1
|
Walbaum B, García-Fructuoso I, Martínez-Sáez O, Schettini F, Sánchez C, Acevedo F, Chic N, Muñoz-Carrillo J, Adamo B, Muñoz M, Partridge AH, Bellet M, Brasó-Maristany F, Prat A, Vidal M. Hormone receptor-positive early breast cancer in young women: A comprehensive review. Cancer Treat Rev 2024; 129:102804. [PMID: 39084152 DOI: 10.1016/j.ctrv.2024.102804] [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: 05/28/2024] [Revised: 07/05/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024]
Abstract
The incidence of breast cancer in ≤ 40 yr-old women (YWBC) has been steadily increasing in recent decades. Although this group of patients represents less than 10 % of all newly diagnosed BC cases it encompasses a significant burden of disease. Usually underrepresented in clinical trials, YWBCs are also characterized by late diagnoses and poorly differentiated, aggressive-subtype disease, partly explaining its poor prognosis along with a high recurrence risk, and high mortality rates. On the other hand, YWBC treatment poses unique challenges such as preservation of fertility, and long-term toxicity and adverse events. Herein, we summarize the current evidence in hormone receptor-positive YWBC including specific risk factors, clinicopathologic and genomic features, and available evidence on response to chemotherapy and endocrine therapy. Overall, we advocate for a more comprehensive multidisciplinary healthcare model to improve the outcomes and the quality of life of this subset of younger patients.
Collapse
Affiliation(s)
- Benjamin Walbaum
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain; Department of Medical Oncology, Pontificia Universidad Catolica de Chile, Santiago, Chile; Faculty of Medicine, Universidad Catolica de Chile, Santiago, Chile
| | - Isabel García-Fructuoso
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Olga Martínez-Sáez
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - César Sánchez
- Department of Medical Oncology, Pontificia Universidad Catolica de Chile, Santiago, Chile; Faculty of Medicine, Universidad Catolica de Chile, Santiago, Chile
| | - Francisco Acevedo
- Department of Medical Oncology, Pontificia Universidad Catolica de Chile, Santiago, Chile; Faculty of Medicine, Universidad Catolica de Chile, Santiago, Chile
| | - Nuria Chic
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Barbara Adamo
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain; Harvard Medical School, Boston, MA, USA
| | - Montserrat Muñoz
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain; Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Meritxell Bellet
- Oncology Department, Breast Cancer Unit, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Institute of Cancer and Blood Disorders, Hospital Clinic of Barcelona, Barcelona, Spain; Reveal Genomics, Barcelona, Spain
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Institute of Cancer and Blood Disorders, Hospital Clinic of Barcelona, Barcelona, Spain; Reveal Genomics, Barcelona, Spain; Institute of Oncology (IOB)-Hospital Quironsalud, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Maria Vidal
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain; Institute of Oncology (IOB)-Hospital Quironsalud, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
2
|
Guan Y, Huang ST, Yu BB. Nomograms to predict the long-term prognosis for non-metastatic invasive lobular breast carcinoma: a population-based study. Sci Rep 2024; 14:19477. [PMID: 39174612 PMCID: PMC11341842 DOI: 10.1038/s41598-024-68931-5] [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: 04/19/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024] Open
Abstract
Invasive lobular breast carcinoma (ILC) is one potential subset that "clinicopathologic features" can conflict with "long-term outcome" and the optimal management strategy is unknown in such discordant situations. The present study aims to predict the long-term, overall survival (OS) and cancer-specific survival (CSS) of ILC. The clinical information of patients with non-metastatic ILC was retrieved from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2020. A total of 31451 patients were enrolled and divided into the training cohort (n=22,017) and validation cohort (n=9434). The last follow-up was December, 31, 2020 and the median follow-up period was 99 months (1-203). Age, marriage, estrogen (ER) status, progesterone (PR) status, grade, tumor size, lymph node ratio (LNR) and combined summary (CS) stage were prognostic factors for both OS and CSS of ILC, whereas chemotherapy and radiation were independent protect factors for OS. The nomograms exhibited satisfactory discriminative ability. For the training and validation cohorts, the C-index of the OS nomogram was 0.765 (95% CI 0.762-0.768) and 0.757 (95% CI 0.747-0.767), and the C-index of the CSS nomogram were 0.812 (95% CI 0.804-0.820) and 0.813 (95% CI 0.799-0.827), respectively. Additionally, decision curve analysis (DCA) demonstrated that the nomograms had superior predictive performance than traditional American Joint Committee on Cancer (AJCC) TNM stage. The novel nomograms to predict long-term prognosis based on LNR are reliable tools to predict survival, which may assist clinicians in identifying high-risk patients and devising individual treatments for patients with ILC. Our findings should aid public health prevention strategies to reduce cancer burden. We provide two R/Shiny apps ( https://ilc-survival2024.shinyapps.io/osnomogram/ ; https://ilc-survival2024.shinyapps.io/cssnomogram/ ) to visualize findings.
Collapse
Affiliation(s)
- Ying Guan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No 71, Hedi Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Shi-Ting Huang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No 71, Hedi Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Bin-Bin Yu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No 71, Hedi Road, Nanning, 530021, Guangxi, People's Republic of China
| |
Collapse
|
3
|
Rosenberg SM, Zheng Y, Ruddy K, Poorvu PD, Snow C, Kirkner GJ, Meyer ME, Tamimi RM, Schapira L, Peppercorn J, Come S, Borges VF, Warner E, Gelber S, Collins L, Winer EP, Partridge AH. Helping ourselves, helping others: the Young Women's Breast Cancer Study (YWS) - a multisite prospective cohort study to advance the understanding of breast cancer diagnosed in women aged 40 years and younger. BMJ Open 2024; 14:e081157. [PMID: 38951008 PMCID: PMC11218027 DOI: 10.1136/bmjopen-2023-081157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/29/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE Compared with older women diagnosed with breast cancer, younger women are more likely to die of breast cancer and more likely to suffer psychosocially in both the short-term and long term. The Young Women's Breast Cancer Study (YWS) is a multisite prospective cohort study established to address gaps in our knowledge about this vulnerable and understudied population. PARTICIPANTS The YWS enrolled 1302 women newly diagnosed with stages 0-IV breast cancer at age 40 years or younger at 13 academic and community sites in North America between 2006 and 2016. Longitudinal patient-reported outcome data are complemented by clinical data abstraction and biospecimen collection at multiple timepoints. FINDINGS TO DATE Key findings related to fertility include that nearly 40% of participants were interested in pregnancy following diagnosis; of those who reported interest, 10% pursued fertility preservation. Overall, approximately 10% of YWS participants became pregnant in the first 5 years after diagnosis; follow-up is ongoing for pregnancies after 5 years. Studies focused on psychosocial outcomes have characterised quality of life, post-traumatic stress and fear of recurrence, with findings detailing the factors associated with the substantial psychosocial burden many young women face during and following active treatment. Multiple studies have leveraged YWS biospecimens, including whole-exome sequencing of tumour analyses that revealed that select somatic alterations occur at different frequencies in young (age≤35) versus older women with luminal A breast cancer, and a study that explored clonal hematopoiesis of indeterminate potential found it to be rare in young survivors. FUTURE PLANS With a median follow-up of approximately 10 years, the cohort is just maturing for many relevant long-term outcomes and provides outstanding opportunities to further study and build collaborations to address gaps in our knowledge, with the ultimate objective to improve care and outcomes for young women with breast cancer. TRIAL REGISTRATION NUMBER NCT01468246.
