1
|
Kikuchi Y, Shimada H, Yamasaki F, Yamashita T, Araki K, Horimoto K, Yajima S, Yashiro M, Yokoi K, Cho H, Ehira T, Nakahara K, Yasuda H, Isobe K, Hayashida T, Hatakeyama S, Akakura K, Aoki D, Nomura H, Tada Y, Yoshimatsu Y, Miyachi H, Takebayashi C, Hanamura I, Takahashi H. Clinical practice guidelines for molecular tumor marker, 2nd edition review part 2. Int J Clin Oncol 2024; 29:512-534. [PMID: 38493447 DOI: 10.1007/s10147-024-02497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
In recent years, rapid advancement in gene/protein analysis technology has resulted in target molecule identification that may be useful in cancer treatment. Therefore, "Clinical Practice Guidelines for Molecular Tumor Marker, Second Edition" was published in Japan in September 2021. These guidelines were established to align the clinical usefulness of external diagnostic products with the evaluation criteria of the Pharmaceuticals and Medical Devices Agency. The guidelines were scoped for each tumor, and a clinical questionnaire was developed based on a serious clinical problem. This guideline was based on a careful review of the evidence obtained through a literature search, and recommendations were identified following the recommended grades of the Medical Information Network Distribution Services (Minds). Therefore, this guideline can be a tool for cancer treatment in clinical practice. We have already reported the review portion of "Clinical Practice Guidelines for Molecular Tumor Marker, Second Edition" as Part 1. Here, we present the English version of each part of the Clinical Practice Guidelines for Molecular Tumor Marker, Second Edition.
Collapse
Affiliation(s)
| | - Hideaki Shimada
- Department of Clinical Oncology, Toho University, Tokyo, Japan.
- Department of Surgery, Toho University, Tokyo, Japan.
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taku Yamashita
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koji Araki
- Department of Otorhinolaryngology-Head and Neck Surgery, National Defense Medical College, Saitama, Japan
| | - Kohei Horimoto
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Masakazu Yashiro
- Department of Molecular Oncology and Therapeutics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Keigo Yokoi
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takuya Ehira
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kazunari Nakahara
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroshi Yasuda
- Department of Gastroenterology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kazutoshi Isobe
- Division of Respiratory Medicine, Department of Internal Medicine (Omori), Toho University, Tokyo, Japan
| | - Tetsu Hayashida
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | | | - Daisuke Aoki
- International University of Health and Welfare Graduate School, Tokyo, Japan
| | - Hiroyuki Nomura
- Department of Obstetrics and Gynecology, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yuji Tada
- Department of Pulmonology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Yuki Yoshimatsu
- Department of Patient-Derived Cancer Model, Tochigi Cancer Center Research Institute, Tochigi, Japan
| | - Hayato Miyachi
- Faculty of Clinical Laboratory Sciences, Nitobe Bunka College, Tokyo, Japan
| | - Chiaki Takebayashi
- Division of Hematology and Oncology, Department of Internal Medicine (Omori), Toho University, Tokyo, Japan
| | - Ichiro Hanamura
- Division of Hematology, Department of Internal Medicine, Aichi Medical University, Aichi, Japan
| | | |
Collapse
|
2
|
Deutsch TM, Fischer C, Riedel F, Haßdenteufel K, Michel LL, Sütterlin M, Riethdorf S, Pantel K, Wallwiener M, Schneeweiss A, Stefanovic S. Relationship of Ki-67 index in biopsies of metastatic breast cancer tissue and circulating tumor cells (CTCs) at the time of biopsy collection. Arch Gynecol Obstet 2024; 309:235-248. [PMID: 37480379 PMCID: PMC10769933 DOI: 10.1007/s00404-023-07080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/11/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND The proliferation marker Ki-67 is a major pathological feature for the description of the state of disease in breast cancer. It helps to define the molecular subtype and to stratify between therapy regimens in early breast cancer and helps to assess the therapy response. Circulating tumor cells (CTCs) are a negative prognostic biomarker for progression free (PFS) and overall survival (OS) in patients with metastatic breast cancer. Therefore, the CTC count is often described as surrogate for the tumor burden. Both, decrease of Ki-67 and CTC count are considered as evidence for therapy response. The presented work analyzed the correlation between the Ki-67 indices of metastatic tissue biopsies and CTC counts in biopsy time-adjacent peripheral blood samples. PATIENTS AND METHODS Blood samples from 70 metastatic breast cancer patients were obtained before the start of a new line of systemic therapy. CTCs were enumerated using CellSearch® (Menarini Silicon Biosystems, Bologna, Italy) whereas intact CTCs (iCTCs) and non-intact or apoptotic CTCs (aCTCs) were distinguished using morphologic criteria. The proportion of cells expressing Ki-67 was evaluated using immunohistochemistry on biopsies of metastases obtained concurrently with CTC sampling before the start of a new line of systemic therapy. RESULTS 65.7% of patients had a Ki-67 index of > 25%. 28.6% of patients had ≥ 5, 47.1% ≥ 1 iCTCs. 37.1% had ≥ 5, 51.4% ≥ 1 aCTCs. No correlation was shown between Ki-67 index and iCTC and aCTC count (r = 0.05 resp. r = 0.05, Spearman's correlation index). High CTC-counts did not coincide with high Ki-67 index. High Ki-67, ≥ 5 iCTCs and aCTCs are associated with poor progression free (PFS) and overall survival (OS). CONCLUSION CTCs and Ki-67 are independent prognostic markers in metastatic breast cancer. High Ki-67 in metastatic tumor tissue is not correlated to high iCTC or aCTC counts in peripheral blood.
Collapse
Affiliation(s)
- Thomas M Deutsch
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Chiara Fischer
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Fabian Riedel
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Kathrin Haßdenteufel
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Laura L Michel
- National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sabine Riethdorf
- Institute of Tumor Biology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Klaus Pantel
- Institute of Tumor Biology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Stefan Stefanovic
- Department of Gynecology and Obstetrics, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
3
|
Zhang W, Xu K, Li Z, Wang L, Chen H. Tumor immune microenvironment components and the other markers can predict the efficacy of neoadjuvant chemotherapy for breast cancer. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2023; 25:1579-1593. [PMID: 36652115 DOI: 10.1007/s12094-023-03075-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
Breast cancer is an epithelial malignant tumor that occurs in the terminal ducts of the breast. Neoadjuvant chemotherapy (NACT) is an important part of breast cancer treatment. Its purpose is to use systemic treatment for some locally advanced breast cancer patients, to decrease the tumor size and clinical stage so that non-operable breast cancer patients can have a chance to access surgical treatment, or patients who are not suitable for breast-conserving surgery can get the opportunity of breast-conserving. However, some patients who do not respond to NACT will lead deterioration in their condition. Therefore, prediction of NACT efficacy in breast cancer is vital for precision therapy. The tumor microenvironment (TME) has a crucial role in the carcinogenesis and therapeutic response of breast cancer. In this review, we summarized the immune cells, immune checkpoints, and other biomarkers in the TME that can evaluate the efficacy of NACT in treating breast cancer. We believe that the detection and evaluation of the TME components in breast cancer are helpful to predict the efficacy of NACT, and the prediction methods are in the prospect. In addition, we also summarized other predictive factors of NACT, such as imaging examination, biochemical markers, and multigene/multiprotein profiling.
Collapse
Affiliation(s)
- Weiqian Zhang
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China.,Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Ke Xu
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China.,Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Zhengfa Li
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China.,Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Linwei Wang
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China
| | - Honglei Chen
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, People's Republic of China. .,Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, 430071, People's Republic of China.
| |
Collapse
|
4
|
Eguchi Y, Nakai T, Kojima M, Wakabayashi M, Sakamoto N, Sakashita S, Miyazaki S, Taki T, Watanabe R, Watanuki R, Yamauchi C, Iwatani T, Mukohara T, Onishi T, Ishii G. A pathologic method for extracting good prognosis group in triple negative breast cancer after neoadjuvant chemotherapy. Cancer Sci 2022; 113:1507-1518. [PMID: 35143092 PMCID: PMC8990870 DOI: 10.1111/cas.15273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/17/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022] Open
Abstract
The area of residual tumor (ART) is a prognostic factor in patients treated with neoadjuvant chemotherapy (NAC) for lung, pancreatic, and rectal cancers. This study aimed to evaluate the usefulness of ART as a method for predicting the prognosis of triple-negative breast cancer (TNBC) patients after neoadjuvant chemotherapy. We included 143 patients with TNBC treated with NAC. The ART at the maximum cut surface of the residual tumor was measured. We divided the patients into three groups: ART-0 (ART=0 mm2 ), ART-low (0 mm2 < ART ≤ 136mm2 ), and ART-high (ART > 136 mm2 ), and compared their clinicopathological factors and prognosis. There were no significant differences in both recurrence-free survival (RFS) and overall survival (OS) between ART-0 and ART-low; however, the ART-high group had significantly shorter RFS and OS than the ART-0 and ART-low groups. Multivariate analysis showed that ART-0, and -low and ypN (-) were independent favorable prognostic factors for RFS. Groups with both ART-low and ypN(-) as well as those with ART-0 and ypN(-) showed significantly longer OS and RFS than the other groups (p<0.05). Moreover, there was no significant difference in the RFS and OS between the ART-0 and ypN(-) groups and the ART-low and ypN(-) groups (p=0.249 and p=0.554, respectively). We concluded that ART is a candidate histopathological evaluation method for predicting the prognosis of TNBC patients treated with NAC. Furthermore, postoperative chemotherapy could be omitted in patients with ART-0 and ypN(-) (pathological complete response) and those with ART-low and ypN(-).
Collapse
Affiliation(s)
- Yuki Eguchi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Advanced Clinical Research on Cancer Course, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.,Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tokiko Nakai
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Motohiro Kojima
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Masashi Wakabayashi
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Naoya Sakamoto
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shingo Sakashita
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Saori Miyazaki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tetsuro Taki
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Reiko Watanabe
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Rurina Watanuki
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Chisako Yamauchi
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tsuguo Iwatani
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Toru Mukohara
- Department of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Tatsuya Onishi
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Genichiro Ishii
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.,Advanced Clinical Research on Cancer Course, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.,Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| |
Collapse
|
5
|
Prihantono, Faruk M. Breast cancer resistance to chemotherapy: When should we suspect it and how can we prevent it? Ann Med Surg (Lond) 2021; 70:102793. [PMID: 34691411 PMCID: PMC8519754 DOI: 10.1016/j.amsu.2021.102793] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022] Open
Abstract
Chemotherapy is an essential treatment for breast cancer, inducing cancer cell death. However, chemoresistance is a problem that limits the effectiveness of chemotherapy. Many factors influence chemoresistance, including drug inactivation, changes in drug targets, overexpression of ABC transporters, epithelial-to-mesenchymal transitions, apoptotic dysregulation, and cancer stem cells. The effectiveness of chemotherapy can be assessed clinically and pathologically. Clinical response evaluation is based on physical examination or imaging (mammography, ultrasonography, computed tomography scan, or magnetic resonance imaging) and includes tumor size changes after chemotherapy. Pathological response evaluation is a method based on tumor residues in histopathological preparations. We should be suspicious of chemoresistance if there are no significant changes clinically according to the Response Evaluation Criteria in Solid Tumors and World Health Organization criteria or pathological changes according to the Miller and Payne criteria, especially after 2–3 cycles of chemotherapy treatments. Chemoresistance is mostly detected after the administration of chemotherapy drugs. No reliable parameters or biomarkers can predict chemotherapy responses appropriately and effectively. Well-known parameters such as cancer type, grade, subtype, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, and MDR-1/P-gP have been used for selecting chemotherapy regimens. Some new methods for predicting chemoresistance include chemosensitivity and chemoresistance assays, multigene expressions, and positron emission tomography assays. The latest approaches are based on evaluation of molecular processes and the metabolic activity of cancer cells. Some methods for preventing chemoresistance include using the right regimen, using some combination of chemotherapy methods, conducting adequate monitoring, and using drugs that could prevent the emergence of multidrug resistance. Chemotherapy is an essential treatment in the management of breast cancer. Chemotherapy is carried out based on the selection of regimens for the specific individual and tumor characteristics. Combination therapy, monitoring, and evaluation are used to prevent chemoresistance.
