.29-2.52; P = .0006). CONCLUSION(S) Nodal micrometastasis is an independent risk factor for breast cancer mortality among women with early-stage breast cancer. Black women are more likely to die from breast cancer with micrometastases than white women.
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Affiliation(s)
- Javaid Iqbal
- Women's College Research Institute/Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Ophira Ginsburg
- Women's College Research Institute/Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Vasily Giannakeas
- Women's College Research Institute/Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paula A Rochon
- Women's College Research Institute/Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - John L Semple
- Women's College Research Institute/Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Steven A Narod
- Women's College Research Institute/Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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13
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Guerra E, Cimadamore A, Simeone P, Vacca G, Lattanzio R, Botti G, Gatta V, D'Aurora M, Simionati B, Piantelli M, Alberti S. p53, cathepsin D, Bcl-2 are joint prognostic indicators of breast cancer metastatic spreading. BMC Cancer 2016; 16:649. [PMID: 27538498 PMCID: PMC4991058 DOI: 10.1186/s12885-016-2713-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/11/2016] [Indexed: 02/04/2023] Open
Abstract
Background Traditional prognostic indicators of breast cancer, i.e. lymph node diffusion, tumor size, grading and estrogen receptor expression, are inadequate predictors of metastatic relapse. Thus, additional prognostic parameters appear urgently needed. Individual oncogenic determinants have largely failed in this endeavour. Only a few individual tumor growth drivers, e.g. mutated p53, Her-2, E-cadherin, Trops, did reach some prognostic/predictive power in clinical settings. As multiple factors are required to drive solid tumor progression, clusters of such determinants were expected to become stronger indicators of tumor aggressiveness and malignant progression than individual parameters. To identify such prognostic clusters, we went on to coordinately analyse molecular and histopathological determinants of tumor progression of post-menopausal breast cancers in the framework of a multi-institutional case series/case-control study. Methods A multi-institutional series of 217 breast cancer cases was analyzed. Twenty six cases (12 %) showed disease relapse during follow-up. Relapsed cases were matched with a set of control patients by tumor diameter, pathological stage, tumor histotype, age, hormone receptors and grading. Histopathological and molecular determinants of tumor development and aggressiveness were then analyzed in relapsed versus non-relapsed cases. Stepwise analyses and model structure fitness assessments were carried out to identify clusters of molecular alterations with differential impact on metastatic relapse. Results p53, Bcl-2 and cathepsin D were shown to be coordinately associated with unique levels of relative risk for disease relapse. As many Ras downstream targets, among them matrix metalloproteases, are synergistically upregulated by mutated p53, whole-exon sequence analyses were performed for TP53, Ki-RAS and Ha-RAS, and findings were correlated with clinical phenotypes. Notably, TP53 insertion/deletion mutations were only detected in relapsed cases. Correspondingly, Ha-RAS missense oncogenic mutations were only found in a subgroup of relapsing tumors. Conclusions We have identified clusters of specific molecular alterations that greatly improve prognostic assessment with respect to singularly-analysed indicators. The combined analysis of these multiple tumor-relapse risk factors promises to become a powerful approach to identify patients subgroups with unfavourable disease outcome. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2713-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emanuela Guerra
- Unit of Cancer Pathology, CeSI-MeT, University of Chieti, Chieti, Italy
| | | | - Pasquale Simeone
- Unit of Cancer Pathology, CeSI-MeT, University of Chieti, Chieti, Italy
| | - Giovanna Vacca
- Unit of Cancer Pathology, CeSI-MeT, University of Chieti, Chieti, Italy
| | - Rossano Lattanzio
- Unit of Cancer Pathology, CeSI-MeT, University of Chieti, Chieti, Italy.,Department of Medical, Oral and Biotechnological Sciences, University 'G. D'Annunzio', Chieti, Italy
| | - Gerardo Botti
- Department of Pathology "Foundation G.Pascale", National Cancer Institute, Naples, Italy
| | - Valentina Gatta
- Department of Psychological, Health ad Territorial Sciences, School of Medicine and Life Sciences, University 'G. D'Annunzio', Chieti, Italy
| | - Marco D'Aurora
- Department of Psychological, Health ad Territorial Sciences, School of Medicine and Life Sciences, University 'G. D'Annunzio', Chieti, Italy
| | | | - Mauro Piantelli
- Unit of Cancer Pathology, CeSI-MeT, University of Chieti, Chieti, Italy.,Department of Medical, Oral and Biotechnological Sciences, University 'G. D'Annunzio', Chieti, Italy
| | - Saverio Alberti
- Unit of Cancer Pathology, CeSI-MeT, University of Chieti, Chieti, Italy. .,Department of Neurosciences, Imaging and Clinical Sciences, University 'G. D'Annunzio', Chieti, Italy.
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14
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Reintgen M, Kerivan L, Reintgen E, Swaninathan S, Reintgen D. Breast Lymphatic Mapping and Sentinel Lymph Node Biopsy: State of the Art: 2015. Clin Breast Cancer 2016; 16:155-65. [DOI: 10.1016/j.clbc.2016.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/03/2016] [Indexed: 12/14/2022]
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15
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Guerra E, Trerotola M, Tripaldi R, Aloisi AL, Simeone P, Sacchetti A, Relli V, D'Amore A, La Sorda R, Lattanzio R, Piantelli M, Alberti S. Trop-2 Induces Tumor Growth Through AKT and Determines Sensitivity to AKT Inhibitors. Clin Cancer Res 2016; 22:4197-205. [PMID: 27022065 DOI: 10.1158/1078-0432.ccr-15-1701] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/29/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Inhibition of AKT is a key target area for personalized cancer medicine. However, predictive markers of response to AKT inhibitors are lacking. Correspondingly, the AKT-dependent chain of command for tumor growth, which will mediate AKT-dependent therapeutic responses, remains unclear. EXPERIMENTAL DESIGN Proteomic profiling was utilized to identify nodal hubs of the Trop-2 cancer growth-driving network. Kinase-specific inhibitors were used to dissect Trop-2-dependent from Trop-2-independent pathways. In vitro assays, in vivo preclinical models, and case series of primary human breast cancers were utilized to define the mechanisms of Trop-2-driven growth and the mode of action of Trop-2-predicted AKT inhibitors. RESULTS Trop-2 and AKT expression was shown to be tightly coordinated in human breast cancers, with virtual overlap with AKT activation profiles at T308 and S473, consistent with functional interaction in vivo AKT allosteric inhibitors were shown to only block the growth of Trop-2-expressing tumor cells, both in vitro and in preclinical models, being ineffective on Trop-2-null cells. Consistently, AKT-targeted siRNA only impacted on Trop-2-expressing cells. Lentiviral downregulation of endogenous Trop-2 abolished tumor response to AKT blockade, indicating Trop-2 as a mandatory activator of AKT. CONCLUSIONS Our findings indicate that the expression of Trop-2 is a stringent predictor of tumor response to AKT inhibitors. They also support the identification of target-activatory pathways, as efficient predictors of response in precision cancer therapy. Clin Cancer Res; 22(16); 4197-205. ©2016 AACR.