Collapse
Affiliation(s)
- Shoshana M Rosenberg
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Yue Zheng
- Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kathryn Ruddy
- Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip D Poorvu
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Craig Snow
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gregory J Kirkner
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meghan E Meyer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rulla M Tamimi
- Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Lidia Schapira
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, California, USA
| | - Jeffrey Peppercorn
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven Come
- Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Virginia F Borges
- Medical Oncology, University of Colorado Denver, Denver, Colorado, USA
| | - Ellen Warner
- Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shari Gelber
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura Collins
- Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Eric P Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Yale University Yale Cancer Center, New Haven, Connecticut, USA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Vuong B, Jacinto AI, Chang SB, Kuehner GE, Savitz AC. Contemporary Review of the Management and Treatment of Young Breast Cancer Patients. Clin Breast Cancer 2024:S1526-8209(24)00148-4. [PMID: 38972829 DOI: 10.1016/j.clbc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024]
Abstract
Approximately 11% of all new breast cancer cases annually are diagnosed in young women, and this continues to be the leading cause of death in women age 20 to 49. Young, premenopausal breast cancer patients present with more advanced stages and with a higher proportion of aggressive subtypes such as triple negative and HER2-enriched tumors. Recently, the United States Preventive Services Task Force (USPSTF) lowered the age threshold to initiate screening mammograms to age 40 to aid in earlier detection. Young age at diagnosis increases the likelihood for a pathogenic mutation, and genetic testing is recommended for all patients age 50 and younger. This population is often underrepresented in landmark clinical trials, and data is extrapolated for the treatment of young women with breast cancer. Despite there being no survival benefit to more extensive surgical treatments, such as mastectomy or contralateral prophylactic mastectomy, many patients opt against breast conservation. Young patients with breast cancer face issues related to treatment toxicities, potential overtreatment of their disease, mental health, sexual health, and fertility preservation. This unique population requires a multidisciplinary care team of physicians, surgeons, genetic counselors, fertility specialists, mental health professionals, physical therapists, and dieticians to provide individualized, comprehensive care. Our aim is to (1) provide a narrative review of retrospective studies, relevant society guidelines, and clinical trials focused on the contemporary treatment and management of YBC patients and (2) discuss important nuances in their care as a guide for members of their multidisciplinary treatment team.
Collapse
Affiliation(s)
- Brooke Vuong
- Department of Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA.
| | - Ana I Jacinto
- Department of Surgery, University of California, Davis, Sacramento, CA
| | - Sharon B Chang
- Department of Surgery, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA
| | - Gillian E Kuehner
- Department of Surgery, Kaiser Permanente Vallejo Medical Center, Vallejo, CA
| | - Alison C Savitz
- Department of Surgery, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, CA
| |
Collapse
|
5
|
Mao M, Chen W, Ye D. Research progress on the structure, function, and use of angiogenin in malignant tumours. Heliyon 2024; 10:e30654. [PMID: 38756602 PMCID: PMC11096933 DOI: 10.1016/j.heliyon.2024.e30654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
Angiogenin (ANG) is a specialised secreted ribonuclease, also known as RNase5, that is widely expressed in vertebrates. ANG dysregulation is closely associated with the development of breast, nasopharyngeal, and lung cancers. In recent years, studies have found that ANG not only induces neovascularisation by activating endothelial cells, but also plays a regulatory role in the plasticity of cancer cells. Cellular plasticity plays pivotal roles in cancer initiation, progression, migration, therapeutic resistance, and relapse. Therefore, it is a promising biomarker for cancer diagnosis, prognostic evaluation, and therapy. This review summarises the current knowledge regarding the roles and clinical applications of ANG in cancer development and progression.
Collapse
Affiliation(s)
- Mingwen Mao
- Department of Otorhinolaryngology-Head and Neck Surgery, Ningbo No.6 Hospital Affiliated Medical School of Ningbo University, 315040, Ningbo, Zhejiang, China
- Department of Otorhinolaryngology-Head and Neck Surgery, Lihuili Hospital of Ningbo University, 315040, Ningbo, Zhejiang, China
| | - Weina Chen
- Department of Clinical Pharmacology, Yinzhou Integrated TCM & Western Medicine Hospital, 315040, Ningbo, Zhejiang, China
| | - Dong Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Lihuili Hospital of Ningbo University, 315040, Ningbo, Zhejiang, China
| |
Collapse
|
6
|
Graham E, Bennett K, Boselli D, Hecksher A, Schepel C, White RL, Hadzikadic-Gusic L. Young Age as a Predictor of Chemotherapy Recommendation and Treatment in Breast Cancer: A National Cancer Database Study. J Surg Res 2024; 296:155-164. [PMID: 38277952 DOI: 10.1016/j.jss.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/17/2023] [Accepted: 12/25/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Breast cancer, although the second most common malignancy in women in the United States, is rare in patients under the age of 40 y. However, this young patient population has high recurrence and mortality rates, with chemotherapy frequently used as adjuvant treatment. We aimed to determine whether age is an independent predictor of chemotherapy recommendation and subsequent treatment and the relationship to Oncotype Dx (ODX) recurrence score (RS). METHODS The National Cancer Database was retrospectively reviewed from 2010-2016 to identify women with early-stage (pT1-pT3, pN0-pN1mic, M0), hormone receptor positive, human epidermal growth factor receptor 2 negative breast cancer who underwent ODX RS testing. RESULTS Of 95,382 patients who met the inclusion criteria, risk groups using the traditional ODX RS cutoffs were 59% low, 33% intermediate, and 8% high. Using Trial Assigning Individualized Options for Treatment RS cutoffs, risk groups were 23% low, 62% intermediate, and 15% high. Chemotherapy recommendation decreased as age at diagnosis increased (P < 0.001). Increasing age was associated with decreased odds of chemotherapy recommendation in univariate models both continuously (odds ratio: 0.98, 95% confidence interval 0.97-0.98; P < 0.001) and categorically by decade (P < 0.001). Age by decade remained an independent prognosticator of chemotherapy recommendation (P < 0.001), adjusted for risk groups. CONCLUSIONS Chemotherapy recommendation and treatment differs by age among patients with early-stage hormone receptor positive breast cancer who undergo ODX testing. While molecular profiling has been shown to accurately predict the benefit of chemotherapy, younger age at diagnosis is a risk factor for discordant use of ODX RS for treatment strategies in breast cancer; with patients aged 18-39 disproportionately affected.