Collapse
Affiliation(s)
- Prihantono
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| |
Collapse
|
6
|
Arafah MA, Ouban A, Ameer OZ, Quek KJ. KI-67 LI Expression in Triple-Negative Breast Cancer Patients and Its Significance. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211016977. [PMID: 34158798 PMCID: PMC8186110 DOI: 10.1177/11782234211016977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/22/2021] [Indexed: 12/25/2022]
Abstract
Purpose: Triple-negative breast cancer (TNBC) is a subset of breast cancer which is known to carry a poor prognosis because of lack of targets for hormonal therapy. Research efforts have focused in recent years on discovering biomarkers of management in TNBCs. KI-67 Labelling Index (LI) is a nuclear protein which has proven to play diagnostic and prognostic roles in many cancers. Materials and methods: We analysed the expression of KI-67 LI by immunohistochemistry in TNBC cases from the University hospital. This expression was cross-checked against clinical-pathological criteria of TNBC patients and against Vimentin expression in TNBC patients with significant KI-67 expression. Results: KI-67 LI was significantly expressed in the majority of TNBC cases. This expression was significantly correlated with lymph node metastases, tumour invasion, high tumour nuclear grade, clinical stage, adverse survival outcome, and failure to achieve pathological complete response. TNBCs’ KI-67 LI expression was also correlated with Vimentin expression, the mesenchymal chief marker of the EMT phenomenon. Conclusion: Collectively, our study presents a strong argument for the use of KI-67 LI as a biomarker of aggressive, metastatic TNBC disease with poor outcome. This study, along with mounting evidence in the scientific literature, presents a case for the use of this nuclear protein in diagnosis, prognosis, and follow-up of patients with this difficult diagnosis.
Collapse
Affiliation(s)
- Maria A Arafah
- Department of Pathology, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abderrahman Ouban
- Department of Pathology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Omar Z Ameer
- Department of Pharmaceutical Sciences, College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ko Jin Quek
- Faculty of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
7
|
Oshi M, Angarita FA, Tokumaru Y, Yan L, Matsuyama R, Endo I, Takabe K. A Novel Three-Gene Score as a Predictive Biomarker for Pathologically Complete Response after Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer. Cancers (Basel) 2021; 13:2401. [PMID: 34065619 PMCID: PMC8156144 DOI: 10.3390/cancers13102401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022] Open
Abstract
Although triple-negative breast cancer (TNBC) typically responds better to neoadjuvant chemotherapy (NAC) compared to the other subtypes, a pathological complete response (pCR) is achieved in less than half of the cases. We established a novel three-gene score using genes based on the E2F target gene set that identified pCR after NAC, which showed robust performance in both training and validation cohorts (total of n = 3862 breast cancer patients). We found that the three-gene score was elevated in TNBC compared to the other subtypes. A high score was associated with Nottingham histological grade 3 in TNBC. Across multiple cohorts, high-score TNBC enriched not only E2F targets but also G2M checkpoint and mitotic spindle, which are all cell proliferation-related gene sets. High-score TNBC was associated with homologous recombination deficiency, high mutation load, and high infiltration of Th1, Th2, and gamma-delta T cells. However, the score did not correlate with drug sensitivity for paclitaxel, 5-fluorouracil, cyclophosphamide, and doxorubicin in TNBC human cell lines. High-score TNBC was significantly associated with a high rate of pCR not only in the training cohort but also in the validation cohorts. High-score TNBC was significantly associated with better survival in patients who received chemotherapy but not in patients who did not receive chemotherapy. The three-gene score is associated with a high mutation rate, immune cell infiltration, and predicts response to NAC in TNBC.
Collapse
Affiliation(s)
- Masanori Oshi
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.O.); (F.A.A.); (Y.T.)
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan; (R.M.); (I.E.)
| | - Fernando A. Angarita
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.O.); (F.A.A.); (Y.T.)
| | - Yoshihisa Tokumaru
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.O.); (F.A.A.); (Y.T.)
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu 501-1193, Japan
| | - Li Yan
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA;
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan; (R.M.); (I.E.)
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan; (R.M.); (I.E.)
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.O.); (F.A.A.); (Y.T.)
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan; (R.M.); (I.E.)
- Department of Surgery, University at Buffalo, The State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY 14263, USA
- Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo 113-8654, Japan
- Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 700-8558, Japan
- Department of Breast Surgery, Fukushima Medical University, Fukushima 960-1295, Japan
| |
Collapse
|
8
|
Aghajanzadeh T, Tebbi K, Talkhabi M. Identification of potential key genes and miRNAs involved in Hepatoblastoma pathogenesis and prognosis. J Cell Commun Signal 2021; 15:131-142. [PMID: 33051830 PMCID: PMC7904995 DOI: 10.1007/s12079-020-00584-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Hepatoblastoma (HB) is one of the most common liver malignancies in children, while the molecular basis of the disease is largely unknown. Therefore, this study aims to explore the key genes and molecular mechanisms of the pathogenesis of HB using a bioinformatics approach. The gene expression dataset GSE131329 was used to find differentially expressed genes (DEGs). Functional and enrichment analyses of the DEGs were performed by the EnrichR. Then, the protein-protein interaction (PPI) network of the up-regulated genes was constructed and visualized using STRING database and Cytoscape software, respectively. MCODE was used to detect the significant modules of the PPI network, and cytoHubba was utilized to rank the important nodes (genes) of the PPI modules. Overall, six ranking methods were employed and the results were validated by the Oncopression database. Moreover, the upstream regulatory network and the miRNA-target interactions of the up-regulated DEGs were analyzed by the X2K web and the miRTarBase respectively. A total of 594 DEGs, including 221 up- and 373 down-regulated genes, were obtained, which were enriched in different cellular and metabolic processes, human diseases, and cancer. Furthermore, 15 hub genes were screened, out of which, 11 were validated. Top 10 transcription factors, kinases, and miRNAs were also determined. To the best of our knowledge, the association of RACGAP1, MKI67, FOXM1, SIN3A, miR-193b, and miR-760 with HB was reported for the first time. Our findings may be used to shed light on the underlying mechanisms of HB and provide new insights for better prognosis and therapeutic strategies.
Collapse
Affiliation(s)
- Taha Aghajanzadeh
- Department of Animal Sciences and Marine Biology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Kiarash Tebbi
- Department of Animal Sciences and Marine Biology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Mahmood Talkhabi
- Department of Animal Sciences and Marine Biology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran.
| |
Collapse
|
9
|
Matsuda M, Kido T, Tsuda T, Okada K, Shiraishi Y, Suekuni H, Kamei Y, Kitazawa R, Mochizuki T. Utility of synthetic MRI in predicting the Ki-67 status of oestrogen receptor-positive breast cancer: a feasibility study. Clin Radiol 2020; 75:398.e1-398.e8. [PMID: 32019671 DOI: 10.1016/j.crad.2019.12.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/31/2019] [Indexed: 01/13/2023]
Abstract
AIM To evaluate the utility of synthetic magnetic resonance imaging (MRI) of the breast in predicting the Ki-67 status in patients with oestrogen receptor (ER)-positive breast cancer. MATERIALS AND METHODS Forty-nine patients with 50 histopathologically proven breast cancers who underwent additional synthetic MRI were enrolled in the present study. Using synthetic MRI images, T1 and T2 relaxation times and their standard deviations (SD) in the breast lesions before (T1-Pre, T2-Pre, PD-Pre, SD of T1-Pre, SD of T2-Pre, SD of PD-Pre) and after (T1-Gd, T2-Gd, PD-Gd, SD of T1-Gd, SD of T2-Gd, SD of PD-Gd) contrast agent injection were obtained. These quantitative values were compared between the low Ki-67 expression (<14%) lesions (low-proliferation group: n=23) and high Ki-67 expression (≥14%) lesions (high-proliferation group: n=27). RESULTS The univariate analysis showed that the SD of T1-Gd (p<0.001) and T2-Gd (p=0.042) were significantly higher in the high-proliferation group than in the low-proliferation group. Multivariate analysis further showed that the SD of T1-Gd was a significant and independent predictor of Ki-67 expression, with an area under the receiver operating characteristic (AUROC) curve of 0.885. The sensitivity, specificity, and accuracy of the SD of T1-Gd with an optimal cut-off value of 98.5 were 77.8%, 87%, and 82%, respectively. CONCLUSION The SD of T1-Gd obtained from synthetic MRI was useful to predict Ki-67 status.
Collapse
Affiliation(s)
- M Matsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - T Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - T Tsuda
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - K Okada
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Y Shiraishi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - H Suekuni
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Y Kamei
- Breast Center, Ehime University Hospital, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - R Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - T Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan; Department of Radiology, I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya Str, Moscow, 119991, Russian Federation
| |
Collapse
|
10
|
Hulikal N, Gajjala SR, Kalawat T, Kadiyala S, Kottu R. Predicting Response to Neoadjuvant Chemotherapy Using 18F FDG PET-CT in Patients with Locally Advanced Breast Cancer. Asian Pac J Cancer Prev 2020; 21:93-98. [PMID: 31983170 PMCID: PMC7294002 DOI: 10.31557/apjcp.2020.21.1.93] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The study was aimed to find the utility of 18F FDG PET CT in assessing response to neoadjuvant chemotherapy (NACT) in female patients with locally advanced breast cancer (LABC). METHODS All willing women with biopsy proven LABC, following clinical evaluation underwent baseline 18F FDG PET CT along with mammosonograpy and contrast enhanced computerized chest radiography (CECT). The response was assessed clinically before each cycle of chemotherapy using RECIST criteria. Those who were progressing clinically were offered alternate chemotherapy or radiation or surgery. Clinical responders were re-evaluated with 18F FDG PET CT, mammosonogram and CT chest before surgery. The pathological response as assed with residual cancer burden score was used as gold standard. RESULTS Of the 30 women eligible, 26 women underwent repeat evaluation and surgery. The mean age was 49 years, 16 women were postmenopausal and 15 tumors were receptor positive. On final histopathology 15 % had completer response and 46 % were non responders. Using a cut off value of 50% of the baseline SUVmax, PET-CT had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 64%, 75%, 75%, 65%, and 69%, respectively in differentiating pathological responders from non-responders. CONCLUSION 18F FDG PET-CT predicted the response with greater accuracy than CT or clinical examination. Hence it can be used to identify non responders early in the course and alternate treatment can be offered to patients.