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Affiliation(s)
- Emanuela Guerra
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Marco Trerotola
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Romina Tripaldi
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Anna Laura Aloisi
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Pasquale Simeone
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Andrea Sacchetti
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Valeria Relli
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Antonella D'Amore
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Rossana La Sorda
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy
| | - Rossano Lattanzio
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy. Department of Medical, Oral and Biotechnological Sciences, University 'G. d'Annunzio,' Chieti, Italy
| | - Mauro Piantelli
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy. Department of Medical, Oral and Biotechnological Sciences, University 'G. d'Annunzio,' Chieti, Italy
| | - Saverio Alberti
- Unit of Cancer Pathology, CeSI-MeT, University 'G. d'Annunzio,' Chieti, Italy. Department of Neuroscience, Imaging and Clinical Sciences, Unit of Physiology and Physiopathology, University 'G. d'Annunzio,' Chieti, Italy.
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16
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Mittendorf EA, Bedrosian I, Hunt KK. Reply to L. Antolini et al. J Clin Oncol 2015; 33:3978-9. [PMID: 26282647 DOI: 10.1200/jco.2015.63.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Kelly K Hunt
- The University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Antolini L, Biganzoli E, Querzoli P, Piantelli M, Alberti S. Lymph Node Micrometastases Do Influence Breast Cancer Outcome. J Clin Oncol 2015; 33:3977-8. [DOI: 10.1200/jco.2015.63.0962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Liikanen J, Leidenius M, Joensuu H, Vironen J, Heikkilä P, Meretoja T. Breast cancer prognosis and isolated tumor cell findings in axillary lymph nodes after core needle biopsy and fine needle aspiration cytology: Biopsy method and breast cancer outcome. Eur J Surg Oncol 2015; 42:64-70. [PMID: 26427542 DOI: 10.1016/j.ejso.2015.08.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/11/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND It is unknown whether performing a core needle biopsy (CNB) to diagnose breast cancer increases the incidence of isolated tumor cells (ITC) in the axillary sentinel lymph nodes. METHODS Patients diagnosed with unilateral invasive pT1 breast cancer (≤2 cm in diameter, n = 1525) at a single center between February 2001 and August 2005 were included in this prospective observational cohort study. The patients were categorized into two groups according to the type of the preoperative breast needle biopsy performed, the CNB and the fine needle aspiration cytology (FNAC) groups, and followed up for a median of 9.5 years after breast surgery. RESULTS 868 (56.9%) patients had FNAC and 657 (43.2%) CNB. In the subset of patients with no axillary metastases (pN0, n = 1005) 70 patients had ITC, 37 (4.3%) out of the 546 patients in FNAC group and 33 (5.0%) out of the 459 patients in the CNB group (p = 0.798). The type of tumor biopsy did not influence breast cancer-specific survival (p = 0.461) or local recurrence-free survival (p = 0.814) in univariable survival analyses. Overall, survival favored the CNB group in a univariable analysis, but no difference in survival emerged in a multivariable analysis (p = 0.718). CONCLUSIONS CNB was not associated with a greater incidence of ITC in axillary lymph nodes as compared with FNAC, and did not have an adverse effect on survival outcomes in a patient population treated with modern adjuvant therapies.
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Affiliation(s)
- J Liikanen
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
| | - M Leidenius
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
| | - H Joensuu
- Helsinki University Central Hospital, Comprehensive Cancer Center, Department of Oncology, P.O. Box 180, FI-00029 Helsinki, Finland.
| | - J Vironen
- Helsinki University Central Hospital, Jorvi Hospital, Breast Surgery Unit, P.O. Box 800, FIN-00029 HUS, Finland.
| | - P Heikkilä
- Helsinki University Central Hospital, Department of Pathology, P.O. Box 400, FIN-00029 HUS, Finland.
| | - T Meretoja
- Helsinki University Central Hospital, Comprehensive Cancer Center, Breast Surgery Unit, P.O. Box 263, FIN-00029 HUS, Finland.
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19
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Kimbrough CW, McMasters KM, Quillo A, Ajkay N. Occult metastases in node-negative breast cancer: A Surveillance, Epidemiology, and End Results-based analysis. Surgery 2015; 158:494-500. [PMID: 26032821 DOI: 10.1016/j.surg.2015.03.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/02/2015] [Accepted: 03/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The role of immunohistochemistry (IHC) for detecting occult lymph node disease in patients initially found to be node-negative by routine pathology is controversial. In this study, we evaluated trends associated with overall survival in node-negative breast cancer patients staged by IHC. METHODS The Surveillance, Epidemiology, and End Results database was queried for all patients with invasive breast adenocarcinoma and negative lymph nodes on routine pathology between 2004 and 2011 who underwent IHC to evaluate for occult nodal disease. Overall survival stratified by N-stage was compared with Kaplan-Meier analysis. Multivariate analysis was performed using a Cox proportional hazards model. RESULTS Overall, 93,070 patients were identified, including 4,657 patients with isolated tumor cells (<0.2 mm diameter or <200 cells) and 6,720 patients with micrometastases (0.2-2 mm diameter). Kaplan-Meier curves demonstrated a difference in overall survival across all groups (P < .0001). On multivariate analysis, micrometastases remained an independent predictor for survival compared with IHC-negative patients (hazard ratio 1.40, 95% confidence interval 1.28-1.53), whereas isolated tumor cells were not a significant predictor (hazard ratio 1.05, 95% confidence interval 0.92-1.20). CONCLUSION Patients with occult micrometastases in axillary lymph nodes found via IHC demonstrated a significant overall survival difference, but isolated tumor cells have no prognostic significance.
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Affiliation(s)
- Charles W Kimbrough
- The Hiram C. Polk, Jr. MD, Department of Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Kelly M McMasters
- The Hiram C. Polk, Jr. MD, Department of Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Amy Quillo
- The Hiram C. Polk, Jr. MD, Department of Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Nicolas Ajkay
- The Hiram C. Polk, Jr. MD, Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
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20
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Li Y, Melnikov AA, Levenson V, Guerra E, Simeone P, Alberti S, Deng Y. A seven-gene CpG-island methylation panel predicts breast cancer progression. BMC Cancer 2015; 15:417. [PMID: 25986046 PMCID: PMC4438505 DOI: 10.1186/s12885-015-1412-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/01/2015] [Indexed: 12/31/2022] Open
Abstract
Background DNA methylation regulates gene expression, through the inhibition/activation of gene transcription of methylated/unmethylated genes. Hence, DNA methylation profiling can capture pivotal features of gene expression in cancer tissues from patients at the time of diagnosis. In this work, we analyzed a breast cancer case series, to identify DNA methylation determinants of metastatic versus non-metastatic tumors. Methods CpG-island methylation was evaluated on a 56-gene cancer-specific biomarker microarray in metastatic versus non-metastatic breast cancers in a multi-institutional case series of 123 breast cancer patients. Global statistical modeling and unsupervised hierarchical clustering were applied to identify a multi-gene binary classifier with high sensitivity and specificity. Network analysis was utilized to quantify the connectivity of the identified genes. Results Seven genes (BRCA1, DAPK1, MSH2, CDKN2A, PGR, PRKCDBP, RANKL) were found informative for prognosis of metastatic diffusion and were used to calculate classifier accuracy versus the entire data-set. Individual-gene performances showed sensitivities of 63–79 %, 53–84 % specificities, positive predictive values of 59–83 % and negative predictive values of 63–80 %. When modelled together, these seven genes reached a sensitivity of 93 %, 100 % specificity, a positive predictive value of 100 % and a negative predictive value of 93 %, with high statistical power. Unsupervised hierarchical clustering independently confirmed these findings, in close agreement with the accuracy measurements. Network analyses indicated tight interrelationship between the identified genes, suggesting this to be a functionally-coordinated module, linked to breast cancer progression. Conclusions Our findings identify CpG-island methylation profiles with deep impact on clinical outcome, paving the way for use as novel prognostic assays in clinical settings. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1412-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yan Li
- Rush University Medical Center, 653 W Congress Pkwy, Chicago, IL, 60612, USA.