Collapse
Affiliation(s)
- Elaina Graham
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Katie Bennett
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Danielle Boselli
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Anna Hecksher
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Courtney Schepel
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Richard L White
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Lejla Hadzikadic-Gusic
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.
| |
Collapse
|
7
|
Hyung J, Lee SB, Kim J, Kim HJ, Ko B, Lee JW, Son BH, Lee HJ, Gong G, Jeong H, Jeong JH, Kim JE, Ahn JH, Jung KH, Kim SB. 21-gene expression assay and clinical outcomes of premenopausal patients with hormone receptor-positive breast cancer. Int J Cancer 2024; 154:748-756. [PMID: 37718333 DOI: 10.1002/ijc.34728] [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: 04/03/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
The prognostic role of the recurrence score (RS) based on the 21-gene expression assay in premenopausal women is not well delineated, and we investigated the association of outcomes and the RS in premenopausal patients who had 21-gene expression assay at Asan Medical Center, Seoul, Korea, between June 2005 and July 2018. Invasive breast cancer-free survival (IBCFS) by STEEP version 2.0 was compared according to the RS and clinical risk factors. A total of 554 patients were included in our study and 116 patients (20.9%) had age <40 years, 238 patients (43.0%) had luminal B subtype (Ki67 ≥ 20%), and 83 patients (15.0%) had RS >25. All patients received adjuvant tamoxifen ± chemotherapy. Overall, patients with RS >25 showed trend toward worse IBCFS from multivariable analysis (adjusted HR 1.89 [95% CI: 0.95-3.73], P = .069). When comparing outcomes according to age and luminal subtypes, patients with luminal B subtype and age <40 years (n = 60) showed significantly worse outcomes compared to the others (luminal A or luminal B + age ≥40 years, n = 494; adjusted HR 2.95 [95% CI: 1.49-5.82], log-rank P < .001). Among patients with luminal B subtype and age <40 years, there was no significant association observed between IBCFS and the RS (log-rank P = .51). In conclusion, while RS >25 showed association with poor outcomes in premenopausal women, it may have less prognostic significance among those with luminal B subtype and age <40 years.
Collapse
Affiliation(s)
- Jaewon Hyung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - BeomSeok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung-Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jin Lee
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyehyun Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hee Ahn
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Yu T, Cheng W, Zhang J, Wang T, Liu Y, Duan Y, Hu A, Feng J, Li M, Li Y, Zhang H, Rong Z, Shang Y, Shakila SS, Ma F, Guo B. Identification of a PANoptosis-related Gene Signature for Predicting the Prognosis, Tumor Microenvironment and Therapy Response in Breast Cancer. J Cancer 2024; 15:428-443. [PMID: 38169571 PMCID: PMC10758028 DOI: 10.7150/jca.90113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
Breast cancer (BC) is the most prevalent malignancy among women worldwide. Mounting evidence suggests that PANoptosis participates in cancer development and therapy. However, the role of PANoptosis in BC remains unclear. In this study, we identified ten PANoptosis-related genes using Cox regression analysis, random forest (RF) algorithm and least absolute shrinkage and selection operator (LASSO) algorithm. A PANoptosis-related score (PRS) was calculated based on the coefficient of LASSO. Notably, we divided the patients into high- and low-risk groups according to the PRS and revealed a negative correlation between PRS and overall survival. Next, a nomogram model was constructed and validated to improve the clinical application of PRS. Functional enrichment analyses and the Bayesian network demonstrated that differentially expressed genes between high- and low-risk groups were mainly enriched in immune-related pathways. Besides, we found significant differences in tumor mutation burden and tumor immune microenvironment between patients in these two groups using bulk-RNA and single-cell RNA sequencing data. Furthermore, charged multivesicular body protein 2B (CHMP2B) was identified as the hub gene by combining LASSO, weighted gene co-expression network analysis, RF and eXtreme Gradient Boosting. Importantly, using immunohistochemistry analysis based on our tissue microarray, we found that CHMP2B was highly expressed in tumor tissue, and CD4 and CD8 were more likely to be positive in the CHMP2B-negative group. Survival analyses revealed that CHMP2B adversely impacted the survival of BC patients. In conclusion, we not only constructed a highly accurate predictive model based on PRS, but also revealed the importance of PANoptosis-related gene signature in the modulation of the tumor microenvironment and drug sensitivity in BC.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Fei Ma
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Baoliang Guo
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| |
Collapse
|
9
|
Srikanthan A, Awan AA, McGee S, Rushton M. Young Women with Breast Cancer: The Current Role of Precision Oncology. J Pers Med 2023; 13:1620. [PMID: 38003935 PMCID: PMC10672565 DOI: 10.3390/jpm13111620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Young adults aged 40 years and younger with breast cancer represent less than 5% of all breast cancer cases, yet it is the leading cause of death among young women with cancer worldwide. Breast cancer that develops at a young age is more aggressive and has biological features that carry an increased risk of relapse and death. Young adults are more likely to have a genetic predisposition and key biomarkers, including endocrine receptors, the HER2 receptor, and proliferation biomarkers, that appear different compared to older adults. Despite being more aggressive, management strategies are largely the same irrespective of age. Given the higher rates of genetic predisposition, fast access to genetic counselling and testing is a necessity. In this review, the biological differences in young adult breast cancer and the current role precision medicine holds in the treatment of young adults with breast cancer are explored. Given the relatively high risk of relapse, developing novel genomic tools to refine the treatment options beyond the current standard is critical. Existing predictive genomic tests require careful interpretation with consideration of the patient's clinical and pathological features in the young patient cohort. Careful evaluation is also required when considering extended endocrine therapy options. Improved characterization of mutations occurring in tumors using next-generation sequencing could identify important driver mutations that arise in young women. Applying the advances of precision medicine equitably to patients in resource-rich and low- and middle-income countries will be critical to impacting the survival of young adults with breast cancer worldwide.
Collapse
Affiliation(s)
- Amirrtha Srikanthan
- Division of Medical Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada; (A.A.A.); (S.M.); (M.R.)
- Department of Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Arif Ali Awan
- Division of Medical Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada; (A.A.A.); (S.M.); (M.R.)
- Department of Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Sharon McGee
- Division of Medical Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada; (A.A.A.); (S.M.); (M.R.)
- Department of Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| | - Moira Rushton
- Division of Medical Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada; (A.A.A.); (S.M.); (M.R.)