Collapse
Affiliation(s)
- Narendra Hulikal
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Sivanath Reddy Gajjala
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Teckchand Kalawat
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Silpa Kadiyala
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Radhika Kottu
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| |
Collapse
|
11
|
Firouzabadi D, Rezvani A, Dehghanian A, Mahmoudi L. Association of ki67 and tumor marker p53 in locally advanced breast cancer patients and evaluation of response to neoadjuvant chemotherapy: a survey in South Iran. Cancer Manag Res 2019; 11:6489-6497. [PMID: 31372050 PMCID: PMC6628949 DOI: 10.2147/cmar.s203831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/16/2019] [Indexed: 01/09/2023] Open
Abstract
Purpose Heterogeneity of breast cancer, the most common cancer in women, complicates approach to its treatment. Neoadjuvant chemotherapy (NAC) in the treatment of locally advanced breast cancer (LABC) with the endpoint of achieving pathologic complete response (pCR) is not always successful. The purpose of this study was to evaluate the clinicopathologic characteristics, biomarker status and response of LABCs to NAC. Patients and methods Core biopsies and post-surgical specimens of LABC patients were evaluated after receiving NAC. Their lymph node involvement, tumor staging, grading, size, tumoral and stromal lymphocytic infiltration (TLI, SLI), hormonal status, ki67, p53 and HER2 expression were evaluated. Response to NAC was assessed using pCR, Miller-Payne grading and residual cancer burden. Results In a total of 71 patients, pCR rate was 5.6%. Strong association was observed between ki67 positivity and p53 expression (P-value˂0.001). Also ki67, TLI and SLI showed association with triple negative tumor subtype (P-value 0.011, 0.002 and 0.014). Good response to NAC was associated with p53 expression. Nodal metastatic residue was also associated with primary tumor’s nuclear grade. Conclusion Strong correlation of ki67 and p53 can suggest probable interchangeability of both markers in the prognosis of LABC. In this study p53 even showed superiority to ki67 having association with good response. Strong association of ki67, TLI and SLI with triple negative tumor subtype can be parallel to an overall better response rate of this subtype. We can also propose the effectiveness of defining nuclear grade as a prognostic factor towards residual lymph node involvement post NAC.
Collapse
Affiliation(s)
- Dena Firouzabadi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Hematology and Oncology Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Hematology Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirreza Dehghanian
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
12
|
Schäfer SA, Hülsewig C, Barth P, von Wahlde MK, Tio J, Kolberg HC, Bernemann C, Blohmer JU, Kiesel L, Kolberg-Liedtke C. Correlation between SFRP1 expression and clinicopathological parameters in patients with triple-negative breast cancer. Future Oncol 2019; 15:1921-1938. [DOI: 10.2217/fon-2018-0564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: Breast cancer is a heterogeneous disease with distinct molecular and clinical behavior demanding reliable biomarkers, especially in triple-negative breast cancer (TNBC). This study seeks to improve the understanding of SFRP1 as a potential biomarker in breast cancer focusing on TNBC. Materials & methods: SFRP1 expression was investigated via immunohistochemistry with two anti-SFRP1-antibodies on tissue-microarrays of 376 invasive breast cancers. Results: Statistical analysis revealed a highly significant association between TNBC (n = 36) and SFRP1 expression (p < 0.001). SFRP1 expression was significantly associated with younger age, higher tumor stage, size and grade. Conclusion: SFRP1 expression is strongly correlated with TNBC on protein level. Associations with age and tumor grade support the role of SFRP1 as a biomarker for chemotherapy response in TNBC.
Collapse
Affiliation(s)
- Sarah Alexandra Schäfer
- Department of Pediatrics, Sana Kliniken Duisburg, Zu den Rehwiesen 9, 47055 Duisburg, Germany
| | - Carolin Hülsewig
- Molecular Health GmbH, Kurfürstenanlage 21, 69115 Heidelberg, Germany
| | - Peter Barth
- Gerhard-Domagk Departement for Pathology, University Münster, Albert-Schweitzer Campus 1 D17, 48149 Münster, Germany
| | - Marie-Kristin von Wahlde
- Department of Gynecology & Obstetrics, University Hospital Münster, Albert-Schweitzer Campus 1 A1, 48149 Münster, Germany
| | - Joke Tio
- Department of Gynecology & Obstetrics, University Hospital Münster, Albert-Schweitzer Campus 1 A1, 48149 Münster, Germany
| | - Hans-Christian Kolberg
- Department of Gynecology & Obstetrics, Marienhospital Bottrop, Josef-Albers-Str. 70, 46236 Bottrop, Germany
| | - Christof Bernemann
- Department of Urology, University Hospital Münster, Albert-Schweitzer Campus 1 A1, University Münster, Medical Faculty, Domagkstr, 48149 Münster, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology & Breast Center, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ludwig Kiesel
- Department of Gynecology & Obstetrics, University Hospital Münster, Albert-Schweitzer Campus 1 A1, 48149 Münster, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology & Breast Center, Charité University Hospital Berlin, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
13
|
Concise approach for screening long non-coding RNAs functionally linked to human breast cancer associated genes. Exp Mol Pathol 2019; 108:89-96. [DOI: 10.1016/j.yexmp.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/06/2019] [Accepted: 04/02/2019] [Indexed: 11/19/2022]
|
14
|
Ayadi EZ, Cherif B, Ben Hamed Y, Mokni M, Rebai A, Ayadi H, Jlidi R. Prognostic Value of BCL2 in Women Patients with Invasive Breast Cancer. Asian Pac J Cancer Prev 2018; 19:3557-3564. [PMID: 30583683 PMCID: PMC6428546 DOI: 10.31557/apjcp.2018.19.12.3557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Breast cancers are heterogeneous, making it essential to recognize several biomarkers for cancer
outcome predictions especially in young women where the classical prediction parameters are not suitable. The goal
from this study is to evaluate the impact of B cell lymphoma 2 (BCL2), P53 and Ki-67 proteins expression on survival
in young women patients with invasive ductal carcinoma. Patients and methods: Samples and clinical data from 238
patients were collected between 2003 and 2017. They were selected according to 2 criteria: age ≤40 years old and most of
them are affected by an Invasive Ductal Carcinoma. We evaluated BCL2, P53 and ki-67 expression by immunochemistry
test, and then we assessed correlations of these biomarkers expression with patient’s clinicopathological characteristics
and survival. Results: Triple negative breast cancer group showed a high frequency among our cohort but we emphasize
an almost equitable distribution among all molecular groups. Contrary to other studies which reported that luminal A
was correlated with better prognosis, our analysis demonstrated that luminal A is correlated with the Scarff, Bloom
and Richardson (SBR) grading 2 or SBR grading 3. To better investigate the prognosis, we analyze three biomarkers
known by their impact on physiopathology behavior on breast cancer BCL2, ki-67and P53. BCL2 is the more relevant
one, it was correlated with molecular subtypes (p=0.0012) and SBR grading (p=0.0016). BCL2 seems to be the good
prognostic biomarker related to survival (p=0.004) with a protective role among patients when endocrine therapy
is not provided and Lymph Node (LN) involvement is positive (p=0.021, p=0.000 respectively). Conclusions: The
classical prognostic parameters based mainly on the molecular classification in breast cancer seem insufficient in the
case of young women. BCL2 protein expression analysis provides a better prognostic value. BCL2 should be clinically
associated in current practice when young women specimens are diagnosticated.
Collapse
Affiliation(s)
- E-Z Ayadi
- Procédés de criblage moléculaire et cellulaire, Centre of Biotechnology of Sfax B.P K.3038 Sfax, Tunisia.,Patholab Private CytoPathology Laboratory R. du Caire, Cité Jardin Sfax,Tunisia.,Patholab Private Cytopathology Laboratory A. Ibn Khaldoun Sfax, Tunisia.
| | | | | | | | | | | | | |
Collapse
|
15
|
|
16
|
Cain EH, Saha A, Harowicz MR, Marks JR, Marcom PK, Mazurowski MA. Multivariate machine learning models for prediction of pathologic response to neoadjuvant therapy in breast cancer using MRI features: a study using an independent validation set. Breast Cancer Res Treat 2018; 173:455-463. [PMID: 30328048 DOI: 10.1007/s10549-018-4990-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine whether a multivariate machine learning-based model using computer-extracted features of pre-treatment dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can predict pathologic complete response (pCR) to neoadjuvant therapy (NAT) in breast cancer patients. METHODS Institutional review board approval was obtained for this retrospective study of 288 breast cancer patients at our institution who received NAT and had a pre-treatment breast MRI. A comprehensive set of 529 radiomic features was extracted from each patient's pre-treatment MRI. The patients were divided into equal groups to form a training set and an independent test set. Two multivariate machine learning models (logistic regression and a support vector machine) based on imaging features were trained to predict pCR in (a) all patients with NAT, (b) patients with neoadjuvant chemotherapy (NACT), and (c) triple-negative or human epidermal growth factor receptor 2-positive (TN/HER2+) patients who had NAT. The multivariate models were tested using the independent test set, and the area under the receiver operating characteristics (ROC) curve (AUC) was calculated. RESULTS Out of the 288 patients, 64 achieved pCR. The AUC values for predicting pCR in TN/HER+ patients who received NAT were significant (0.707, 95% CI 0.582-0.833, p < 0.002). CONCLUSIONS The multivariate models based on pre-treatment MRI features were able to predict pCR in TN/HER2+ patients.
Collapse
Affiliation(s)
- Elizabeth Hope Cain
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27705, USA.
| | - Ashirbani Saha
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27705, USA
| | - Michael R Harowicz
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27705, USA.,Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey R Marks
- Department of Surgery, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27705, USA
| | - P Kelly Marcom
- Department of Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27705, USA
| | - Maciej A Mazurowski
- Department of Radiology, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27705, USA.,Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| |
Collapse
|
17
|
LeVasseur N, Gelmon KA. Can We Hang Our Hats on One Percent? Oncologist 2018; 23:642-644. [PMID: 29728470 PMCID: PMC6067937 DOI: 10.1634/theoncologist.2018-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/23/2018] [Indexed: 11/28/2022] Open
Abstract
This commentary discusses the results of a recent study assessing Ki‐67 changes in residual breast cancer after neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- Nathalie LeVasseur
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Karen A Gelmon
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| |
Collapse
|
18
|
Guarneri V, Barbieri E, Piacentini F, Giovannelli S, Ficarra G, Frassoldati A, Maiorana A, D'Amico R, Conte P. Predictive and Prognostic Role of P53 According to Tumor Phenotype in Breast Cancer Patients Treated with Preoperative Chemotherapy: A Single-Institution Analysis. Int J Biol Markers 2018; 25:104-11. [DOI: 10.1177/172460081002500208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction and aims The p53 protein is a mediator of the cellular response to DNA damage. The aim of this study was to evaluate the predictive and/or prognostic value of p53 expression in relation to the molecular subtypes of breast cancer in patients treated with preoperative chemotherapy. Patients and methods Patients with stage II-III breast cancer were included in the study. The expression of p53 was evaluated by immunohistochemistry on the diagnostic core biopsy specimen. Patients received 4–6 courses of preoperative chemotherapy. Pathological complete response (pCR) was defined as complete disappearance of invasive tumor in the breast and axillary lymph nodes. Results 154 patients were included in the study and the molecular subtypes of their tumors were classified as follows: triple negative 18.2%, hormone receptor positive 60.4%, and HER2 positive 21.4%. p53 was expressed in 43.5% of the patients. A significant association between p53 expression and breast cancer molecular subtypes, tumor differentiation, and proliferation was observed. pCR was achieved in 8 patients (5.2%). p53 expression, molecular subtype, and nuclear grading were significant predictors of pCR (odds ratio for pCR in patients with p53-expressing tumors 10.03, p=0.0077). In univariate analysis, the expression of p53 as well as high proliferation and lymph node involvement after preoperative chemotherapy were predictors of a worse disease-free survival. Patients with p53 positivity also had a worse overall survival. In multivariate analysis, both p53 expression and nodal status after preoperative chemotherapy were significantly associated with disease-free and overall survival: the hazard ratios for relapse and death in patients with p53-expressing versus non-p53-expressing tumors were 2.29 (p=0.015) and 7.74 (p=0.002), respectively. The hazard ratios for relapse and death in node-positive versus node-negative patients were 3.63 (p=0.003) and 3.64 (p=0.041), respectively. Conclusions In this series of patients, p53 expression was significantly associated with markers of aggressive tumor biology, and with a higher likelihood of attaining pCR. p53 expression was a negative prognostic parameter for disease-free and overall survival in univariate and multivariate analysis.