| | | | - Victor Levenson
- US Biomarkers, Inc, 29 Buckingham Ln., Buffalo Grove, IL, 60089, USA. .,Currently at Center for Translational Research, Catholic Health Initiatives, Englewood, USA.
| | - Emanuela Guerra
- Unit of Cancer Pathology, CeSI, 'G. d'Annunzio' University Foundation, Via L. Polacchi 11, 66100, Chieti, Italy.
| | - Pasquale Simeone
- Unit of Cancer Pathology, CeSI, 'G. d'Annunzio' University Foundation, Via L. Polacchi 11, 66100, Chieti, Italy.
| | - Saverio Alberti
- Unit of Cancer Pathology, CeSI, 'G. d'Annunzio' University Foundation, Via L. Polacchi 11, 66100, Chieti, Italy. .,Department of Neuroscience, Imaging and Clinical Sciences, Unit of Physiology and Physiopathology, 'G. d'Annunzio' University, Via dei Vestini, 66100, Chieti, Italy.
| | - Youping Deng
- Rush University Medical Center, 653 W Congress Pkwy, Chicago, IL, 60612, USA.
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Blighe K, Kenny L, Patel N, Guttery DS, Page K, Gronau JH, Golshani C, Stebbing J, Coombes RC, Shaw JA. Whole genome sequence analysis suggests intratumoral heterogeneity in dissemination of breast cancer to lymph nodes. PLoS One 2014; 9:e115346. [PMID: 25546409 PMCID: PMC4278903 DOI: 10.1371/journal.pone.0115346] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/22/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intratumoral heterogeneity may help drive resistance to targeted therapies in cancer. In breast cancer, the presence of nodal metastases is a key indicator of poorer overall survival. The aim of this study was to identify somatic genetic alterations in early dissemination of breast cancer by whole genome next generation sequencing (NGS) of a primary breast tumor, a matched locally-involved axillary lymph node and healthy normal DNA from blood. METHODS Whole genome NGS was performed on 12 µg (range 11.1-13.3 µg) of DNA isolated from fresh-frozen primary breast tumor, axillary lymph node and peripheral blood following the DNA nanoball sequencing protocol. Single nucleotide variants, insertions, deletions, and substitutions were identified through a bioinformatic pipeline and compared to CIN25, a key set of genes associated with tumor metastasis. RESULTS Whole genome sequencing revealed overlapping variants between the tumor and node, but also variants that were unique to each. Novel mutations unique to the node included those found in two CIN25 targets, TGIF2 and CCNB2, which are related to transcription cyclin activity and chromosomal stability, respectively, and a unique frameshift in PDS5B, which is required for accurate sister chromatid segregation during cell division. We also identified dominant clonal variants that progressed from tumor to node, including SNVs in TP53 and ARAP3, which mediates rearrangements to the cytoskeleton and cell shape, and an insertion in TOP2A, the expression of which is significantly associated with tumor proliferation and can segregate breast cancers by outcome. CONCLUSION This case study provides preliminary evidence that primary tumor and early nodal metastasis have largely overlapping somatic genetic alterations. There were very few mutations unique to the involved node. However, significant conclusions regarding early dissemination needs analysis of a larger number of patient samples.
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Affiliation(s)
- Kevin Blighe
- Department of Cancer Studies and Molecular Medicine, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, United Kingdom
| | - Laura Kenny
- Division of Cancer, Imperial College, Hammersmith Hospital Campus, London, W12 0NN, United Kingdom
| | - Naina Patel
- Division of Cancer, Imperial College, Hammersmith Hospital Campus, London, W12 0NN, United Kingdom
| | - David S. Guttery
- Department of Cancer Studies and Molecular Medicine, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, United Kingdom
| | - Karen Page
- Department of Cancer Studies and Molecular Medicine, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, United Kingdom
| | - Julian H. Gronau
- Division of Cancer, Imperial College, Hammersmith Hospital Campus, London, W12 0NN, United Kingdom
| | - Cyrus Golshani
- Division of Cancer, Imperial College, Hammersmith Hospital Campus, London, W12 0NN, United Kingdom
| | - Justin Stebbing
- Division of Cancer, Imperial College, Hammersmith Hospital Campus, London, W12 0NN, United Kingdom
| | - R. Charles Coombes
- Division of Cancer, Imperial College, Hammersmith Hospital Campus, London, W12 0NN, United Kingdom
| | - Jacqueline A. Shaw
- Department of Cancer Studies and Molecular Medicine, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, United Kingdom
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Babar M, Madani R, Jackson P, Layer GT, Kissin MW, Irvine TE. One Step Nucleic Acid Amplification (OSNA) positive micrometastases and additional histopathological NSLN metastases: Results from a single institution over 53 months. Surgeon 2014; 14:76-81. [PMID: 25444440 DOI: 10.1016/j.surge.2014.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 05/26/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The role of sentinel lymph node micrometastases on histopathological analysis is controversial in axillary staging and management in clinically node negative breast cancer. Long-term studies addressing the clinical relevance of occult breast cancer in sentinel lymph nodes based on molecular analysis are lacking. One Step Nucleic Acid Amplification (OSNA), a highly sensitive assay of cytokeratin 19 mRNA, is used intra-operatively for the detection of lymph node macro- and micrometastases in breast cancer. AIM The aim of this study is to review the rate of micrometastases and further histopathological NSLN metastases, in our unit following the introduction of OSNA in Guildford. METHODS Data was collected prospectively from the period of introduction 01/12/2008 to 31/05/2013. All patients eligible for sentinel lymph node biopsy were offered OSNA and operations were performed by the consultant breast surgeons. Presence or absence of micro-metastases depends on the agreed cut-off point on the amplification curve. On detection of micrometastases (+) and positive but inhibited (i+) metastases, a level 1 axillary clearance (ANC) was performed and for a macrometastasis (++), a level 3 ANC was carried out. RESULTS 66% of the patients had negative SLN (n = 672) and 34% (n = 336) had positive sentinel lymph nodes who had further axillary surgery. Of these, 45% (n = 152/336) had macrometastases, 40% (n = 136/336) had micrometastases and 15% (48/336) had positive but inhibited results. There was no difference in the patient demographics and tumour characteristics in the various positive SLN groups. In patients with micrometastases, 15% (20/136) had further positive NLSNs and a further 6% (8/136) had >4 overall positive nodes (SLN + NSLN) thus requiring adjuvant supraclavicular/chest wall radiotherapy (p < 0.05). 25% of node positive patients had further NLSN metastases (85/336) and in these patients, the ratio of positive SLN/harvested SLN (+SLN/SLN) is constant at 1:1. This shows the likelihood of further positive NSLNs if all the harvested lymph nodes are positive. This linear trend is present in both micro-and macrometastases, thus correlating with the size and number of NSLN metastases. CONCLUSION Our study reflects the tumour burden of NSLNs based on the molecular analysis of the SLN. OSNA has the potential to accurately identify axillary micrometastases. Micro-metastases are important as some of the patients with micrometastases had overall four positive nodes [SLN + NSLN] (criteria for radiotherapy in the absence of other adverse clinicopathological features). Also, our study highlights certain factors that predict the NSLN metastases, pending validation by further prospective long-term data. This will allow accurate calculation of the axillary tumour burden, particularly in patients with micro-metastases.