- Department of Medicine, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
| |
Collapse
|
10
|
Tesch ME. Precision medicine in extended adjuvant endocrine therapy for breast cancer. Curr Opin Oncol 2023; 35:453-460. [PMID: 37621168 DOI: 10.1097/cco.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW In this review, the evolving role of currently available genomic assays for hormone receptor-positive, early-stage breast cancer in the selection of patients for extended adjuvant endocrine therapy will be discussed. RECENT FINDINGS Several studies have investigated the prognostic performance of the Oncotype DX, Breast Cancer Index (BCI), Prosigna, and EndoPredict genomic assays in the late recurrence setting (>5 years after diagnosis), beyond standardly used clinicopathologic parameters, with mixed results. Recently, BCI has also been validated to predict the likelihood of benefit from extended endocrine therapy, though certain data limitations may need to be addressed to justify routine use in clinical practice. SUMMARY Even after 5 years of adjuvant endocrine therapy, patients with hormone receptor-positive breast cancer have a significant risk for late recurrence, including distant metastases, that might be prevented with longer durations of endocrine therapy. However, the added toxicity and variable benefit derived from extended endocrine therapy make optimal patient selection crucial. Genomic assays are in development to risk-stratify patients for late recurrence and determine efficacy of extended endocrine therapy, with the aim to help guide extended endocrine therapy decisions for clinicians and individualize treatment strategies for patients.
Collapse
Affiliation(s)
- Megan E Tesch
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Lipsyc-Sharf M, Jain E, Collins LC, Rosenberg SM, Ruddy KJ, Tamimi RM, Schapira L, Come SE, Peppercorn JM, Borges VF, Warner E, Snow C, Krop IE, Kim D, Weiss J, Zanudo JGT, Partridge AH, Wagle N, Waks AG. Genomics of ERBB2-Positive Breast Cancer in Young Women Before and After Exposure to Chemotherapy Plus Trastuzumab. JCO Precis Oncol 2023; 7:e2300076. [PMID: 37364233 DOI: 10.1200/po.23.00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/18/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE Erb-B2 receptor tyrosine kinase 2 (ERBB2)-positive breast cancer (BC) is particularly common in young women. Genomic features of ERBB2-positive tumors before and after chemotherapy and trastuzumab (chemo + H) have not been described in young women and are important for guiding study of therapeutic resistance in this population. METHODS From a large prospective cohort of women age 40 years or younger with BC, we identified patients with ERBB2-positive BC and tumor tissue available before and after chemo + H. Whole-exome sequencing (WES) was performed on each tumor and on germline DNA from blood. Tumor-normal pairs were analyzed for mutations and copy number (CN) changes. RESULTS Twenty-two women had successful WES on samples from at least one time point; 12 of these had paired sequencing results from before and after chemo + H and 10 had successful sequencing from either time point. TP53 was the only significantly recurrently mutated gene in both pre- and post-treatment samples. MYC gene amplification was observed in four post-treatment tumors. Seven of 12 patients with paired samples showed acquired and/or clonally enriched alterations in cancer-related genes. One patient had an increased clonality putative activating mutation in ERBB2. Another patient acquired a clonal hotspot mutation in TP53. Other genomic changes acquired in post-treatment specimens included alterations in NOTCH2, STIL, PIK3CA, and GATA3. There was no significant change in median ERBB2 CN (20.3 v 22.6; Wilcoxon P = .79) between paired samples. CONCLUSION ERBB2-positive BCs in young women displayed substantial genomic evolution after treatment with chemo + H. Approximately half of patients with paired samples demonstrated acquired and/or clonally enriched genomic changes in cancer genes. ERBB2 CN changes were uncommon. We identified several genes warranting exploration as potential mechanisms of resistance to therapy in this population.
Collapse
Affiliation(s)
- Marla Lipsyc-Sharf
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Esha Jain
- Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Repare Therapeutics, Cambridge, MA
| | - Laura C Collins
- Harvard Medical School, Boston, MA
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Rulla M Tamimi
- Weill Cornell Medicine, New York, NY
- Brigham and Women's Hospital, Boston, MA
| | | | - Steven E Come
- Harvard Medical School, Boston, MA
- Breast Medical Oncology Program, Beth Israel Deaconess Medical Center and Dana-Farber/Harvard Cancer Center, Boston, MA
| | | | | | - Ellen Warner
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Craig Snow
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
| | - Ian E Krop
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Yale Cancer Center, New Haven, CT
| | - Dewey Kim
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Jakob Weiss
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Jorge Gomez Tejeda Zanudo
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Nikhil Wagle
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Adrienne G Waks
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
12
|
S Mano M. Borderline indications for ovarian suppression: addressing uncertainties with patients. Future Oncol 2022; 18:4111-4118. [PMID: 36519535 DOI: 10.2217/fon-2022-0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Ovarian function suppression (OFS) is a potentially life-saving treatment for young women diagnosed with high-risk hormonal-receptor (HR)+ early breast cancer (EBC), albeit one associated with significant side effects that may adversely affect quality of life. Of particular concern, this article raises a few borderline indications that were largely unaddressed in pivotal clinical trials but are still commonly encountered in daily practice. These, referred to here as 'borderline indications of OFS' remain a source of uncertainty for patients and physicians and are concisely addressed in this article.
Collapse
Affiliation(s)
- Max S Mano
- Centro Paulista de Oncologia, Grupo Oncoclínicas, São Paulo - SP, 04538-132, Brazil
| |
Collapse
|
13
|
Talcott JA. Risk Assessment Models for Febrile Neutropenia: The Reification of Clinical Decision Making. JCO Oncol Pract 2022; 18:823-825. [PMID: 36067455 DOI: 10.1200/op.22.00442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
|
14
|
Correlation between Ferroptosis-Related Gene Signature and Immune Landscape: Prognosis in Breast Cancer. J Immunol Res 2022; 2022:6871518. [PMID: 36313179 PMCID: PMC9613394 DOI: 10.1155/2022/6871518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
Breast cancer (BC) is the most commonly diagnosed cancer and second leading cause of cancer-related death in women worldwide. Ferroptosis, an iron-dependent newly discovered mode of cell death, can be induced by lenaltinib and plays an important role in the biological behaviors of BC. Therefore, the prognostic value of ferroptosis-related genes (FRGs) in BC warrants further investigation. FRG expression profiles and clinical data were downloaded from The Cancer Genome Atlas (TCGA) database and Gene Expression Omnibus (GEO). Immune-related pathways were found in the functional analysis. Significant differences in enrichment scores for immune cells were observed. Some patients from TCGA-BRCA were included as the training cohort. A six-gene prediction signature was constructed with the least absolute shrinkage and selection operator Cox regression. This model was validated in the rest of the TCGA-BRCA and GEO cohort. The expressions of the six FRGs were verified with real-time quantitative polymerase chain reaction and immunohistochemistry in the Human Protein Atlas. Relapse or metastasis was more likely in the high-risk group. Risk score was an independent predictor of disease-free survival. Collectively, the ferroptosis-related risk model established in this study may serve as an effective tool to predict the prognosis in BC.