Collapse
Affiliation(s)
- Valentina Guarneri
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - Elena Barbieri
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - Federico Piacentini
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - Simona Giovannelli
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - Guido Ficarra
- Department of Pathology, Modena University Hospital, Modena - Italy
| | - Antonio Frassoldati
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | | | - Roberto D'Amico
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| | - PierFranco Conte
- Department of Oncology, Hematology and Respiratory Diseases Modena University Hospital, Modena - Italy
| |
Collapse
|
19
|
Bull JMC. A review of immune therapy in cancer and a question: can thermal therapy increase tumor response? Int J Hyperthermia 2017; 34:840-852. [PMID: 28974121 DOI: 10.1080/02656736.2017.1387938] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Immune therapy is a successful cancer treatment coming into its own. This is because checkpoint molecules, adoptive specific lymphocyte transfer and chimeric antigen T-cell (CAR-T) therapy are able to induce more durable responses in an increasing number of malignancies compared to chemotherapy. In addition, immune therapies are able to treat bulky disease, whereas standard cytotoxic therapies cannot treat large tumour burdens. Checkpoint inhibitor monoclonal antibodies are becoming widely used in the clinic and although more complex, adoptive lymphocyte transfer and CAR-T therapies show promise. We are learning that there are nuances to predicting the successful use of the checkpoint inhibitors as well as to specific-antigen adoptive and CAR-T therapies. We are also newly aware of a here-to-fore unrealised natural force, the status of the microbiome. However, despite better understanding of mechanisms of action of the new immune therapies, the best responses to the new immune therapies remain 20-30%. Likely the best way to improve this somewhat low response rate for patients is to increase the patient's own immune response. Thermal therapy is a way to do this. All forms of thermal therapy, from fever-range systemic thermal therapy, to high-temperature HIFU and even cryotherapy improve the immune response pre-clinically. It is time to test the immune therapies with thermal therapy in vivo to test for optimal timing of the combinations that will best enhance tumour response and then to begin to test the immune therapies with thermal therapy in the clinic as soon as possible.
Collapse
Affiliation(s)
- Joan M C Bull
- a Division of Oncology, Department of Internal Medicine , The University of Texas Medical School at Houston , Houston , TX , USA
| |
Collapse
|
20
|
Li Y, Liu X, Tang H, Yang H, Meng X. RNA Sequencing Uncovers Molecular Mechanisms Underlying Pathological Complete Response to Chemotherapy in Patients with Operable Breast Cancer. Med Sci Monit 2017; 23:4321-4327. [PMID: 28880852 PMCID: PMC5600194 DOI: 10.12659/msm.903272] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background This study aimed to identify key genes contributing to pathological complete response (pCR) to chemotherapy by mRNA sequencing (RNA-seq). Material/Methods RNA was extracted from the frozen biopsy tissue of patients with pathological complete response and patients with non-pathological complete response. Sequencing was performed on the HiSeq2000 platform. Differentially expressed genes (DEGs) were identified between the pCR group and non-pCR (NpCR) group. Pathway enrichment analysis of DEGs was performed. A protein-protein interaction network was constructed, then module analysis was performed to identify a subnetwork. Finally, transcription factors were predicted. Results A total of 673 DEGs were identified, including 419 upregulated ones and 254 downregulated ones. The PPI network constructed consisted of 276 proteins forming 471 PPI pairs, and a subnetwork containing 18 protein nodes was obtained. Pathway enrichment analysis revealed that PLCB4 and ADCY6 were enriched in pathways renin secretion, gastric acid secretion, gap junction, inflammatory mediator regulation of TRP channels, retrograde endocannabinoid signaling, melanogenesis, cGMP-PKG signaling pathway, calcium signaling pathway, chemokine signaling pathway, cAMP signaling pathway, and rap1 signaling pathway. CNR1 was enriched in the neuroactive ligand-receptor interaction pathway, retrograde endocannabinoid signaling pathway, and rap1 signaling pathway. The transcription factor-gene network consists of 15 transcription factors and 16 targeted genes, of which 5 were downregulated and 10 were upregulated. Conclusions We found key genes that may contribute to pCR to chemotherapy, such as PLCB4, ADCY6, and CNR1, as well as some transcription factors.
Collapse
Affiliation(s)
- Yongfeng Li
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Xiaozhen Liu
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Hongchao Tang
- 2nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
| | - Hongjian Yang
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Xuli Meng
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| |
Collapse
|
21
|
Zhu Z, Li Y, Yang X, Pan W, Pan H. The reversion of anti-cancer drug antagonism of tamoxifen and docetaxel by the hyaluronic acid-decorated polymeric nanoparticles. Pharmacol Res 2017; 126:84-96. [PMID: 28734999 DOI: 10.1016/j.phrs.2017.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/24/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
Docetaxel (DTX) and tamoxifen (TMX) are first-line drugs used to treat breast cancer. However when used in combination, they produce antagonism because of their differential metabolic pathways. In order to prevent this antagonism, an amphiphilic copolymer, cholesterol modified hyaruronic acid (HA-CHOL), was synthesized for investigating the co-delivery of TMX and DTX. In vitro drug release experiment of the Co-encapsulated (encapsulated DTX+TMX) nanoparticles (Co-NPs) revealed that NPs with unique release mechanism can markedly reduce the release of these drugs in the circulatory system. However, when reaching in cell, TMX can release rapidly to prevent DTX from coming into contact with metabolizing enzymes. In vitro cytotoxicity experiment revealed that the Co-NPs exhibited a significant synergistic effect for inhibiting the proliferation of the cancer cell lines A549, MCF7 and S180. NPs carrying Coumarin-6(Cou6) exhibited increased cellular uptake compared with Cou6 solution at similar drug concentrations. As an in vivo treatment of xenograft tumors involving 180 cells, the Co-NPs displayed a clear tumor-inhibiting effect. This led us to conclude that the reversion of drug antagonism by NPs was attributed to the increased stability of the nanoparticles in the blood circulation, the efficient cellular uptake, the hierarchical drug metabolism in the tumor and the good and orderly delivery of the drugs to the tumor tissue.
Collapse
Affiliation(s)
- Zhihong Zhu
- School of Pharmacy, Shenyang Pharmaceutics University, Shenyang, Liaoning, 110016, China, China
| | - Yuenan Li
- School of Pharmacy, Shenyang Pharmaceutics University, Shenyang, Liaoning, 110016, China, China
| | - Xinggang Yang
- School of Pharmacy, Shenyang Pharmaceutics University, Shenyang, Liaoning, 110016, China, China
| | - Weisan Pan
- School of Pharmacy, Shenyang Pharmaceutics University, Shenyang, Liaoning, 110016, China, China.
| | - Hao Pan
- College of Pharmacy, Liaoning University, Shenyang, 110036, China, China.
| |
Collapse
|
22
|
Giannini V, Mazzetti S, Marmo A, Montemurro F, Regge D, Martincich L. A computer-aided diagnosis (CAD) scheme for pretreatment prediction of pathological response to neoadjuvant therapy using dynamic contrast-enhanced MRI texture features. Br J Radiol 2017; 90:20170269. [PMID: 28707546 DOI: 10.1259/bjr.20170269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To assess whether a computer-aided, diagnosis (CAD) system can predict pathological Complete Response (pCR) to neoadjuvant chemotherapy (NAC) prior to treatment using texture features. METHODS Response to treatment of 44 patients was defined according to the histopatology of resected tumour and extracted axillary nodes in two ways: (a) pCR+ (Smith's Grade = 5) vs pCR- (Smith's Grade < 5); (b) pCRN+ (pCR+ and absence of residual lymph node metastases) vs pCRN - . A CAD system was developed to: (i) segment the breasts; (ii) register the DCE-MRI sequence; (iii) detect the lesion and (iv) extract 27 3D texture features. The role of individual texture features, multiparametric models and Bayesian classifiers in predicting patients' response to NAC were evaluated. RESULTS A cross-validated Bayesian classifier fed with 6 features was able to predict pCR with a specificity of 72% and a sensitivity of 67%. Conversely, 2 features were used by the Bayesian classifier to predict pCRN, obtaining a sensitivity of 69% and a specificity of 61%. CONCLUSION A CAD scheme, that extracts texture features from an automatically segmented 3D mask of the tumour, could predict pathological response to NAC. Additional research should be performed to validate these promising results on a larger cohort of patients and using different classification strategies. Advances in knowledge: This is the first study assessing the role of an automatic CAD system in predicting the pathological response to NAC before treatment. Fully automatic methods represent the backbone of standardized analysis and may help in timely managing patients candidate to NAC.
Collapse
Affiliation(s)
- Valentina Giannini
- 1 Department of Surgical Sciences, University of Torino , Turin , Italy.,2 Department of Radiology, Candiolo Cancer Institute , Torino , Italy
| | - Simone Mazzetti
- 1 Department of Surgical Sciences, University of Torino , Turin , Italy.,2 Department of Radiology, Candiolo Cancer Institute , Torino , Italy
| | - Agnese Marmo
- 2 Department of Radiology, Candiolo Cancer Institute , Torino , Italy
| | - Filippo Montemurro
- 3 Department of Breast Cancer, Candiolo Cancer Institute , Candiolo , Italy
| | - Daniele Regge
- 1 Department of Surgical Sciences, University of Torino , Turin , Italy.,2 Department of Radiology, Candiolo Cancer Institute , Torino , Italy
| | - Laura Martincich
- 2 Department of Radiology, Candiolo Cancer Institute , Torino , Italy
| |
Collapse
|
23
|
Bauckneht M, Piva R, Sambuceti G, Grossi F, Morbelli S. Evaluation of response to immune checkpoint inhibitors: Is there a role for positron emission tomography? World J Radiol 2017; 9:27-33. [PMID: 28298962 PMCID: PMC5334499 DOI: 10.4329/wjr.v9.i2.27] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/02/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
Strategies targeting intracellular negative regulators such as immune checkpoint inhibitors (ICPIs) have demonstrated significant antitumor activity across a wide range of solid tumors. In the clinical practice, the radiological effect of immunotherapeutic agents has raised several more relevant and complex challenges for the determination of their imaging-based response at single patient level. Accordingly, it has been suggested that the conventional Response Evaluation Criteria in Solid Tumors assessment alone, based on dimensional evaluation provided by computed tomography (CT), tends to underestimate the benefit of ICPIs at least in a subset of patients, supporting the need of immune-related response criteria. Different from CT, very few data are available for the evaluation of immunotherapy by means of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET). Moreover, since the antineoplastic activity of ICPIs is highly related to the activation of T cells against cancer cells, FDG accumulation might cause false-positive findings. Yet, discrimination between benign and malignant processes represents a huge challenge for FDG-PET in this clinical setting. Consequently, it might be of high interest to test the complex and variegated response to ICPIs by means of PET and thus it is worthwhile to ask if a similar introduction of immune-related PET-based criteria could be proposed in the future. Finally, PET might offer a new insight into the biology and pathophysiology of ICPIs thanks to a growing number of non-invasive immune-diagnostic approaches based on non-FDG tracers.