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Affiliation(s)
- M Babar
- Department of Breast and Oncoplastic Surgery, Royal Surrey County Hospital, Guildford, UK.
| | - R Madani
- Department of Breast and Oncoplastic Surgery, Royal Surrey County Hospital, Guildford, UK
| | - P Jackson
- Department of Histopathology Royal Surrey County Hospital, Guildford, UK
| | - G T Layer
- Department of Breast and Oncoplastic Surgery, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK
| | - M W Kissin
- Department of Breast and Oncoplastic Surgery, Royal Surrey County Hospital, Guildford, UK
| | - T E Irvine
- Department of Breast and Oncoplastic Surgery, Royal Surrey County Hospital, Guildford, UK
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Lattanzio R, Ghasemi R, Brancati F, Sorda RL, Tinari N, Perracchio L, Iacobelli S, Mottolese M, Natali PG, Piantelli M. Membranous Nectin-4 expression is a risk factor for distant relapse of T1-T2, N0 luminal-A early breast cancer. Oncogenesis 2014; 3:e118. [PMID: 25178039 PMCID: PMC4183981 DOI: 10.1038/oncsis.2014.32] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/18/2014] [Accepted: 07/24/2014] [Indexed: 12/21/2022] Open
Abstract
Nectins are Ca(2+)-independent immunoglobulin-like cell adhesion molecules that compose a family of four members that regulate several cellular activities such as movement, proliferation, survival, differentiation, polarization, and the entry of viruses. Nectin-4 has recently emerged as a metastatis-associated protein in several cancers. Here, we have evaluated the association between the expression of Nectin-4 and the clinical outcome of patients with node-negative, T1/T2 breast cancers.The study group consisted of 197 patients presenting with primary unilateral breast carcinoma (T1/T2), with no evidence of nodal involvement and distant metastases. Nectin-4 protein expression was assessed by immunohistochemistry on tissue microarrays, and the results correlated with the clinical data using Kaplan-Meier curves and multivariate Cox regression analysis. Thirty-four out of 197 tumors (17.3%) exhibited Nectin-4 expression on cell membrane (m-Nectin-4) and 122 out of the 163m-Nectin-4 negative tumors (74.8%) showed high cytoplasmic expression of Nectin-4 (c-Nectin-4(High)). At Kaplan-Meier analysis, m-Nectin-4 positivity was significantly associated with a lower disease-free survival (DFS) and distant relapse-free survival (DRFS) rate in patients with a luminal-A phenotype (P=0.030 and P=0.002, respectively). Multivariate analysis showed that in luminal-A tumors m-Nectin-4 positivity is an independent prognostic factor for DFS (P=0.018) and DRFS (P=0.004), but not for local relapse-free survival (LRFS). On the other hand, c-Nectin-4(High) was significantly associated with higher rates of DFS and LRFS, but not DRFS, in the whole population (P=0.008 and P=0.004, respectively) and in patients with luminal-A tumors (P=0.022 and P=0.018, respectively). In patients with luminal-A tumors, multivariate analysis showed that the prognostic value of c-Nectin-4(Low/Negative) is limited to DFS (P=0.012) and LRFS (P=0.022). We suggest that Nectin-4 represents a prognostic factor and a therapeutic target in luminal-A early stage breast cancer.
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Affiliation(s)
- R Lattanzio
- 1] Department of Experimental and Clinical Sciences, Chieti, Italy [2] Center of Excellence for Research on Aging, Chieti, Italy [3] MediaPharma s.r.l., Chieti, Italy
| | - R Ghasemi
- 1] Department of Experimental and Clinical Sciences, Chieti, Italy [2] Center of Excellence for Research on Aging, Chieti, Italy [3] Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - F Brancati
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - R L Sorda
- 1] Department of Experimental and Clinical Sciences, Chieti, Italy [2] Center of Excellence for Research on Aging, Chieti, Italy [3] MediaPharma s.r.l., Chieti, Italy
| | - N Tinari
- 1] Department of Experimental and Clinical Sciences, Chieti, Italy [2] Center of Excellence for Research on Aging, Chieti, Italy [3] MediaPharma s.r.l., Chieti, Italy
| | - L Perracchio
- Department of Pathology, Regina Elena Cancer Institute, Rome, Italy
| | - S Iacobelli
- 1] Department of Experimental and Clinical Sciences, Chieti, Italy [2] Center of Excellence for Research on Aging, Chieti, Italy [3] MediaPharma s.r.l., Chieti, Italy
| | - M Mottolese
- Department of Pathology, Regina Elena Cancer Institute, Rome, Italy
| | - P G Natali
- CINBO Laboratories, University 'G. D'Annunzio', Chieti, Italy
| | - M Piantelli
- 1] Department of Experimental and Clinical Sciences, Chieti, Italy [2] Center of Excellence for Research on Aging, Chieti, Italy [3] MediaPharma s.r.l., Chieti, Italy
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Mittendorf EA, Hunt KK. Significance and management of micrometastases in patients with breast cancer. Expert Rev Anticancer Ther 2014; 7:1451-61. [DOI: 10.1586/14737140.7.10.1451] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Long-range transcriptome sequencing reveals cancer cell growth regulatory chimeric mRNA. Neoplasia 2013; 14:1087-96. [PMID: 23226102 DOI: 10.1593/neo.121342] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 08/16/2012] [Accepted: 09/30/2012] [Indexed: 12/15/2022] Open
Abstract
mRNA chimeras from chromosomal translocations often play a role as transforming oncogenes. However, cancer transcriptomes also contain mRNA chimeras that may play a role in tumor development, which arise as transcriptional or post-transcriptional events. To identify such chimeras, we developed a deterministic screening strategy for long-range sequence analysis. High-throughput, long-read sequencing was then performed on cDNA libraries from major tumor histotypes and corresponding normal tissues. These analyses led to the identification of 378 chimeras, with an unexpectedly high frequency of expression (≈2 x 10(-5) of all mRNA). Functional assays in breast and ovarian cancer cell lines showed that a large fraction of mRNA chimeras regulates cell replication. Strikingly, chimeras were shown to include both positive and negative regulators of cell growth, which functioned as such in a cell-type-specific manner. Replication-controlling chimeras were found to be expressed by most cancers from breast, ovary, colon, uterus, kidney, lung, and stomach, suggesting a widespread role in tumor development.
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Lattanzio R, Marchisio M, La Sorda R, Tinari N, Falasca M, Alberti S, Miscia S, Ercolani C, Di Benedetto A, Perracchio L, Melucci E, Iacobelli S, Mottolese M, Natali PG, Piantelli M. Overexpression of activated phospholipase Cγ1 is a risk factor for distant metastases in T1-T2, N0 breast cancer patients undergoing adjuvant chemotherapy. Int J Cancer 2012; 132:1022-31. [PMID: 22847294 DOI: 10.1002/ijc.27751] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/18/2012] [Indexed: 01/05/2023]
Abstract
Phospholipase Cγ1 (PLCγ1) is highly expressed in several tumors. We have previously reported that both stable and inducible PLCγ1 down-regulation resulted in an almost complete inhibition of breast cancer-derived experimental lung metastasis formation. The aim of our study is to evaluate the association between the expression of PLCγ1 and of PLCγ1 phosphorylated at Tyr1253 (PLCγ1-pY1253) and at Tyr783 (PLCγ1-pY783) with the clinical outcome of patients with node negative, T1/T2 breast cancers. The study groups consisted of 292 (training set) and 122 (validation set) patients presenting with primary unilateral breast carcinoma (T1-T2), with no evidence of nodal involvement and distant metastases. PLCγ1, PLCγ1-pY1253 and PLCγ1-pY783 protein expression were assessed by immunohistochemistry on tissue microarrays and the results correlated with the clinical data using Kaplan-Meier curves and multivariate Cox regression analysis. Tumor cells while expressing variable proportions of cytoplasmic PLCγ1, express PLCγ1-pY1253 and PLCγ1-pY783 predominantly in the nucleus. High expression of PLCγ1, and of its activated forms, is associated with a worse clinical outcome in terms of incidence of distant metastases, and not of local relapse in T1-T2, N0 breast cancer patients undergone adjuvant chemotherapy. PLCγ1 over-expression appears to be a reliable predictive surrogate marker of development of metastases. Thus, targeting PLCγ1 pathways might represent a potential therapeutic approach for the prevention of metastatic disease in breast cancer.