Collapse
|
15
|
De Rose F, Meduri B, Carmen De Santis M, Ferro A, Marino L, Ray Colciago R, Gregucci F, Vanoni V, Apolone G, Di Cosimo S, Delaloge S, Cortes J, Curigliano G. Rethinking breast cancer follow-up based on individual risk and recurrence management. Cancer Treat Rev 2022; 109:102434. [DOI: 10.1016/j.ctrv.2022.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
|
16
|
Huang X, Luo Z, Liang W, Xie G, Lang X, Gou J, Liu C, Xu X, Fu D. Survival Nomogram for Young Breast Cancer Patients Based on the SEER Database and an External Validation Cohort. Ann Surg Oncol 2022; 29:5772-5781. [PMID: 35661275 PMCID: PMC9356966 DOI: 10.1245/s10434-022-11911-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/03/2022] [Indexed: 12/21/2022]
Abstract
Background Young breast cancer (YBC) patients are more prone to lymph node metastasis than other age groups. Our study aimed to investigate the predictive value of lymph node ratio (LNR) in YBC patients and create a nomogram to predict overall survival (OS), thus helping clinical diagnosis and treatment. Methods Patients diagnosed with YBC between January 2010 and December 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were enrolled and randomly divided into a training set and an internal validation set with a ratio of 7:3. An independent cohort from our hospital was used for external validation. Univariate and least absolute shrinkage and selection operator (LASSO) regression were used to identify the significant factors associated with prognosis, which were used to create a nomogram for predicting 3- and 5-year OS. Results We selected seven survival predictors (tumor grade, T-stage, N-stage, LNR, ER status, PR status, HER2 status) for nomogram construction. The C-indexes in the training set, the internal validation set, and the external validation set were 0.775, 0.778 and 0.817, respectively. The nomogram model was well calibrated, and the time-dependent ROC curves verified the superiority of our model for clinical usefulness. In addition, the nomogram classification could more precisely differentiate risk subgroups and improve the discrimination of YBC prognosis. Conclusions LNR is a strong predictor of OS in YBC patients. The novel nomogram based on LNR is a reliable tool to predict survival, which may assist clinicians in identifying high-risk patients and devising individual treatments.
Collapse
Affiliation(s)
- Xiao Huang
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Zhou Luo
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Wei Liang
- Graduate School, Dalian Medical University, Dalian, China
| | - Guojian Xie
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Xusen Lang
- Graduate School, Dalian Medical University, Dalian, China
| | - Jiaxiang Gou
- Graduate School, Dalian Medical University, Dalian, China
| | - Chenxiao Liu
- Graduate School, Dalian Medical University, Dalian, China
| | - Xiangnan Xu
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Deyuan Fu
- Department of Breast Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
| |
Collapse
|
17
|
Waks AG, Kim D, Jain E, Snow C, Kirkner GJ, Rosenberg SM, Oh C, Poorvu PD, Ruddy KJ, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Brachtel EF, Warner E, Collins LC, Partridge AH, Wagle N. Somatic and Germline Genomic Alterations in Very Young Women with Breast Cancer. Clin Cancer Res 2022; 28:2339-2348. [PMID: 35101884 PMCID: PMC9359721 DOI: 10.1158/1078-0432.ccr-21-2572] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Young age at breast cancer diagnosis correlates with unfavorable clinicopathologic features and worse outcomes compared with older women. Understanding biological differences between breast tumors in young versus older women may lead to better therapeutic approaches for younger patients. EXPERIMENTAL DESIGN We identified 100 patients ≤35 years old at nonmetastatic breast cancer diagnosis who participated in the prospective Young Women's Breast Cancer Study cohort. Tumors were assigned a surrogate intrinsic subtype based on receptor status and grade. Whole-exome sequencing of tumor and germline samples was performed. Genomic alterations were compared with older women (≥45 years old) in The Cancer Genome Atlas, according to intrinsic subtype. RESULTS Ninety-three tumors from 92 patients were successfully sequenced. Median age was 32.5 years; 52.7% of tumors were hormone receptor-positive/HER2-negative, 28.0% HER2-positive, and 16.1% triple-negative. Comparison of young to older women (median age 61 years) with luminal A tumors (N = 28 young women) revealed three significant differences: PIK3CA alterations were more common in older patients, whereas GATA3 and ARID1A alterations were more common in young patients. No significant genomic differences were found comparing age groups in other intrinsic subtypes. Twenty-two patients (23.9%) in the Young Women's Study cohort carried a pathogenic germline variant, most commonly (13 patients, 14.1%) in BRCA1/2. CONCLUSIONS Somatic alterations in three genes (PIK3CA, GATA3, and ARID1A) occur at different frequencies in young versus older women with luminal A breast cancer. Additional investigation of these genes and associated pathways could delineate biological susceptibilities and improve treatment options for young patients with breast cancer. See related commentary by Yehia and Eng, p. 2209.
Collapse
Affiliation(s)
- Adrienne G. Waks
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Dewey Kim
- Dana-Farber Cancer Institute, Boston, Massachusetts.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Esha Jain
- Dana-Farber Cancer Institute, Boston, Massachusetts.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Craig Snow
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Shoshana M. Rosenberg
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Coyin Oh
- Harvard Medical School, Boston, Massachusetts
| | - Philip D. Poorvu
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | | | - Jeffrey Peppercorn
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford University, Palo Alto, California
| | | | - Steven E. Come
- Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elena F. Brachtel
- Massachusetts General Hospital, Boston, Massachusetts.,Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ellen Warner
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laura C. Collins
- Harvard Medical School, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ann H. Partridge
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Nikhil Wagle
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,The Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Corresponding Author: Nikhil Wagle, Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115. E-mail:
| |
Collapse
|
18
|
Kjällquist U, Acs B, Margolin S, Karlsson E, Kessler LE, Garcia Hernandez S, Ekholm M, Lundgren C, Olsson E, Lindman H, Foukakis T, Matikas A, Hartman J. Real World Evaluation of the Prosigna/PAM50 Test in a Node-Negative Postmenopausal Swedish Population: A Multicenter Study. Cancers (Basel) 2022; 14:2615. [PMID: 35681597 PMCID: PMC9179899 DOI: 10.3390/cancers14112615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022] Open
Abstract
Molecular signatures to guide decisions for adjuvant chemotherapy are recommended in early ER-positive, HER2-negative breast cancer. The objective of this study was to assess what impact gene-expression-based risk testing has had following its recommendation by Swedish national guidelines. Postmenopausal women with ER-positive, HER2-negative and node negative breast cancer at intermediate clinical risk and eligible for chemotherapy were identified retrospectively from five Swedish hospitals. Tumor characteristics, results from Prosigna® test and final treatment decision were available for all patients. Treatment recommendations were compared with the last version of regional guidelines before the introduction of routine risk signature testing. Among the 360 included patients, 41% (n = 148) had a change in decision for adjuvant treatment based on Prosigna® test result. Out of the patients with clinical indication for adjuvant chemotherapy, 52% (n = 118) could avoid treatment based on results from Prosigna® test. On the contrary, 23% (n = 30) of the patients with no indication were escalated to receive adjuvant chemotherapy after testing. Ki67 could not distinguish between the Prosigna® risk groups or intrinsic subtypes and did not significantly differ between patients in which decision for adjuvant therapy was changed based on the test results. In conclusion, we report the first real-world data from implementation of gene-expression-based risk assessment in a Swedish context, which may facilitate the optimization of future versions of the national guidelines.