Collapse
|
24
|
Dębska-Szmich S, Krakowska M, Czernek U, Habib-Lisik M, Zięba A, Potemski P. The role of preoperative systemic treatment in patients with breast cancer. Contemp Oncol (Pozn) 2016; 20:93-101. [PMID: 27358586 PMCID: PMC4925732 DOI: 10.5114/wo.2016.60067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 05/29/2014] [Indexed: 12/31/2022] Open
Abstract
The goal of preoperative pharmacotherapy in patients with breast cancer is to enable breast conserving surgery in stage T3N0-1M0 or radical mastectomy in patients with primary inoperative tumors (T1-4N0-3M0). The choice of optimal treatment should be based not only on risk factors resulting from the stage but also on predicted cancer responsiveness to the treatment. The breast cancer subtypes defined by immunohistochemical profile (expression of ER, PR, HER2 and Ki67) are characterized by different responsiveness to therapy. Complete response confirmed by histopathological evaluation after neoadjuvant chemotherapy is a positive prognostic factor in some breast cancer subtypes. This marker is not of value in postmenopausal patients with ER/PR+ HER2- tumors, who are candidates for neoadjuvant hormone therapy. These patients have a good prognosis if in a histopathological report after surgery there are features such as pT1, pN0, Ki67 < 3%, and ER Allred score ≥ 3. The goal of the paper is to present current knowledge about preoperative pharmacotherapy of breast cancer.
Collapse
Affiliation(s)
- Sylwia Dębska-Szmich
- Department of Chemotherapy, Chair of Oncology, Medical University of Lodz, Poland
| | - Magdalena Krakowska
- Department of Chemotherapy, Chair of Oncology, Medical University of Lodz, Poland
| | - Urszula Czernek
- Department of Chemotherapy, Chair of Oncology, Medical University of Lodz, Poland
| | - Maja Habib-Lisik
- Department of Chemotherapy, Chair of Oncology, Medical University of Lodz, Poland
| | - Agnieszka Zięba
- Department of Chemotherapy, Chair of Oncology, Medical University of Lodz, Poland
| | - Piotr Potemski
- Department of Chemotherapy, Chair of Oncology, Medical University of Lodz, Poland
| |
Collapse
|
25
|
Szentmartoni G, Tokes AM, Tokes T, Somlai K, Szasz AM, Torgyík L, Kulka J, Dank M. Morphological and pathological response in primary systemic therapy of patients with breast cancer and the prediction of disease free survival: a single center observational study. Croat Med J 2016; 57:131-9. [PMID: 27106355 PMCID: PMC4856188 DOI: 10.3325/cmj.2016.57.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim To identify breast cancer subtypes likely to respond to primary systemic therapy (PST or neoadjuvant therapy) and to assess the accuracy of physical examination (PE) and breast ultrasonography (US) in evaluating and predicting residual size of breast carcinoma following PST. Methods 116 patients who received at least two cycles of PST between 1998 and 2009 were selected from a prospectively collected clinical database. Radiological assessment was done by mammography and US. Prior to PST, tumors were subclassified according to core biopsy (NCB) and/or fine-needle aspiration-based immunohistochemical profiles of NCB. Pathological response rates were assessed following the surgeries by using Chevallier classification. Tumor measurements by PE and US were obtained before and after PST. Different clinical measurements were compared with histological findings. Disease-free survival (DFS) was assessed. Results Pathological complete remission (pCR = Chevallier I/II) was observed in 25 patients (21.5%), 44% of whom had triple negative histology, 28% Her2 positive and 76% had high-grade tumor. Of 116 patients, 24 received taxane-based PST, 48 combined taxane + anthracycline treatment, 8 trastuzumab combinations, 21 anthracycline-based treatments, and 15 other treatments. In the taxane treated group, the pCR rate was 30%, in the taxane + anthracycline group 25%, in the anthracycline group 9.5%, and in trastuzumab group 37.5%. After PST, PE and US were both significantly associated with pathology (P < 0.001 and P = 0.004, respectively). Concerning OS, significant difference was observed between the Chevallier III and IV group (P = 0.031) in favor of Chevallier III group. In the pCR group, fewer events were observed during the follow-up period. Conclusions Our results show that even limited, routinely used immunohistochemical profiling of tumors can predict the likelihood of pCR to PST: patients with triple negative and Her2-positive cancers are more likely to achieve pCR to PST. Also, PE is better correlated with pathological findings than US.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Magdolna Dank
- Magdolna Dank, Semmelweis Univ. Dept. of Clinical Oncology, Tomo str. 25-29, Budapest: H-1083, Hungary,
| |
Collapse
|
26
|
Horii R, Honma N, Ogiya A, Kozuka Y, Yoshida K, Yoshida M, Horiguchi SI, Ito Y, Mukai H. The Japanese Breast Cancer Society clinical practice guidelines for pathological diagnosis of breast cancer, 2015 edition. Breast Cancer 2016; 23:391-9. [PMID: 26914491 DOI: 10.1007/s12282-016-0675-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/27/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Rie Horii
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Naoko Honma
- Department of Pathology, School of Medicine, Toho University, Tokyo, Japan
| | - Akiko Ogiya
- Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuji Kozuka
- Department of Pathology, Mie University Hospital, Mie, Japan
| | - Kazuya Yoshida
- Breast Center, Northern Fukushima Medical Center, Fukushima, Japan
| | - Masayuki Yoshida
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shin-Ichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious disease Center Komagome Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Breast Medical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hirofumi Mukai
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Chiba, Japan
| |
Collapse
|
27
|
Alba E, Lluch A, Ribelles N, Anton-Torres A, Sanchez-Rovira P, Albanell J, Calvo L, García-Asenjo JAL, Palacios J, Chacon JI, Ruiz A, De la Haba-Rodriguez J, Segui-Palmer MA, Cirauqui B, Margeli M, Plazaola A, Barnadas A, Casas M, Caballero R, Carrasco E, Rojo F. High Proliferation Predicts Pathological Complete Response to Neoadjuvant Chemotherapy in Early Breast Cancer. Oncologist 2016; 21:150-5. [PMID: 26786263 DOI: 10.1634/theoncologist.2015-0312] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/11/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the neoadjuvant setting, changes in the proliferation marker Ki67 are associated with primary endocrine treatment efficacy, but its value as a predictor of response to chemotherapy is still controversial. PATIENTS AND METHODS We analyzed 262 patients with centralized basal Ki67 immunohistochemical evaluation derived from 4 GEICAM (Spanish Breast Cancer Group) clinical trials of neoadjuvant chemotherapy for breast cancer. The objective was to identify the optimal threshold for Ki67 using the receiver-operating characteristic curve method to maximize its predictive value for chemotherapy benefit. We also evaluated the predictive role of the defined Ki67 cutoffs for molecular subtypes defined by estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2). RESULTS A basal Ki67 cutpoint of 50% predicted pathological complete response (pCR). Patients with Ki67 >50% achieved a pCR rate of 40% (36 of 91) versus a pCR rate of 19% in patients with Ki67 ≤ 50% (33 of 171) (p = .0004). Ki67 predictive value was especially relevant in ER-HER2- and ER-HER2+ patients (pCR rates of 42% and 64%, respectively, in patients with Ki67 >50% versus 15% and 45%, respectively, in patients with Ki67 ≤ 50%; p = .0337 and .3238, respectively). Both multivariate analyses confirmed the independent predictive value of the Ki67 cutpoint of 50%. CONCLUSION Basal Ki67 proliferation index >50% should be considered an independent predictive factor for pCR reached after neoadjuvant chemotherapy, suggesting that cell proliferation is a phenomenon closely related to chemosensitivity. These findings could help to identify a group of patients with a potentially favorable long-term prognosis. IMPLICATIONS FOR PRACTICE The use of basal Ki67 status as a predictive factor of chemotherapy benefit could facilitate the identification of a patient subpopulation with high probability of achieving pathological complete response when treated with primary chemotherapy, and thus with a potentially favorable long-term prognosis.
Collapse
Affiliation(s)
- Emilio Alba
- Virgen de la Victoria University Hospital, Málaga, Spain
| | - Ana Lluch
- Valencia University Hospital, Valencia, Spain
| | - Nuria Ribelles
- Virgen de la Victoria University Hospital, Málaga, Spain
| | | | | | - Joan Albanell
- Hospital del Mar Medical Research Institute-Institut Hospital del Mar d'Investigacions Mediques and Pompeu Fabra University, Barcelona, Spain
| | - Lourdes Calvo
- A Coruña University Hospital Complex, A Coruña, Spain
| | | | | | | | - Amparo Ruiz
- Valencian Institute of Oncology, Valencia, Spain
| | | | | | | | - Mireia Margeli
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | | | - Maribel Casas
- GEICAM-Spanish Breast Cancer Research Group, Madrid, Spain
| | | | - Eva Carrasco
- GEICAM-Spanish Breast Cancer Research Group, Madrid, Spain
| | - Federico Rojo
- Fundación Jiménez Diaz University Hospital, Madrid, Spain
| |
Collapse
|
28
|
Practical issues concerning the implementation of Ki-67 proliferative index measurement in breast cancer reporting. Pathology 2015; 47:13-20. [PMID: 25474507 DOI: 10.1097/pat.0000000000000192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Commercial molecular tests which rely heavily on proliferation markers to stratify breast cancer are in increasing demand, but are expensive and not widely available. There is heightened interest in the use of Ki-67 immunohistochemistry as a marker of proliferation. This study sought to examine practical issues in the incorporation of Ki-67 measurement into breast cancer reporting.We conducted a prospective study of Ki-67 proliferative activity in 85 breast carcinomas in 70 patients. We considered whether dual staining with cytokeratin and Ki-67 was necessary to exclude background cells in automated digital image analysis (DIA) and how well a semi-quantitative assessment (SQA) method of Ki-67 proliferation and formal manual counting by two pathologists correlated with DIA.Our study showed good correlation between single and dual stained specimens by DIA (Spearman correlation coefficient 0.8), with a kappa statistic of 0.51 (moderate agreement) but with significantly fewer positive cells identified in dual stained sections. There was fair correlation between SQA and DIA by two pathologists (Spearman correlation coefficient 0.7 and 0.7). Using a ≥10% cut-off to define cases with a 'low' and 'high' proliferative index gave a kappa statistic of 0.25 and 0.32 (fair agreement). There was fair correlation between formal manual counts between two pathologists (Spearman correlation coefficient 0.7; kappa 0.32). Repeat DIA on all cases showed excellent correlation (Spearman coefficient 0.98; kappa 1.0).Automated digital analysis of Ki-67 PI is likely to be more accurate and consistent than semi-quantitative assessment and more practicable than formal manual counting. There remain challenges in standardisation of technique within and across laboratories, interpretation of results and in evaluating clinical relevance.