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Affiliation(s)
- Rossano Lattanzio
- Department of Biomedical Sciences, University G. D'Annunzio, Chieti, Italy
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Valla M, Gjertrud Mjønes P, Knopp S. Implementation of step sectioning in the examination of sentinel lymph nodes to improve the detection of micrometastases in breast cancer patients. APMIS 2012; 120:521-8. [PMID: 22716207 DOI: 10.1111/j.1600-0463.2011.02858.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The object of this study was to examine whether a new protocol for examination of sentinel lymph nodes (SLNs) would lead to the detection of more metastases. Sections of 1 mm would identify most SLN macrometastases, and step sections at intervals of 200-250 μm would identify most micrometastases. A total of 111 breast cancer patients who underwent the SLN procedure at St. Olavs University Hospital in Trondheim, Norway in 2008 were included in the study group. Their SLNs were processed according to a new standardized protocol with sections of 2-3 mm being step sectioned at intervals of 200-250 μm. A total of 109 breast cancer patients undergoing the SLN procedure in 2007 were used as a reference group. Metastases were found in 29% of the cases, compared with 26% in the reference group. Step sectioning of SLNs revealed metastases in five cases initially found to be negative. The metastases of the study group were smaller, with a median value of 1.25 mm compared with 4.25 mm in the reference group. Step sectioning led to the detection of metastases in SLNs initially found to be negative. The median size of the metastases was considerably smaller in the study group than in the reference group.
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Affiliation(s)
- Marit Valla
- Department of Pathology and Medical Genetics, St. Olavs University Hospital, Trondheim, Norway.
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Guerra E, Trerotola M, Aloisi AL, Tripaldi R, Vacca G, La Sorda R, Lattanzio R, Piantelli M, Alberti S. The Trop-2 signalling network in cancer growth. Oncogene 2012; 32:1594-600. [PMID: 22562244 DOI: 10.1038/onc.2012.151] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Our findings show that upregulation of a wild-type Trop-2 has a key controlling role in human cancer growth, and that tumour development is quantitatively driven by Trop-2 expression levels. However, little is known about the regulation of expression of the TROP2 gene. Hence, we investigated the TROP2 transcription control network. TROP2 expression was shown to depend on a highly interconnected web of transcription factors: TP63/TP53L, ERG, GRHL1/Get-1 (grainyhead-like epithelial transactivator), HNF1A/TCF-1 (T-cell factor), SPI1/PU.1, WT (Wilms' tumour)1, GLIS2, AIRE (autoimmune regulator), FOXM1 (forkhead box M1) and FOXP3, with HNF4A as the major network hub. TROP2 upregulation was shown to subsequently drive the expression and activation of CREB1 (cyclic AMP-responsive-element binding protein), Jun, NF-κB, Rb, STAT1 and STAT3 through induction of the cyclin D1 and ERK (extracellular signal regulated kinase)/MEK (MAPK/ERK kinase) pathways. Growth-stimulatory signalling through NF-κB, cyclin D1 and ERK was shown to require an intact Trop-2 cytoplasmic tail. Network hubs and interacting partners are co-expressed with Trop-2 in primary human tumours, supporting a role of this signalling network in cancer growth.
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Affiliation(s)
- E Guerra
- Unit of Cancer Pathology, Department of Oncology and Experimental Medicine and CeSI, Foundation University 'G. d'Annunzio', Chieti, Italy
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Wu Y, Mittendorf EA, Kelten C, Tucker SL, Wei W, Middleton LP, Broglio K, Buchholz TA, Hunt KK, Sahin AA. Occult axillary lymph node metastases do not have prognostic significance in early stage breast cancer. Cancer 2012; 118:1507-14. [PMID: 22009292 DOI: 10.1002/cncr.26458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/22/2011] [Accepted: 06/22/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND Axillary lymph node status is one of the most powerful prognostic indicators in patients with breast cancer and has implications for adjuvant treatment. It has been demonstrated that enhanced histologic evaluation of axillary lymph nodes, including serial sectioning of paraffin tissue blocks and immunohistochemical (IHC) staining, increases the rate of detection of occult metastases. The clinical significance of occult lymph node metastases has been the subject of debate. METHODS In the current study, the authors identified 267 patients who underwent axillary lymph node dissection (ALND) between 1987 and 1995 and were lymph node negative according to a routine pathologic evaluation, which included the complete submission of all lymph nodes and an examination of 1 hematoxylin and eosin (H&E)-stained section per paraffin block. Patients did not receive systemic chemotherapy or hormone therapy. All of the dissected lymph nodes from these patients were re-evaluated by intensified pathologic methods (serial sectioning with H&E levels plus IHC). Occult metastases were categorized by detection method and size. The clinical significance of the occult metastases was determined. RESULTS Thirty-nine patients (15%) who had lymph node-negative results on routine evaluation of their ALND specimens had occult metastases identified. Eight of these patients (20%) had macrometastases >2.0 mm, 15 (40%) had micrometastases (range, >0.2 mm to ≤2 mm), and 16 (40%) had isolated tumor cells (≤0.2 mm). The presence of occult metastases and the size of metastases did not affect recurrence-free or overall survival. CONCLUSIONS The presence of occult metastasis did not have clinical significance in this cohort of patients with early stage breast cancer.
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Affiliation(s)
- Yun Wu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Trerotola M, Cantanelli P, Guerra E, Tripaldi R, Aloisi AL, Bonasera V, Lattanzio R, Lange RD, Weidle UH, Piantelli M, Alberti S. Upregulation of Trop-2 quantitatively stimulates human cancer growth. Oncogene 2012; 32:222-33. [DOI: 10.1038/onc.2012.36] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Hasebe T, Iwasaki M, Akashi-Tanaka S, Hojo T, Shibata T, Sasajima Y, Kinoshita T, Tsuda H. Prognostic significance of mitotic figures in metastatic mammary ductal carcinoma to the lymph nodes. Hum Pathol 2011; 42:1823-32. [DOI: 10.1016/j.humpath.2011.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/12/2011] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
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Houvenaeghel G, Bannier M, Nos C, Giard S, Mignotte H, Jacquemier J, Martino M, Esterni B, Belichard C, Classe JM, Tunon de Lara C, Cohen M, Payan R, Blanchot J, Rouanet P, Penault-Llorca F, Bonnier P, Fournet S, Agostini A, Marchal F, Garbay JR. Non sentinel node involvement prediction for sentinel node micrometastases in breast cancer: nomogram validation and comparison with other models. Breast 2011; 21:204-9. [PMID: 22014859 DOI: 10.1016/j.breast.2011.09.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/12/2011] [Accepted: 09/18/2011] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The risk of non sentinel node (NSN) involvement varies in function of the characteristics of sentinel nodes (SN) and primary tumor. Our aim was to determine and validate a statistical tool (a nomogram) able to predict the risk of NSN involvement in case of SN micro or sub-micrometastasis of breast cancer. We have compared this monogram with other models described in the literature. METHODS We have collected data on 905 patients, then 484 other patients, to build and validate the nomogram and compare it with other published scores and nomograms. RESULTS Multivariate analysis conducted on the data of the first cohort allowed us to define a nomogram based on 5 criteria: the method of SN detection (immunohistochemistry or by standard coloration with HES); the ratio of positive SN out of total removed SN; the pathologic size of the tumor; the histological type; and the presence (or not) of lympho-vascular invasion. The nomogram developed here is the only one dedicated to micrometastasis and developed on the basis of two large cohorts. The results of this statistical tool in the calculation of the risk of NSN involvement is similar to those of the MSKCC (the similarly more effective nomogram according to the literature), with a lower rate of false negatives. CONCLUSION this nomogram is dedicated specifically to cases of SN involvement by metastasis lower or equal to 2 mm. It could be used in clinical practice in the way to omit ALND when the risk of NSN involvement is low.