Collapse
Affiliation(s)
- Una Kjällquist
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Breast Center, Theme Cancer, Karolinska University Hospital, Solna, 17167 Stockholm, Sweden
| | - Balazs Acs
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Sara Margolin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden;
- Department of Oncology, Södersjukhuset, 11828 Stockholm, Sweden
| | - Emelie Karlsson
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
| | - Luisa Edman Kessler
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Breast Center, Capio St:Göran’s Hospital, 11235 Stockholm, Sweden;
| | | | - Maria Ekholm
- Department of Oncology, Jönköping County, 55185 Jönköping, Sweden; (M.E.); (C.L.)
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Christine Lundgren
- Department of Oncology, Jönköping County, 55185 Jönköping, Sweden; (M.E.); (C.L.)
- Department of Oncology and Pathology, Institute of Clinical Sciences, Lund University, 22184 Lund, Sweden
| | - Erik Olsson
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden; (E.O.); (H.L.)
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden; (E.O.); (H.L.)
| | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Breast Center, Theme Cancer, Karolinska University Hospital, Solna, 17167 Stockholm, Sweden
| | - Alexios Matikas
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Breast Center, Theme Cancer, Karolinska University Hospital, Solna, 17167 Stockholm, Sweden
| | - Johan Hartman
- Department of Oncology-Pathology, Karolinska Institute, 17164 Stockholm, Sweden; (B.A.); (E.K.); (L.E.K.); (T.F.); (A.M.); (J.H.)
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, 17176 Stockholm, Sweden
| |
Collapse
|
19
|
Tesch ME, Partridge AH. Treatment of Breast Cancer in Young Adults. Am Soc Clin Oncol Educ Book 2022; 42:1-12. [PMID: 35580291 DOI: 10.1200/edbk_360970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although breast cancer is rare and understudied in adults age 40 and younger, recent epidemiologic data show an increasing incidence of breast cancer among young women in the United States and ongoing inferior long-term outcomes. Given breast cancers arising at a young age are more likely to present at advanced stages and to have aggressive biology, multimodal treatments are often indicated. Elevated local recurrence risks and greater propensity for germline cancer predisposition mutations can impact local therapy choices. Recently, escalated systemic therapy regimens for triple-negative breast cancer incorporating immunotherapy, de-escalated anti-HER2 therapy, and emerging targeted agents, including CDK4/6 inhibitors and PARP inhibitors, for early-stage disease may be employed in younger and older patients alike, with some special considerations. Prognostic genomic signatures can spare low-risk young women with hormone receptor-positive breast cancer adjuvant chemotherapy, but management of intermediate-risk patients remains controversial. Ovarian function suppression and extended endocrine therapy are improving outcomes in hormone receptor-positive breast cancer, but treatment adherence is a particular problem for young patients. Young women may also face greater challenges in long-term survivorship, including impaired fertility, difficulties in psychosocial adjustment, and other treatment-related comorbidities. Consideration of these age-specific issues through dedicated multidisciplinary strategies is necessary for optimal care of young women with breast cancer.
Collapse
|
20
|
Xue C, Li G, Zheng Q, Gu X, Bao Z, Lu J, Li L. The functional roles of the circRNA/Wnt axis in cancer. Mol Cancer 2022; 21:108. [PMID: 35513849 PMCID: PMC9074313 DOI: 10.1186/s12943-022-01582-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/22/2022] [Indexed: 01/09/2023] Open
Abstract
CircRNAs, covalently closed noncoding RNAs, are widely expressed in a wide range of species ranging from viruses to plants to mammals. CircRNAs were enriched in the Wnt pathway. Aberrant Wnt pathway activation is involved in the development of various types of cancers. Accumulating evidence indicates that the circRNA/Wnt axis modulates the expression of cancer-associated genes and then regulates cancer progression. Wnt pathway-related circRNA expression is obviously associated with many clinical characteristics. CircRNAs could regulate cell biological functions by interacting with the Wnt pathway. Moreover, Wnt pathway-related circRNAs are promising potential biomarkers for cancer diagnosis, prognosis evaluation, and treatment. In our review, we summarized the recent research progress on the role and clinical application of Wnt pathway-related circRNAs in tumorigenesis and progression.
Collapse
Affiliation(s)
- Chen Xue
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, National Clinical Research Center for Infectious Diseases, Zhejiang University, No. 79 Qingchun Road, Shangcheng District, 310003 Hangzhou, China
| | - Ganglei Li
- grid.13402.340000 0004 1759 700XDepartment of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, 310003 Hangzhou, China
| | - Qiuxian Zheng
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, National Clinical Research Center for Infectious Diseases, Zhejiang University, No. 79 Qingchun Road, Shangcheng District, 310003 Hangzhou, China
| | - Xinyu Gu
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, National Clinical Research Center for Infectious Diseases, Zhejiang University, No. 79 Qingchun Road, Shangcheng District, 310003 Hangzhou, China
| | - Zhengyi Bao
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, National Clinical Research Center for Infectious Diseases, Zhejiang University, No. 79 Qingchun Road, Shangcheng District, 310003 Hangzhou, China
| | - Juan Lu
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, National Clinical Research Center for Infectious Diseases, Zhejiang University, No. 79 Qingchun Road, Shangcheng District, 310003 Hangzhou, China
| | - Lanjuan Li
- grid.13402.340000 0004 1759 700XState Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, National Clinical Research Center for Infectious Diseases, Zhejiang University, No. 79 Qingchun Road, Shangcheng District, 310003 Hangzhou, China
| |
Collapse
|
21
|
Oliveira LJC, Amorim LC, Megid TBC, de Resende CAA, Mano MS. Gene expression signatures in early Breast Cancer: better together with clinicopathological features. Crit Rev Oncol Hematol 2022; 175:103708. [DOI: 10.1016/j.critrevonc.2022.103708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/24/2022] Open
|
22
|
Chen H, Luo H, Wang J, Li J, Jiang Y. Identification of a pyroptosis-related prognostic signature in breast cancer. BMC Cancer 2022; 22:429. [PMID: 35443644 PMCID: PMC9019977 DOI: 10.1186/s12885-022-09526-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 12/23/2022] Open
Abstract
Background The relationship between pyroptosis and cancer is complex. It is controversial that whether pyroptosis represses or promotes tumor development. This study aimed to explore prognostic molecular characteristics to predict the prognosis of breast cancer (BRCA) based on a comprehensive analysis of pyroptosis-related gene expression data. Methods RNA-sequcing data of BRCA were collected from The Cancer Genome Atlas (TCGA) and Gene Expression Ominibus (GEO) datasets. First, pyroptosis-related differentially expressed genes (DEGs) between normal and tumor tissues were identified from the TCGA database. Based on the DEGs, 1053 BRCA patients were divided into two clusters. Second, DEGs between the two clusters were used to construct a signature by a least absolute shrinkage and selection operator (LASSO) Cox regression model, and the GEO cohort was used to validate the signature. Various statistical methods were applied to assess this gene signature. Finally, Single-sample gene set enrichment analysis (ssGSEA) was employed to compare the enrichment scores of 16 types of immune cells and 13 immune-related pathways between the low- and high-risk groups. We calculated the tumor mutational burden (TMB) of TCGA cohort and evaluated the correlations between the TMB and riskscores of the TCGA cohort. We also compared the TMB between the low- and high-risk groups. Results A total of 39 pyroptosis-related DEGs were identified from the TCGA-breast cancer dataset. A prognostic signature comprising 16 genes in the two clusters of DEGs was developed to divide patients into high-risk and low-risk groups, and its prognostic performance was excellent in two independent patient cohorts. The high-risk group generally had lower levels of immune cell infiltration and lower activity of immune pathway activity than did the low-risk group, and different risk groups revealed different proportions of immune subtypes. The TMB is higher in high-risk group compared with low-risk group. OS of low-TMB group is better than that of high-TMB group. Conclusion A 16-gene signature comprising pyroptosis-related genes was constructed to assess the prognosis of breast cancer patients and its prognostic performance was excellent in two independent patient cohorts. The signature was found closely associated with the tumor immune microenvironment and the potential correlation could provide some clues for further studies. The signature was also correlated with TMB and the mechanisms are still warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09526-z.