Collapse
|
29
|
Texture analysis on MR images helps predicting non-response to NAC in breast cancer. BMC Cancer 2015; 15:574. [PMID: 26243303 PMCID: PMC4526309 DOI: 10.1186/s12885-015-1563-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/16/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To assess the performance of a predictive model of non-response to neoadjuvant chemotherapy (NAC) in patients with breast cancer based on texture, kinetic, and BI-RADS parameters measured from dynamic MRI. METHODS Sixty-nine patients with invasive ductal carcinoma of the breast who underwent pre-treatment MRI were studied. Morphological parameters and biological markers were measured. Pathological complete response was defined as the absence of invasive and in situ cancer in breast and nodes. Pathological non-responders, partial and complete responders were identified. Dynamic imaging was performed at 1.5 T with a 3D axial T1W GRE fat-suppressed sequence. Visual texture, kinetic and BI-RADS parameters were measured in each lesion. ROC analysis and leave-one-out cross-validation were used to assess the performance of individual parameters, then the performance of multi-parametric models in predicting non-response to NAC. RESULTS A model based on four pre-NAC parameters (inverse difference moment, GLN, LRHGE, wash-in) and k-means clustering as statistical classifier identified non-responders with 84 % sensitivity. BI-RADS mass/non-mass enhancement, biological markers and histological grade did not contribute significantly to the prediction. CONCLUSION Pre-NAC texture and kinetic parameters help predicting non-benefit to NAC. Further testing including larger groups of patients with different tumor subtypes is needed to improve the generalization properties and validate the performance of the predictive model.
Collapse
|
30
|
Utility of [18F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in the Initial Staging and Response Assessment of Locally Advanced Breast Cancer Patients Receiving Neoadjuvant Chemotherapy. Indian J Surg Oncol 2015; 6:330-6. [PMID: 27065657 DOI: 10.1007/s13193-015-0421-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 05/19/2015] [Indexed: 10/23/2022] Open
Abstract
In India up to 50 % of breast cancer patients still present as locally advanced breast cancer (LABC). The conventional methods of metastatic work up include physical examination, bone scan, chest & abdominal imaging, and biochemical tests. It is likely that the conventional staging underestimates the extent of initial spread and there is a need for more sophisticated staging procedure. The PET/CT can detect extra-axillary and occult distant metastases and also aid in predicting response to chemotherapy at an early point in time. To evaluate the utility of FDG PET/CT in initial staging and response assessment of patients with LABC receiving NACT. A prospective study of all biopsy confirmed female patients diagnosed with LABC receiving NACT from April 2013 to May 2014. The conventional work up included serum chemistry, CECT chest and abdomen and bone scan. A baseline whole body PET/CT was done in all patients. A repeat staging evaluation and a whole body PET/CT was done after 2/3rd cycle of NACT in non-responders and after 3/4 cycles in clinical responders. The histopathology report of the operative specimen was used to document the pathological response. The FDG PET/CT reported distant metastases in 11 of 38 patients, where as conventional imaging revealed metastases in only 6. Almost all the distant lesions detected by conventional imaging were detected with PET/CT, which showed additional sites of metastasis in 3 patients. In 2 patients, PET/CT detected osteolytic bone metastasis which were not detected by bone scan. In 5 patients PET CT detected N3 disease which were missed on conventional imaging. A total of 14 patients had second PET/CT done to assess the response to NACT and 11 patients underwent surgery. Two patients had complete pathological response. Of these 1 patient had complete metabolic and morphologic response and other had complete metabolic and partial morphologic response on second PET/CT scan. The 18 FDG PET/CT can detect more number of metastasis as well as additional sites of metastasis compared to conventional methods. The response assessment resulted in change of treatment regimen in 14 % of patients.
Collapse
|
31
|
Pico de Coaña Y, Choudhury A, Kiessling R. Checkpoint blockade for cancer therapy: revitalizing a suppressed immune system. Trends Mol Med 2015; 21:482-91. [PMID: 26091825 DOI: 10.1016/j.molmed.2015.05.005] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 01/22/2023]
Abstract
Immune checkpoint receptors are crucial molecules for fine-tuning immune responses. Checkpoint signaling dampens T cell activation to avoid autoimmunity and the destructive effects of an excessive inflammatory response. It is well established that tumors use several mechanisms to avoid elimination by the immune system, and one involves hijacking these checkpoint pathways. Checkpoint blockade therapy utilizes monoclonal antibodies to release the brakes from suppressed T cells, allowing them to be activated and recover their antitumor activity. This therapeutic approach has revolutionized cancer immunotherapy, and extraordinary increases in overall survival were noted, first with anti-CTLA-4 (cytotoxic T lymphocyte-associated protein 4) and subsequently with anti-PD-1 (programmed cell death receptor-1) in melanoma and other malignancies.
Collapse
Affiliation(s)
- Yago Pico de Coaña
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden.
| | | | - Rolf Kiessling
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
32
|
Kim T, Han W, Kim MK, Lee JW, Kim J, Ahn SK, Lee HB, Moon HG, Lee KH, Kim TY, Han SW, Im SA, Park IA, Kim JY, Noh DY. Predictive Significance of p53, Ki-67, and Bcl-2 Expression for Pathologic Complete Response after Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer. J Breast Cancer 2015; 18:16-21. [PMID: 25834606 PMCID: PMC4381118 DOI: 10.4048/jbc.2015.18.1.16] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/05/2015] [Indexed: 12/31/2022] Open
Abstract
Purpose Patients with triple-negative breast cancer (TNBC) with pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) have superior survival outcomes compared to those with residual disease after NAC. This study investigated the value of three biomarkers, p53, Ki-67, and Bcl-2 for predicting pCR in NAC-treated patients with TNBC. Methods Between 2003 and 2012, 198 patients with pathologically confirmed primary TNBC were treated with two different taxane-based chemotherapeutic regimens prior to surgery. Before NAC, expression of p53 (cutoff 25%), Ki-67 (cutoff 10%), and Bcl-2 (cutoff 10%) was assessed immunohistochemically in core biopsy specimens. The incidence of pCR was correlated with the expression of these biomarkers. Results Overall, pCR occurred in 37 of the 198 patients (18.7%). A significant association was observed between the pCR rate and overexpression of the p53 and Ki-67 biomarkers. Multivariate analysis showed that only p53 expression was independently associated with pCR to NAC (odds ratio, 3.961; p=0.003). The sensitivity, specificity, positive predictive value, and negative predictive value of p53 expression for predicting pCR were 77.8%, 50.3%, 26.2%, and 90.9%, respectively. The pCR rate was the lowest (5.2%) in patients with low expression of both p53 and Ki-67, and it was the highest (25.8%) when both biomarkers showed high expression. Conclusion Expression of p53 was significantly associated with pCR after NAC in patients with TNBC, suggesting that this biomarker might be particularly valuable in identifying TNBC patients prone to have residual disease after NAC.
Collapse
Affiliation(s)
- Taeryung Kim
- Department of Surgery, Breast Cancer Center, Gachon University Gil Hospital, Incheon, Korea
| | - Wonshik Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoon Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Woo Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soo Kyung Ahn
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Byoel Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - In Ae Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong-Young Noh
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
33
|
Christgen M, Winkens W, Kreipe HH. [Determination of proliferation in breast cancer by immunohistochemical detection of Ki-67]. DER PATHOLOGE 2014; 35:54-60. [PMID: 24414612 DOI: 10.1007/s00292-013-1843-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gene expression profiling has demonstrated the prognostic relevance of genes associated with proliferation in breast cancer. The immunohistochemical marker Ki-67 enables routine assessment of proliferation activity in pathology. In a number of retrospective but only few prospective studies the prognostic relevance of Ki-67 in breast cancer could be shown. Although there is no standardized approach with regard to which area of a histological section and how many cells should be counted in a quantitative or semiquantitative fashion as well as to the threshold, Ki-67 is broadly applied in breast pathology. This can be explained by the good reproducibility of the degree of proliferation assessed by Ki-67, at least in the low and high ranges, the possibility to substantiate grading and better practicability in core biopsies in comparison to mitotic counting. In neoadjuvant therapy of hormone receptor positive breast cancer, Ki-67 can probably predict the efficacy of pure hormone receptor blockade without chemotherapy.
Collapse
Affiliation(s)
- M Christgen
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | | | | |
Collapse
|
34
|
Mastoraki A, Kazani A, Mastoraki S, Konstantiadou I, Kokoropoulos P, Smyrniotis V, Arkadopoulos N. Breast-Cancer Subtyping in Clinical Practice: Clinicopathologic Features and Outcomes. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2014.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Aikaterini Kazani
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Sotiria Mastoraki
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Ioanna Konstantiadou
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Panagiotis Kokoropoulos
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Vasilios Smyrniotis
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, Athens University, Medical School, and Attikon University Hospital, Athens, Greece
| |
Collapse
|
35
|
Loibl S, von Minckwitz G, Untch M, Denkert C. Predictive factors for response to neoadjuvant therapy in breast cancer. Oncol Res Treat 2014; 37:563-8. [PMID: 25486071 DOI: 10.1159/000367643] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/12/2014] [Indexed: 11/19/2022]
Abstract
Within 2 decades, neoadjuvant therapy (NAT) has become a standard treatment option in breast cancer. The advantage of NAT is the ability to monitor the treatment effect. Pathological complete response (pCR) after NAT is a very good predictor for long-term outcome. Clinical factors, such as age and body mass index, as well as recently identified biomarkers can predict the chance of achieving a pCR. Hormone-receptor status, proliferation markers, immune infiltrates and genetic alterations, such as germline BRCA and PIK3CA, can now be measured almost on a routine basis due to the decreased analysis costs.
Collapse
|
36
|
Prognostic significance of Bcl-2 expression in non-basal triple-negative breast cancer patients treated with anthracycline-based chemotherapy. Tumour Biol 2014; 35:12255-63. [PMID: 25179840 DOI: 10.1007/s13277-014-2534-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/20/2014] [Indexed: 11/27/2022] Open
Abstract
B cell lymphoma/leukemia-2 (Bcl-2) expression has generally been associated with estrogen receptor positivity and favorable prognosis in breast cancer. We examined immunohistochemical expression of Bcl-2 in 492 triple-negative breast cancers (TNBCs) using tissue microarrays and investigated its correlation with clinicopathologic features and clinical outcome. A total of 47 (9.5 %) TNBCs showed Bcl-2 expression. Bcl-2 expression was not associated with any of the clinicopathologic parameters and did not affect patient survival in TNBCs (Bcl-2-positive vs Bcl-2-negative TNBCs; overall survival (OS), P = 0.258; disease-free survival (DFS), P = 0.436). When TNBCs were divided into basal (cytokeratin 5/6 (CK5/6)+ and/or epidermal growth factor receptor (EGFR)+) and non-basal (CK5/6- and EGFR-) subgroups, Bcl-2 expression showed a significant association with worse OS (P = 0.002) and DFS (P = 0.002) in the non-basal subgroup. Among patients treated with an anthracycline, Bcl-2 expression also showed an association with decreased survival (OS, P = 0.004; DFS, P = 0.003) in the non-basal subgroup. In multivariate analyses, Bcl-2 expression was an independent poor prognostic factor for OS (P = 0.003) and DFS (P = 0.002) in this subgroup of TNBCs. Our results suggest that positive expression of Bcl-2 predicts no benefit from adjuvant anthracycline-based chemotherapy in non-basal TNBC patients. In conclusion, Bcl-2 status showed both prognostic and predictive values in non-basal TNBCs; therefore, assessment of Bcl-2 status and basal phenotype can provide information on prognostic and therapeutic classifications of TNBCs.