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Prognostic impact of isolated tumor cells in breast cancer axillary nodes: single tumor cell(s) versus tumor cell cluster(s) and microanatomic location. Breast Cancer Res Treat 2011; 131:645-51. [PMID: 21927853 DOI: 10.1007/s10549-011-1771-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 09/03/2011] [Indexed: 10/17/2022]
Abstract
In breast cancer, it has been shown that pN0(i+) and pN1mi have a comparable negative impact on disease-free survival, compared with pN0. However, pN0(i+) is considered to be a heterogeneous group. We determined the effect of metastatic size and microanatomic location within the pN0(i+) group on breast cancer recurrence. We included all Dutch breast cancer patients diagnosed in 1998-2005 with favorable primary tumor characteristics and a final nodal status of pN0(i+). For this analysis, only patients without adjuvant systemic therapy were eligible (n = 513). Presence of single tumor cells versus cell clusters, metastatic size and microanatomic location were recorded. Primary endpoint was disease-free survival. Analyses were adjusted for age at diagnosis, tumor size, tumor grade, axillary treatment and hormone receptor status. The 5-year disease-free survival of patients with single tumor cell(s) (n = 93) was 78.6% and with tumor cell cluster(s) (n = 404) 77.1%. The hazard ratio for disease events was 1.05 (95% CI 0.63-1.76) for cell cluster(s) compared with single cell(s). In a Cox regression model, doubling of metastatic tumor size corresponded to a hazard ratio of 1.21 (95% CI 1.02-1.43). The adjusted hazard ratio was 0.90 (95% CI 0.54-1.50) for parenchymal (n = 112) versus sinusoidal location (n = 395). Single tumor cells bear similar prognostic information as small tumor cell clusters, even though results do suggest that within the pN0(i+) group, increasing size of nodal involvement is associated with reduced survival. Microanatomic location does not seem to have prognostic relevance.
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Tveito S, Andersen K, Kåresen R, Fodstad Ø. Analysis of EpCAM positive cells isolated from sentinel lymph nodes of breast cancer patients identifies subpopulations of cells with distinct transcription profiles. Breast Cancer Res 2011; 13:R75. [PMID: 21816090 PMCID: PMC3236339 DOI: 10.1186/bcr2922] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 05/18/2011] [Accepted: 08/04/2011] [Indexed: 01/01/2023] Open
Abstract
Introduction The presence of tumor cells in the axillary lymph nodes is the most important prognostic factor in early stage breast cancer. However, the optimal method for sentinel lymph node (SLN) examination is still sought and currently many different protocols are employed. To examine two approaches for tumor cell detection we performed, in sequence, immunomagnetic enrichment and RT-PCR analysis on SLN samples from early stage breast cancer patients. This allowed us to compare findings based on the expression of cell surface proteins with those based on detection of intracellular transcripts. Methods Enrichment of EpCAM and Mucin 1 expressing cells from fresh SLN samples was achieved using magnetic beads coated with the appropriate antibodies. All resulting cell fractions were analyzed by RT-PCR using four chosen breast epithelial markers (hMAM, AGR2, SBEM, TFF1). Gene expression was further analyzed using RT-PCR arrays and markers for epithelial to mesenchymal transition (EMT). Results Both EpCAM and Mucin 1 enriched for the epithelial-marker expressing cells. However, EpCAM-IMS identified epithelial cells in 71 SLNs, whereas only 35 samples were positive with RT-PCR targeting breast epithelial transcripts. Further analysis of EpCAM positive but RT-PCR negative cell fractions showed that they had increased expression of MMPs, repressors of E-cadherin, SPARC and vimentin, all transcripts associated with the process of epithelial to mesenchymal transition. Conclusions The EpCAM IMS-assay detected tumor cells with epithelial and mesenchymal-like characteristics, thus proving to be a more robust marker than pure epithelial derived biomarkers. This finding has clinical implications, as most methods for SLN analysis today rely on the detection of epithelial transcripts or proteins.
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Affiliation(s)
- Siri Tveito
- Department of Tumor Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, PB 4953 Nydalen, 0424 Oslo, Norway.
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Clinical significance of sentinel lymph node isolated tumour cells in breast cancer. Breast Cancer Res Treat 2011; 127:325-34. [PMID: 21455668 DOI: 10.1007/s10549-011-1476-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 03/19/2011] [Indexed: 12/16/2022]
Abstract
The advent of sentinel lymph node biopsy (SLNB) and improvements in histopathological and molecular analysis have increased the rate at which isolated tumour cells (ITC) are identified. However, their biological and clinical significance has been the subject of much debate. In this article we review the literature concerning SLNB with particular reference to ITC. The controversies regarding histopathological assessment, clinical relevance and management implications are explored. The literature review was facilitated by Medline, PubMed, Embase and Cochrane databases. Published studies have reported divergent results regarding the biological significance and clinical implications of ITC in general and SLN ITC in particular. Some studies demonstrate no associations, whilst others have found these to be indicators of poor prognosis, associated with non-SLN involvement, in addition to local recurrence and distant disease. Absolute consensus regarding the optimal analytical technique for SLN has yet to be reached, particularly concerning immunohistochemical (IHC) techniques targeting cytokeratins and contemporary molecular analysis. The clinical relevance of ITC within the SLN should be primarily determined by the magnitude of their impact on patient management and outcome measures. The modest up-staging within current classification systems is justified and reflects the marginally poorer prognosis for women with SLN ITC. Management need not be altered where further axillary treatment with surgical clearance or radiotherapy and systemic adjuvant treatment are already indicated. However, in the absence of level-1 guidance, each case requires discussion with regard to other tumour and patient related factors in the context of the multidisciplinary team. The identification of ITC remains highly dependent on the analytical technique employed and there exists potential for stage migration and impact on management decisions. Evidence supporting the routine analysis of deeper tissue sections by IHC is lacking and molecular technologies should be restricted to research purposes at present.