Collapse
Affiliation(s)
- Hanghang Chen
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, No.1023 Shatai South Road, Guangzhou, 510515, Guangdong Province, China
| | - Haihua Luo
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, No.1023 Shatai South Road, Guangzhou, 510515, Guangdong Province, China
| | - Jieyan Wang
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, No.1023 Shatai South Road, Guangzhou, 510515, Guangdong Province, China
| | - Jinming Li
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, No.1023 Shatai South Road, Guangzhou, 510515, Guangdong Province, China. .,Department of Bioinformatics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China.
| | - Yong Jiang
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, No.1023 Shatai South Road, Guangzhou, 510515, Guangdong Province, China.
| |
Collapse
|
23
|
Andre F, Ismaila N, Allison KH, Barlow WE, Collyar DE, Damodaran S, Henry NL, Jhaveri K, Kalinsky K, Kuderer NM, Litvak A, Mayer EL, Pusztai L, Raab R, Wolff AC, Stearns V. Biomarkers for Adjuvant Endocrine and Chemotherapy in Early-Stage Breast Cancer: ASCO Guideline Update. J Clin Oncol 2022; 40:1816-1837. [PMID: 35439025 DOI: 10.1200/jco.22.00069] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To update recommendations on appropriate use of breast cancer biomarker assay results to guide adjuvant endocrine and chemotherapy decisions in early-stage breast cancer. METHODS An updated literature search identified randomized clinical trials and prospective-retrospective studies published from January 2016 to October 2021. Outcomes of interest included overall survival and disease-free or recurrence-free survival. Expert Panel members used informal consensus to develop evidence-based recommendations. RESULTS The search identified 24 studies informing the evidence base. RECOMMENDATIONS Clinicians may use Oncotype DX, MammaPrint, Breast Cancer Index (BCI), and EndoPredict to guide adjuvant endocrine and chemotherapy in patients who are postmenopausal or age > 50 years with early-stage estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative (ER+ and HER2-) breast cancer that is node-negative or with 1-3 positive nodes. Prosigna and BCI may be used in postmenopausal patients with node-negative ER+ and HER2- breast cancer. In premenopausal patients, clinicians may use Oncotype in patients with node-negative ER+ and HER2- breast cancer. Current data suggest that premenopausal patients with 1-3 positive nodes benefit from chemotherapy regardless of genomic assay result. There are no data on use of genomic tests to guide adjuvant chemotherapy in patients with ≥ 4 positive nodes. Ki67 combined with other parameters or immunohistochemistry 4 score may be used in postmenopausal patients without access to genomic tests to guide adjuvant therapy decisions. BCI may be offered to patients with 0-3 positive nodes who received 5 years of endocrine therapy without evidence of recurrence to guide decisions about extended endocrine therapy. None of the assays are recommended for treatment guidance in individuals with HER2-positive or triple-negative breast cancer. Treatment decisions should also consider disease stage, comorbidities, and patient preferences.Additional information is available at www.asco.org/breast-cancer-guidelines.
Collapse
Affiliation(s)
| | | | | | | | | | | | - N Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Komal Jhaveri
- Memorial Sloan Kettering Cancer Center, New York, NY.,Weill Cornell Medical College, New York, NY
| | - Kevin Kalinsky
- Winship Cancer Institute at Emory University, Atlanta, GA
| | | | - Anya Litvak
- Cancer Center at Saint Barnabas Medical Center, Livingston, NJ
| | | | | | - Rachel Raab
- Messino Cancer Centers-A Division of American Oncology Partners, Asheville, NC
| | | | | |
Collapse
|
24
|
Duan F, Zhong M, Ye J, Wang L, Jiang C, Yuan Z, Bi X, Huang J. The Iron-Inflammation Axis in Early-Stage Triple-Negative Breast Cancer. Front Cell Dev Biol 2022; 10:784179. [PMID: 35281097 PMCID: PMC8904738 DOI: 10.3389/fcell.2022.784179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/09/2022] [Indexed: 01/19/2023] Open
Abstract
The iron-related homeostasis and inflammatory biomarker have been identified as prognostic factors for cancers. We aimed to explore the prognostic value of a novel comprehensive biomarker, the iron-monocyte-to-lymphocyte ratio (IronMLR) score, in patients with early-stage triple-negative breast cancer (TNBC) in this study. We retrospectively analysed a total of 257 early-stage TNBC patients treated at Sun Yat-sen University Cancer Center (SYSUCC) between March 2006 and October 2016. Their clinicopathological information and haematological data tested within 1 week of the diagnosis were collected. According to the IronMLR score cutoff value of 6.07 μmol/L determined by maximally selected rank statistics, patients were stratified into the low- and high-IronMLR groups, after a median follow-up of 92.3 months (95% confidence interval [CI] 76.0–119.3 months), significant differences in 5-years disease-free survival (DFS) rate (81.2%, 95% CI 76.2%–86.5% vs. 65.5%, 95% CI 50.3%–85.3%, p = 0.012) and 5-years overall survival (OS) rate (86.0%, 95% CI 81.6%–90.7% vs. 65.5%, 95% CI 50.3%–85.3%, p = 0.011) were seen between two groups. Further multivariate Cox regression analysis revealed the IronMLR score as an independent predictor for DFS and OS, respectively, we then established a prognostic nomogram integrating the IronMLR score, T stage and N stage for individualized survival predictions. The prognostic model showed good predictive performance with a C-index of DFS 0.725 (95% CI 0.662–0.788) and OS 0.758 (95% CI 0.689–0.826), respectively. Besides, calibration curves for 1-, 3-, 5-DFS, and OS represented satisfactory consistency between actual and nomogram predicted survival. In conclusion, the Iron-inflammation axis might be a potential prognostic biomarker of survival outcomes for patients with early-stage TNBC, prognostic nomograms based on it with good predictive performance might improve individualized survival predictions.