Collapse
|
37
|
Can ki-67 play a role in prediction of breast cancer patients' response to neoadjuvant chemotherapy? BIOMED RESEARCH INTERNATIONAL 2014; 2014:628217. [PMID: 24783217 PMCID: PMC3982412 DOI: 10.1155/2014/628217] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/11/2014] [Indexed: 12/16/2022]
Abstract
Background. Currently the choice of breast cancer therapy is based on prognostic factors. The proliferation marker Ki-67 is used increasingly to determine the method of therapy. The current study analyses the predictive value of Ki-67 in foreseeing breast cancer patients' responses to neoadjuvant chemotherapy. Methods. This study includes patients with invasive breast cancer treated between 2008 and 2013. The clinical response was assessed by correlating Ki-67 to histological examination, mammography, and ultrasonography findings. Results. The average Ki-67 value in our patients collectively (n = 77) is 34.9 ± 24.6%. The average Ki-67 value is the highest with 37.4 ± 24.0% in patients with a pCR. The Ki-67 values do not differ significantly among the 3 groups: pCR versus partial pathological response versus stable disease/progress (P = 0.896). However, Ki-67 values of patients with luminal, Her2 enriched, and basal-like cancers differed significantly from each other. Furthermore, within the group of luminal tumors Ki-67 values of patients with versus without pCR also differed significantly. Conclusion. Our data shows that the Ki-67 value predicts the response to neoadjuvant chemotherapy as a function of the molecular subtype, reflecting the daily routine concerning Ki-67 and its impressing potential and limitation as a predictive marker for neoadjuvant chemotherapy response.
Collapse
|
38
|
Yang D, Chen MB, Wang LQ, Yang L, Liu CY, Lu PH. Bcl-2 expression predicts sensitivity to chemotherapy in breast cancer: a systematic review and meta-analysis. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2013; 32:105. [PMID: 24370277 PMCID: PMC3922829 DOI: 10.1186/1756-9966-32-105] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/10/2013] [Indexed: 12/25/2022]
Abstract
Background Numerous studies have yielded inconclusive results regarding the relationship between anti-apoptotic protein Bcl-2 expression and the sensitivity to chemotherapy in the patients with breast cancer. The purpose of the current study was therefore to elaborate their relationship. Methods, findings A total of 23 previously published eligible studies involving 2,467 cases were identified and included in this meta-analysis. Negative Bcl-2 expression was associated with good chemotherapy response in breast cancer patients (total objective response [OR]: risk ratio [RR] = 1.16, 95% confidence interval [CI] = 1.02-1.32, p = 0.026; total complete response [CR]: RR = 1.67, 95% CI = 1.24-2.24, p = 0.001; pathological CR: RR = 1.92, 95% CI = 1.38-2.69, p < 0.001). In further stratified analyses, this association remained for sub-groups of response in neoadjuvant chemotherapy setting, especially pathological CR. Besides, negative Bcl-2 expression was significantly associated with good OR and pathological CR in anthracycline-based chemotherapy subgroup. Furthermore, there were significant links between negative Bcl-2 expression and taxane-based chemotherapy with pathological CR, but not OR. Conclusion The results of the present meta-analysis suggest that Bcl-2 expression is a predictive factor for chemotherapy sensitivity in breast cancer patients. They could also potentially benefit further clinical treatment for breast cancers.
Collapse
Affiliation(s)
| | | | | | | | - Chao-Ying Liu
- Department of Medical Oncology, Wuxi People's Hospital affiliated to Nanjing Medical University, 299 Qingyang Road, Wuxi City, Jiangsu Province 214023, China.
| | | |
Collapse
|
39
|
Mikami Y, Ueno T, Yoshimura K, Tsuda H, Kurosumi M, Masuda S, Horii R, Toi M, Sasano H. Interobserver concordance of Ki67 labeling index in breast cancer: Japan Breast Cancer Research Group Ki67 ring study. Cancer Sci 2013; 104:1539-43. [PMID: 23905924 DOI: 10.1111/cas.12245] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 11/26/2022] Open
Abstract
The standardized assessment of Ki67 labeling index (LI) is of clinical importance to identify patients with primary breast cancer who could benefit from chemotherapy. In this study, we evaluated the interobserver concordance of Ki67 LI assessment. Six surgical pathologists participated and all the slides were prepared from archival breast cancer tissues fixed in 10% buffered formalin for 24 h and stained with MIB-1. Three independent studies were conducted. In the first study, 30 stained slides were assessed using two different methods: the scoring system, with a positive rate scored from 1 (0-9%) to 10 (90-100%) by visual estimate; and the counting method, with approximately 1000 cells counted in hot spots. In the second study, 20 tumors with Ki67 LI 5-25% were assessed, and in the third study, 15 printed photographs of stained slides were assessed to avoid variations by selecting different fields. In study 1, the counting system (intraclass correlation coefficient [ICC], 0.66 [95% confidence interval 0.52-0.78]) demonstrated a better correlation than the scoring system (ICC, 0.57 [0.42-0.72]). In study 2, the assessment for Ki67 LI of 5-25% demonstrated a correlation (ICC, 0.68 [0.50-0.81]) similar to that of study 1 (unrestricted range of Ki67 LI). In study 3, the assessment of Ki67 LI by counting yielded a good concordance (ICC, 0.94 [0.88-0.97]). In conclusion, there was better concordance with the counting system, and concordance was high when the assessed field was predetermined, indicating that the selection of the evaluation area is critical for obtaining reproducible Ki67 LI in breast cancer.
Collapse
Affiliation(s)
- Yoshiki Mikami
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Abdel-Fatah TMA, Perry C, Dickinson P, Ball G, Moseley P, Madhusudan S, Ellis IO, Chan SYT. Bcl2 is an independent prognostic marker of triple negative breast cancer (TNBC) and predicts response to anthracycline combination (ATC) chemotherapy (CT) in adjuvant and neoadjuvant settings. Ann Oncol 2013; 24:2801-7. [PMID: 23908177 DOI: 10.1093/annonc/mdt277] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND TNBC represents a heterogeneous subgroup of BC with poor prognosis and frequently resistant to CT. MATERIAL AND METHODS The relationship between Bcl2 immunohistochemical protein expression and clinico-pathological outcomes was assessed in 736 TNBC-patients: 635 patients had early primary-TNBC (EP-TNBC) and 101 had primary locally advanced (PLA)-TNBC treated with neo-adjuvant- ATC-CT. RESULTS Negative Bcl2 (Bcl2-) was observed in 70% of EP-TNBC and was significantly associated with high proliferation, high levels of P-Cadherin, E-Cadherin and HER3 (P's < 0.01), while Bcl2+ was significantly associated with high levels of p27, MDM4 and SPAG5 (P < 0.01). After controlling for chemotherapy and other prognostic factors, Bcl2- was associated with 2-fold increased risk of death (P = 0.006) and recurrence (P = 0.0004). Furthermore, the prognosis of EP-TNBC/Bcl2- patients had improved both BC-specific survival (P = 0.002) and disease-free survival (P = 0.003), if they received adjuvant-ATC-CT. Moreover, Bcl2- expression was an independent predictor of pathological complete response of primary locally advanced triple negative breast cancer (PLA-TNBC) treated with neoadjuvant-ATC-CT (P = 0.008). CONCLUSION Adding Bcl2 to the panel of markers used in current clinical practice could provide both prognostic and predictive information in TNBC. TNBC/Bcl2- patients appear to benefit from ATC-CT, whereas Bcl2+ TNBC seems to be resistant to ATC-CT and may benefit from a trial of different type of chemotherapy with/without novel-targeted agents.
Collapse
Affiliation(s)
- T M A Abdel-Fatah
- Clinical Oncology Department, Nottingham University Hospitals, Nottingham
| | | | | | | | | | | | | | | |
Collapse
|
41
|
USP-11 as a predictive and prognostic factor following neoadjuvant therapy in women with breast cancer. Cancer J 2013; 19:10-7. [PMID: 23337751 DOI: 10.1097/ppo.0b013e3182801b3a] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE USP-11, a member of the ubiquitin-specific protease family, has emerged as an essential regulator of double-strand break repair. Few studies have shown that silencing USP-11 led to hypersensitivity to poly(ADP-ribose) polymerase inhibition, ionizing radiation, and DNA-damaging agents. We sought to examine the predictive and prognostic relevance of USP-11 in patients treated with neoadjuvant systemic therapy (NST) for breast cancer. METHODS Fifty-six women who were treated with NST for breast cancer between 1999 and 2004 were included in the study. The Kaplan-Meier product-limit method was used to estimate disease-free survival and overall survival rates. Logistic regression models were fit to determine the associations between USP-11 status, pathological complete response (pCR), and survival. RESULTS Sixteen patients (29%) had high-USP-11-expressing tumors, and 40 (71%) patients had low-USP-11-expressing tumors. No significant differences were observed in pCR rates with respect to USP-11 status. At a median follow-up of 7.4 years, 33 patients (59%) experienced a disease recurrence or death. Patients with high-USP-11-expressing tumors had a higher risk of recurrence (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.51-9.93; P = 0.005) and death (OR, 6.03; 95% CI, 2.00-18.17; P = 0.001) than those with low-USP-11-expressing tumors. Patients who did not achieve a pCR had an increased risk of recurrence (OR, 5.16; 95% CI, 1.16-23.07; P = 0.03). CONCLUSIONS Our data indicate that USP-11 is not a predictor of a pCR after anthracycline-taxane-containing NST for breast cancer. Low USP-11 expression was independently correlated with better survival outcomes.
Collapse
|
42
|
von Minckwitz G, Schmitt WD, Loibl S, Müller BM, Blohmer JU, Sinn BV, Eidtmann H, Eiermann W, Gerber B, Tesch H, Hilfrich J, Huober J, Fehm T, Barinoff J, Rüdiger T, Erbstoesser E, Fasching PA, Karn T, Müller V, Jackisch C, Denkert C. Ki67 measured after neoadjuvant chemotherapy for primary breast cancer. Clin Cancer Res 2013; 19:4521-31. [PMID: 23812670 DOI: 10.1158/1078-0432.ccr-12-3628] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The value of Ki67 measured on residual disease after neoadjuvant chemotherapy is not sufficiently described. EXPERIMENTAL DESIGN Participants of the GeparTrio study with primary breast cancer randomly received neoadjuvant response-guided [8 cycles TAC (docetaxel/doxorubicin/cyclophosphamide) in responding and TAC-NX (vinorelbine/capecitabine) in nonresponding patients] or conventional (6 cycles TAC) chemotherapy according to interim response assessment. Ki-67 levels were centrally measured immunohistochemically after neoadjuvant treatment if tumor tissue was available. Here, we analyze 1,151 patients having a pathologic complete response (pCR; n, 484), or residual disease with low (0-15%), intermediate (15.1-35%), or high (35.1-100%) posttreatment Ki67 levels in 488, 77, and 102 patients, respectively. RESULTS Patients with high posttreatment Ki67 levels showed higher risk for disease relapse (P < 0.0001) and death (P < 0.0001) compared with patients with low or intermediate Ki67 levels. Patients with low Ki67 levels showed a comparable outcome to patients with a pCR (P = 0.211 for disease-free and P = 0.779 for overall survival). Posttreatment Ki67 levels provided more prognostic information than pretreatment Ki67 levels or changes of Ki67 from pre- to posttreatment. Information on pCR plus posttreatment Ki67 levels surmount the prognostic information of pCR alone in hormone-receptor-positive disease [hazard ratios (HR), 1.82-5.88] but not in hormone-receptor-negative disease (HR: 0.61-1.73). Patients with conventional and response-guided treatment did not show a different distribution of posttreatment Ki67 (P = 0.965). CONCLUSIONS Posttreatment Ki67 levels provide prognostic information for patients with hormone-receptor-positive breast cancer and residual disease after neoadjuvant chemotherapy. Levels were not prognostic for outcome after response-guided chemotherapy. High posttreatment Ki67 indicates the need for innovative postneoadjuvant treatments.