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Khafagy M, Mostafa A, Fakhr I. Distribution of axillary lymph node metastases in different levels and groups in breast cancer, a pathological study. J Egypt Natl Canc Inst 2011; 23:25-30. [DOI: 10.1016/j.jnci.2011.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 02/18/2011] [Indexed: 12/01/2022] Open
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Fritzsche FR, Reineke T, Morawietz L, Kristiansen G, Dietel M, Fink D, Rageth C, Honegger C, Caduff R, Moch H, Varga Z. Pathological Processing Techniques and Final Diagnosis of Breast Cancer Sentinel Lymph Nodes. Ann Surg Oncol 2010; 17:2892-8. [DOI: 10.1245/s10434-010-1097-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Indexed: 11/18/2022]
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Cai S, Thati S, Bagby TR, Diab HM, Davies NM, Cohen MS, Forrest ML. Localized doxorubicin chemotherapy with a biopolymeric nanocarrier improves survival and reduces toxicity in xenografts of human breast cancer. J Control Release 2010; 146:212-8. [PMID: 20403395 DOI: 10.1016/j.jconrel.2010.04.006] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 04/01/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Abstract
Patients with metastatic breast cancer have a five-year survival rate of 27% compared to 98% for localized cancer, and the presence of even a few cancer cells in lymph nodes, known as isolated tumor cells or nanometastases, significantly increases the risk of relapse in the absence of aggressive treatment. Therefore, diagnosis and treatment of lymphatic metastases in early breast cancer plays an important role in patient survival. Here, we demonstrate the first description of a delivery system for localized doxorubicin chemotherapy to the breast tissue. The hyaluronan-doxorubicin nanoconjugate exhibits a sustained release characteristic in vitro and in vivo in the breast tissues of rodents bearing human breast cancer xenografts. In addition, the conjugate reduces dose-limiting cardiac toxicity with minimal toxicity observed in normal tissues. Finally, the conjugate dramatically inhibits breast cancer progression in vivo, leading to an increased survival rate. Thus, localized chemotherapy to the breast lymphatics with a nanocarrier may represent an improved strategy for treatment of early stage breast cancers.
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Affiliation(s)
- Shuang Cai
- Department of Pharmaceutical Chemistry, University of Kansas, United States
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Rao DA, Forrest ML, Alani AWG, Kwon GS, Robinson JR. Biodegradable PLGA based nanoparticles for sustained regional lymphatic drug delivery. J Pharm Sci 2010; 99:2018-31. [PMID: 19902520 PMCID: PMC5178132 DOI: 10.1002/jps.21970] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The purpose of this work is to evaluate biodegradable drug carriers with defined size, hydrophobicity, and surface charge density for preferential lymphatic uptake and retention for sustained regional drug delivery. PLGA-PMA:PLA-PEG (PP) nanoparticles of defined size and relative hydrophobicity were prepared by nanoprecipitation method. These were compared with PS particles of similar sizes and higher hydrophobicity. PLGA-PMA:PLGA-COOH (PC) particles at 80:20, 50:50, and 20:80 ratios were prepared by nanoprecipitation for the charge study. Particle size and zeta potential were characterized by dynamic light scattering and laser doppler anemometry, respectively. Particles were administered in vivo to rats subcutaneously. Systemic and lymph node uptake was evaluated by marker recovery. Lymphatic uptake and node retention of PP nanoparticles was shown to be inversely related to size. Lymphatic uptake and node retention of PP particles, as compared to PS particles, was shown to be inversely related to hydrophobicity. Lastly, lymphatic uptake and node retention of PC nanoparticles were directly related to the anionic charge on the particles. In vivo lymphatic uptake and retention in a rat model indicates that the 50 nm PP particles are ideal for sustained regional delivery into the lymphatics for prevention/treatment of oligometastases.
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Affiliation(s)
- Deepa A Rao
- Department of Pharmaceutical Sciences, Drake University, Des Moines, Iowa 50265, USA.
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41
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de Boer M, van Dijck JAAM, Bult P, Borm GF, Tjan-Heijnen VCG. Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. J Natl Cancer Inst 2010; 102:410-25. [PMID: 20190185 DOI: 10.1093/jnci/djq008] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The prognostic relevance of isolated tumor cells and micrometastases in lymph nodes from patients with breast cancer has become a major issue since the introduction of the sentinel lymph node procedure. We conducted a systematic review of this issue. METHODS Studies published from January 1, 1977, until August 11, 2008, were identified by use of MEDLINE, EMBASE, and the Cochrane Library. A total of 58 studies (total number of patients = 297,533) were included and divided into three categories according to the method for pathological assessment of the lymph nodes: cohort studies with single-section pathological examination of axillary lymph nodes (n = 285,638 patients), occult metastases studies with retrospective examination of negative lymph nodes by step sectioning and/or immunohistochemistry (n = 7740 patients), and sentinel lymph node biopsy studies with intensified work-up of the sentinel but not of the nonsentinel lymph nodes (n = 4155 patients). We used random-effects meta-analyses to calculate pooled estimates of the relative risks (RRs) of 5- and 10-year disease recurrence and death and the multivariably corrected pooled hazard ratio (HR) of overall survival of the cohort studies. RESULTS In the cohort studies, the presence (vs the absence) of metastases of 2 mm or less in diameter in axillary lymph nodes was associated with poorer overall survival (pooled HR of death = 1.44, 95% confidence interval [CI] = 1.29 to 1.62). In the occult metastases studies, the presence (vs the absence) of occult metastases was associated with poorer 5-year disease-free survival (pooled RR = 1.55, 95% CI = 1.32 to 1.82) and overall survival (pooled RR = 1.45, 95% CI = 1.11 to 1.88), although these endpoints were not consistently assessed in multivariable analyses. Sentinel lymph node biopsy studies were limited by small patient groups and short follow-up. CONCLUSION The presence (vs the absence) of metastases of 2 mm or less in diameter in axillary lymph nodes detected on single-section examination was associated with poorer disease-free and overall survival.
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Affiliation(s)
- M de Boer
- Division of Medical Oncology, Department of Internal Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Rao DA, Forrest ML, Alani AWG, Kwon GS, Robinson JR. Biodegradable PLGA based nanoparticles for sustained regional lymphatic drug delivery. J Pharm Sci 2009. [PMID: 19902520 DOI: 10.1002/jps.21970.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this work is to evaluate biodegradable drug carriers with defined size, hydrophobicity, and surface charge density for preferential lymphatic uptake and retention for sustained regional drug delivery. PLGA-PMA:PLA-PEG (PP) nanoparticles of defined size and relative hydrophobicity were prepared by nanoprecipitation method. These were compared with PS particles of similar sizes and higher hydrophobicity. PLGA-PMA:PLGA-COOH (PC) particles at 80:20, 50:50, and 20:80 ratios were prepared by nanoprecipitation for the charge study. Particle size and zeta potential were characterized by dynamic light scattering and laser doppler anemometry, respectively. Particles were administered in vivo to rats subcutaneously. Systemic and lymph node uptake was evaluated by marker recovery. Lymphatic uptake and node retention of PP nanoparticles was shown to be inversely related to size. Lymphatic uptake and node retention of PP particles, as compared to PS particles, was shown to be inversely related to hydrophobicity. Lastly, lymphatic uptake and node retention of PC nanoparticles were directly related to the anionic charge on the particles. In vivo lymphatic uptake and retention in a rat model indicates that the 50 nm PP particles are ideal for sustained regional delivery into the lymphatics for prevention/treatment of oligometastases.
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Affiliation(s)
- Deepa A Rao
- Department of Pharmaceutical Sciences, Drake University, Des Moines, Iowa 50265, USA.
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Leidenius MHK, Vironen JH, Heikkilä PS, Joensuu H. Influence of Isolated Tumor Cells in Sentinel Nodes on Outcome in Small, Node-Negative (pT1N0M0) Breast Cancer. Ann Surg Oncol 2009; 17:254-62. [DOI: 10.1245/s10434-009-0723-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Indexed: 02/01/2023]
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Daniele L, Annaratone L, Allia E, Mariani S, Armando E, Bosco M, Macrì L, Cassoni P, D’Armento G, Bussolati G, Cserni G, Sapino A. Technical limits of comparison of step-sectioning,immunohistochemistry and RT-PCR on breast cancer sentinel nodes: a study on methacarn-fixed tissue. J Cell Mol Med 2009; 13:4042-50. [PMID: 18671755 PMCID: PMC4516551 DOI: 10.1111/j.1582-4934.2008.00449.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 07/25/2008] [Indexed: 11/28/2022] Open
Abstract
The optimal pathological assessment of sentinel nodes (SLNs) in breast cancer is a matter of debate. Currently, multilevel histological evaluation and immunohistochemistry (IHC) are recommended, but alternative RT-PCR procedures have been developed. To assess the reliability of these different procedures, we devised a step-sectioning protocol at 100 micron-intervals of 74 SLNs using methacarn fixation. mRNA was extracted from sections collected from levels 4 to 5. Mammaglobin, CEA and CK19 were used for RT-PCR. mRNA extraction was successful in 69 SLNs. Of these, 7 showed macrometastases (>2mm), 2 showed micrometastases (<2 mm) and 7 showed isolated tumour cells (ITC) by IHC. RT-PCR was positive for the three markers in 6 of 7 macrometastases and in 1 of 2 micrometastases. In the 2 RT-PCR negative cases, metastases were detected only on sections distant from those analysed by RT-PCR. CEA and/or CK19 were positive by RT-PCR in 3 of 7 ITC and in 23 morphologically negative SLNs. In conclusion, the main goal of our study was to show that the use of alternate sections of the same sample for different procedures is the key reason for the discrepancies between molecular and morphological analyses of SLN. We believe that only prospective studies with quantitative mRNA analysis of specific metastatic markers on the whole lymph node can elucidate the utility of molecular assessments of SLN.
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Affiliation(s)
- Lorenzo Daniele
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Laura Annaratone
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Elena Allia
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Sara Mariani
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Enrico Armando
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Martino Bosco
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Luigia Macrì
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Paola Cassoni
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Giuseppe D’Armento
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Gianni Bussolati
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
| | - Gabor Cserni
- Department of Surgical Pathology, Bács-Kiskun County Teaching HospitalKecskemét, Hungary
| | - Anna Sapino
- Department of Biomedical Sciences and Human Oncology, University of TurinTurin, Italy
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Cserni G, Decker T. [Sentinel node biopsy in breast cancer: pathological analysis and interpretation]. DER PATHOLOGE 2009; 30:156-62. [PMID: 19224216 DOI: 10.1007/s00292-008-1099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This overview examines how the introduction of sentinel lymph node biopsy (SLNB) has changed the pathological staging of breast cancer. The more intensive analysis of the sentinel lymph nodes (gross slicing, step sections, immunohistological or molecular analysis) has lead to stage shifting in breast cancer. Regarding the rate of up-staging by positive results of SLNB, there are significant differences between institutes, some method-related, some related to the interpretation of results. Methodological differences should be reduced by means of reliable guidelines with the goal of systematically identifying metastases of a particular size (a macrometastasis over 2 mm being the minimum criterion). The next review of the TNM classification should result in a reduction in interobserver variability as a result of better definitions of staging categories for isolated tumor cells and micrometastases. In addition, a staging category is expected for metastases which have been identified by calibrated quantitative molecular tests only and which are larger than isolated tumors. Even in settings where nodal staging by SLNB is based on molecular tests at least a proportion of the lymph node should be investigated histologically.
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Affiliation(s)
- G Cserni
- Bács-Kiskun County Teaching Hospital, Kecskemét, Ungarn.
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Axillary recurrence rate after tumour negative and micrometastatic positive sentinel node procedures in breast cancer patients, a population based multicenter study. Eur J Surg Oncol 2009; 35:25-31. [DOI: 10.1016/j.ejso.2008.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 05/27/2008] [Accepted: 06/02/2008] [Indexed: 11/22/2022] Open
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Kim G, Choi JH, Kim WW, Lee SK, Lim HI, Cho EY, Lee JE, Nam SJ, Yang JH. Implications of Isolated Tumor Cells in Sentinel Lymph Nodes of Breast Cancer Patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.6.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gyunji Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyuck Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wan Wook Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye In Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ambrogi F, Biganzoli E, Boracchi P. Estimates of clinically useful measures in competing risks survival analysis. Stat Med 2008; 27:6407-25. [DOI: 10.1002/sim.3455] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Reed J, Rosman M, Verbanac KM, Mannie A, Cheng Z, Tafra L. Prognostic implications of isolated tumor cells and micrometastases in sentinel nodes of patients with invasive breast cancer: 10-year analysis of patients enrolled in the prospective East Carolina University/Anne Arundel Medical Center Sentinel Node Multicenter Study. J Am Coll Surg 2008; 208:333-40. [PMID: 19317993 DOI: 10.1016/j.jamcollsurg.2008.10.036] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 10/16/2008] [Accepted: 10/27/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is a more sensitive and accurate nodal staging procedure than axillary lymph node dissection (ALND). Because of increased pathologic evaluation in the sentinel node era, more nodal micrometastases (MIC) (> 0.2 mm to 2 mm) and isolated tumor cells (ITC; < or = 0.2 mm) have been identified. We present the 10-year analysis of our prospective SLN study, focusing on regional axillary node status and distant metastases in patients with nodal ITC and MIC. STUDY DESIGN From 1996 to 2005, breast cancer patients were enrolled in an Institutional Review Board-approved, multicenter study. SLNs were examined at multiple levels by hematoxylin and eosin; most (85%) hematoxylin and eosin-negative SLNs were also examined by cytokeratin immunohistochemistry. Data from 1,259 patients with invasive breast cancer and in whom an SLN was found were reviewed for this analysis. RESULTS Of the 1,259 patients, 893 (71%) had negative SLNs, 25 (2%) had ITCs, 57 (5%) had MIC, and 284 (23%) had positive SLNs. None of the 13 patients with ITCs who underwent an ALND had additional positive nodes, compared with 27% (11 of 41) of patients with MIC. At a mean followup of 4.9 years, the distant recurrence rates for SLN-negative, ITC, MIC, and SLN-positive groups were 6%, 8%, 14%, and 21%, respectively. The presence of MIC in the SLN was associated with a significantly shorter disease-free interval than was SLN negativity (p < 0.02 by Cox regression model). CONCLUSIONS This prospective breast cancer study found that sentinel node MIC, but not ITCs, were associated with additional positive nodes and with distant recurrence. These data suggest that ALND may be unnecessary in patients with ITCs. But ALND and more aggressive adjuvant therapy should be considered in patients with SLN micrometastases.
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Affiliation(s)
- Jennifer Reed
- The Breast Center for Anne Arundel Medical Center, Annapolis, MD 21401, USA
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Hulvat M, Rajan P, Rajan E, Sarker S, Schermer C, Aranha G, Yao K. Histopathologic characteristics of the primary tumor in breast cancer patients with isolated tumor cells of the sentinel node. Surgery 2008; 144:518-24; discussion 524. [DOI: 10.1016/j.surg.2008.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 06/12/2008] [Indexed: 11/24/2022]
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