Collapse
|
43
|
Wan F, Dong L, Zhang F, Wang Y, Chen F, Ni S, Chen Y, Long J. Clinical study of the relationship between γ-synuclein and the response of neoadjuvant chemotherapy in breast cancer. J Int Med Res 2013; 41:743-53. [PMID: 23696593 DOI: 10.1177/0300060513484434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate relationships between several protein biomarkers and clinical responses to neoadjuvant chemotherapy (NAC) in breast cancer. METHODS Tumour tissue samples from female patients with locally advanced breast carcinoma (stages IIA to IIIC), treated with NAC regimens (including 5-fluorouracil, epirubicin, cyclophosphamide and docetaxel, epirubicin, cyclophosphamide) were analysed retrospectively. Immunohistochemical analysis was used to test for protein levels of oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER)-2, protein 53 (p53) and γ-synuclein. Relationships between protein biomarkers and responses to NAC were analysed by multivariate logistic regression analysis. RESULTS Data from 154 patients (median age, 51 years; range 27-75 years) were included. Multivariate logistic regression analysis showed that γ-synuclein was an independent predictor of NAC objective response rate, and a statistically significant relationship was observed between NAC regimen, γ-synuclein levels and pathological complete response rate. CONCLUSIONS These study findings suggest that γ-synuclein - in combination with other markers such as ER, PR and HER-2 - may serve as a biomarker for response to NAC in breast cancer and warrants further study.
Collapse
Affiliation(s)
- Fan Wan
- Department of Surgery, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Li K, Chen B, Xu L, Feng J, Xia G, Cheng J, Wang J, Gao F, Wang X. Reversal of multidrug resistance by cisplatin-loaded magnetic Fe3O4 nanoparticles in A549/DDP lung cancer cells in vitro and in vivo. Int J Nanomedicine 2013; 8:1867-77. [PMID: 23690684 PMCID: PMC3656817 DOI: 10.2147/ijn.s43752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to explore whether magnetic Fe(3)O(4) nanoparticles (Fe(3)O(4)-MNP) loaded with cisplatin (Fe(3)O(4)-MNP-DDP) can reverse DDP resistance in lung cancer cells and to investigate mechanisms of multidrug resistance in vitro and in vivo. MTT assay showed that DDP inhibited both A549 cells and DDP-resistant A549 cells in a time-dependent and dose-dependent manner, and that this inhibition was enhanced by Fe(3)O(4)-MNP. An increased rate of apoptosis was detected in the Fe(3)O(4)-MNP-DDP group compared with a control group and the Fe(3)O(4)-MNP group by flow cytometry, and typical morphologic features of apoptosis were confirmed by confocal microscopy. Accumulation of intracellular DDP in the Fe(3)O(4)-MNP-DDP group was greater than that in the DDP group by inductively coupled plasma mass spectrometry. Further, lower levels of multidrug resistance-associated protein-1, lung resistance-related protein, Akt, and Bad, and higher levels of caspase-3 genes and proteins, were demonstrated by reverse transcriptase polymerase chain reaction and Western blotting in the presence of Fe(3)O(4)-MNP-DDP. We also demonstrated that Fe(3)O(4)-MNP enhanced the effect of DDP on tumor growth in BALB/c nude mice bearing DDP-resistant human A549 xenografts by decreasing localization of lung resistance-related protein and Ki-67 immunoreactivity in cells. There were no apparent signs of toxicity in the animals. Overall, these findings suggest potential clinical application of Fe(3)O(4)-MNP-DDP to increase cytotoxicity in lung tumor xenografts.
Collapse
Affiliation(s)
- Ke Li
- Department of Hematology, Key Medical Disciplines of Jiangsu Province, Zhongda Hospital, Medical School, Southeast University, Nanjing
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Treatment Response to Preoperative Anthracycline-Based Chemotherapy in Locally Advanced Breast Cancer: The Relevance of Proliferation and Apoptosis Rates. Pathol Oncol Res 2013; 19:577-88. [DOI: 10.1007/s12253-013-9621-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 02/28/2013] [Indexed: 12/11/2022]
|
46
|
Teleki I, Krenacs T, Szasz MA, Kulka J, Wichmann B, Leo C, Papassotiropoulos B, Riemenschnitter C, Moch H, Varga Z. The potential prognostic value of connexin 26 and 46 expression in neoadjuvant-treated breast cancer. BMC Cancer 2013; 13:50. [PMID: 23374644 PMCID: PMC3583680 DOI: 10.1186/1471-2407-13-50] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 01/30/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several classification systems are available to assess pathological response to neoadjuvant chemotherapy in breast cancer, but reliable biomarkers to predict the efficiency of primary systemic therapy (PST) are still missing. Deregulation of gap junction channel forming connexins (Cx) has been implicated in carcinogenesis and tumour progression through loss of cell cycle control. In this study we correlated Cx expression and cell proliferation with disease survival and pathological response to neoadjuvant chemotherapy in breast cancers using existing classification systems. METHODS The expression of Cx26, Cx32, Cx43, Cx46 and Ki67 was evaluated in 96 breast cancer patients prior to and after neoadjuvant chemotherapy using duplicate cores in tissue microarrays (TMA). Cx plaques of <1μm were detected with multilayer, multichannel fluorescence digital microscopy. Current classifications to assess residual tumour burden after primary systemic therapy included the EWGBSP, CPS-EG, Miller-Payne, Sataloff and NSABP systems. RESULTS In our cohort dominated by hormone receptor (ER/PR) positive and HER2 negative cases, only the CPS-EG classification showed prognostic relevance: cases with scores 1-2 had significantly better overall survival (p=0.015) than cases with scores 3-5. Pre-chemotherapy Cx43 expression correlated positively with hormone receptor status both before and after chemotherapy and had a negative correlation with HER2 expression pre-chemotherapy. There was a positive correlation between Cx32 and HER2 expression pre-chemotherapy and between Cx32 and Ki67 expression post-chemotherapy. A negative correlation was found between post-chemotherapy Cx46 and Ki67 expression. Decreased post-chemotherapy Cx26 expression (<5%) statistically correlated with better overall survival (p=0.011). Moderate or higher Cx46 expression (>20%) pre- and post-chemotherapy correlated with significantly better survival in the intermediate prognostic subgroups of EWGBSP TR2b (p(pre-chemo)=0.006; Sataloff TB (p(pre-chemo)=0.005; p(post-chemo)=0.029) and in Miller-Payne G3 (p(pre-chemo)=0.002; p(post-chemo)=0.012) classifications. Pre-chemotherapy, Cx46 expression was the only marker that correlated with overall survival within these subgroups. CONCLUSION Our results suggest that Cx46 and Cx26 expression in breast cancer may improve the assessment of pathological response and refine intermediate prognostic subgroups of residual tumour classifications used after neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- Ivett Teleki
- 1st Department of Pathology & Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Tibor Krenacs
- 1st Department of Pathology & Experimental Cancer Research, Semmelweis University, Budapest, Hungary
- MTA-SE Tumour Progression Research Group, Budapest, Hungary
| | - Marcell A Szasz
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Janina Kulka
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Barna Wichmann
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Cornelia Leo
- Division of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Zsuzsanna Varga
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
47
|
Impact of the first tumor response at eight weeks on overall survival in metastatic breast cancer patients treated with first-line combination chemotherapy. Med Oncol 2013; 30:415. [PMID: 23322522 DOI: 10.1007/s12032-012-0415-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 11/11/2012] [Indexed: 02/08/2023]
Abstract
The aim of this was to determine whether the change of size observed at the first response evaluation after initiation of first-line combination chemotherapy correlates with overall survival (OS) in patients with metastatic breast cancer (MBC). The change in size of tumors derived from measurements according to Response Evaluation Criteria In Solid Tumors (RECIST) at the first evaluation on computed tomography (CT) was obtained from a multicenter, randomized phase III trial ("TEX trial," n = 287) comparing treatment with a combination of epirubicin and paclitaxel alone or with capecitabine (TEX). Cox regression and Kaplan-Meier analyses were performed to evaluate the correlations between the first change in tumor size, response according to RECIST and OS. Data from CT evaluations of 233 patients were available. Appearance of new lesions or progression of non-target lesions (new/non-target) indicated short OS by univariable regression analysis (HR 3.76, 95 % CI 1.90-7.42, p < 0.001). A decrease by >30 % at this early time point was prognostic favorable (HR 0.69, 95 % CI 0.49-0.98, p = 0.04) and not significantly less than the best overall response according to RECIST. After adjustment for previous adjuvant treatment and the treatment given within the frame of the randomized trial, OS was still significantly shorter in patients with new/non-target lesions after a median 8 weeks of treatment (HR 4.41, 95 % CI 2.74-7.11, p < 0.001). Disease progression at the first evaluation correlates with OS in patients with MBC treated with first-line combination chemotherapy. The main reason for early disease progression was the appearance of new lesions or progression of non-target lesions. These patients had poor OS even though more lines of treatment were available. Thus, these factors should be focused on in the response evaluations besides tumor size changes.
Collapse
|
48
|
Nakagawa T, Sato K, Moriwaki M, Wada R, Arakawa A, Saito M, Kasumi F. Successful Endocrine Therapy for Locally Advanced Mucinous Carcinoma of the Breast. Breast J 2012; 18:632-3. [DOI: 10.1111/tbj.12031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Koichi Sato
- Department of Surgery; Juntendo Shizuoka Hospital of Juntendo; University School of Medicine; Shizuoka; Japan
| | - Minoru Moriwaki
- Department of Surgery; Juntendo Shizuoka Hospital of Juntendo; University School of Medicine; Shizuoka; Japan
| | - Ryo Wada
- Department of Pathology; Juntendo Shizuoka Hospital of Juntendo; University School of Medicine; Shizuoka; Japan
| | - Atsushi Arakawa
- Department of Pathology; Juntendo University Hospital of Juntendo; University School of Medicine; Tokyo; Japan
| | | | | |
Collapse
|
49
|
Abstract
In breast cancer, tumor biological markers are gaining impact and have become equal to traditional markers of pathology. Molecular expression profiling has led to new categories, which by receiving translation into immunohistochemical terms have entered routine pathology use. Besides the triple negative (basal) type, there are hormone receptor positive luminal A and B types and the HER2 type. The distinction between luminal A and B type is not yet clear cut and the proliferation marker Ki-67 as well as diverse RNA expression profiles are used for distinction in order to decide which patients might benefit from pure endocrine and which from combined chemo-endocrine therapy. Prospective studies are necessary to answer these questions. Study data are further awaited to clarify the heterogeneity of triple negative cases which include most of the BRCA1 associated cancers and to elucidate whether within the HER2 category, polysome or pseudopolysome cancer will respond to therapy.
Collapse
Affiliation(s)
- H H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover.
| |
Collapse
|
50
|
Fuksa L, Micuda S, Grim J, Ryska A, Hornychova H. Predictive Biomarkers in Breast Cancer: Their Value in Neoadjuvant Chemotherapy. Cancer Invest 2012; 30:663-78. [DOI: 10.3109/07357907.2012.725441] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|