Collapse
Affiliation(s)
- Fangfang Duan
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Muyi Zhong
- Department of Breast Oncology, Dongguan People's Hospital, Dongguan, China
| | - Jinhui Ye
- Department of Breast Oncology, The First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Li Wang
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chang Jiang
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhongyu Yuan
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiwen Bi
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiajia Huang
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
25
|
Breast Cancer Management in 2021: A Primer for the OB GYN. Best Pract Res Clin Obstet Gynaecol 2022; 82:30-45. [DOI: 10.1016/j.bpobgyn.2022.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/18/2022]
|
26
|
The Utility of the Oncotype DX Test for Breast Cancer Patients in an Australian Multidisciplinary Setting. Breast J 2022; 2022:1199245. [PMID: 35711899 PMCID: PMC9187289 DOI: 10.1155/2022/1199245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
Introduction The Oncotype DX test is a genomic assay that generates a Recurrence Score (RS) predicting the 10-year risk of recurrence and response to adjuvant chemotherapy in ER+/HER2− breast cancer patients. The aims were to determine breast cancer distant recurrence and correlate with adjuvant chemoendocrine prescribing patterns based on the Oncotype DX recurrence score. Methods We conducted a retrospective single-institution case series of 71 patients who had Oncotype DX assay testing after definitive surgery between 2012 and 2016. Both node-positive and node-negative patients were included. Patients were divided into Oncotype DX low risk (RS < 11) (n = 10, 14%), intermediate risk (RS 11–25) (n = 45, 63%), and high risk (RS > 25) (n = 16, 23%). Median follow-up was 6.1 years (range 4–8.9 years). Adjuvant treatment regimens and oncological outcomes were determined. Results. Mean age at diagnosis was 56 years (range, 33–77). Invasive ductal carcinoma (IDC) accounted for the majority (87%), with most tumors measuring between 10–20 mm (52%). 48% of the cohort were node positive. 15 of 16 high-risk patients (94%) received chemotherapy. 96% of intermediate-risk patients received endocrine therapy alone, one patient received chemoendocrine therapy (2%), and one declined systemic therapy (2%). In the low-risk group, 100% received endocrine therapy only. The high-risk group had the lowest mean ER% (P < 0.05), greatest mean mitotic rate (P < 0.05), and greatest proportion of Ki67% > 14. Five patients developed distant recurrence (7%): three from the intermediate-risk group (7%), one from the low-risk group (10%), and one from the high-risk group (6%). Conclusion This is the first Australian study reporting the experience with medium-term recurrence outcomes of using the Oncotype DX assay in breast cancer. Chemotherapy was rarely given for patients with low-to-intermediate RS and always offered in high RS. This pattern of prescribing was associated with low rates of distant recurrence. National funding models should be considered.
Collapse
|
27
|
Hua X, Duan F, Zhai W, Song C, Jiang C, Wang L, Huang J, Lin H, Yuan Z. A Novel Inflammatory-Nutritional Prognostic Scoring System for Patients with Early-Stage Breast Cancer. J Inflamm Res 2022; 15:381-394. [PMID: 35079223 PMCID: PMC8776566 DOI: 10.2147/jir.s338421] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose We attempted to explore the prognostic value of baseline inflammatory and nutritional biomarkers at diagnosis in patients with early-stage breast cancer and develop a novel scoring system, the inflammatory-nutritional prognostic score (INPS). Patients and Methods We collected clinicopathological and baseline laboratory data of 1259 patients with early-stage breast cancer between December 2010 and November 2012 from Sun Yat-sen University Cancer Center. Eligible patients were randomly divided into training and validation cohorts (n = 883 and 376, respectively) in a 7:3 ratio. We selected the most valuable biomarkers to develop INPS by the least absolute shrinkage and selection operator (LASSO) Cox regression model. A prognostic nomogram incorporating INPS and other independent clinicopathological factors was developed based on the stepwise multivariate Cox regression method. Then, we used the concordance index (C-index), calibration plot, and time-dependent receiver operating characteristic (ROC) analysis to evaluate the prognostic performance and predictive accuracy of the predictive nomogram. Results Four inflammatory-nutritional biomarkers, including neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), prognostic nutritional index (PNI), and albumin-alkaline phosphatase ratio (AAPR), were selected using the LASSO Cox analysis to construct INPS, which remained an independent prognostic indicator per the multivariate Cox regression analysis. Patients were stratified into low- and high-INPS groups based on the cutoff INPS determined by the maximally selected rank statistics. The prognostic model for overall survival consisting of INPS and other independent clinicopathological indicators showed excellent discrimination with C-indexes of 0.825 (95% confidence interval [CI]: 0.786–0.864) and 0.740 (95% CI: 0.657–0.822) in the training and validation cohorts, respectively. The time-dependent ROC curves showed a higher predictive accuracy of our prognostic nomogram than that of traditional tumor-node-metastasis staging. Conclusion Baseline INPS is an independent indicator of OS in patients with early-stage breast cancer. The INPS-based prognostic nomogram could be used as a practical tool for individualized prognostic predictions.
Collapse
Affiliation(s)
- Xin Hua
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Fangfang Duan
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Wenyu Zhai
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Chenge Song
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Chang Jiang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Li Wang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Jiajia Huang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
| | - Huanxin Lin
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Huanxin Lin, Department of Radiotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China, Email
| | - Zhongyu Yuan
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Zhongyu Yuan, Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China, Email
| |
Collapse
|
28
|
Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, Lin NU, Perez EA, Goldstein LJ, Chia SKL, Dhesy-Thind S, Rastogi P, Alba E, Delaloge S, Martin M, Kelly CM, Ruiz-Borrego M, Gil-Gil M, Arce-Salinas CH, Brain EGC, Lee ES, Pierga JY, Bermejo B, Ramos-Vazquez M, Jung KH, Ferrero JM, Schott AF, Shak S, Sharma P, Lew DL, Miao J, Tripathy D, Pusztai L, Hortobagyi GN. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer. N Engl J Med 2021; 385:2336-2347. [PMID: 34914339 PMCID: PMC9096864 DOI: 10.1056/nejmoa2108873] [Citation(s) in RCA: 384] [Impact Index Per Article: 128.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The recurrence score based on the 21-gene breast-cancer assay has been clinically useful in predicting a chemotherapy benefit in hormone-receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, axillary lymph-node-negative breast cancer. In women with positive lymph-node disease, the role of the recurrence score with respect to predicting a benefit of adjuvant chemotherapy is unclear. METHODS In a prospective trial, we randomly assigned women with hormone-receptor-positive, HER2-negative breast cancer, one to three positive axillary lymph nodes, and a recurrence score of 25 or lower (scores range from 0 to 100, with higher scores indicating a worse prognosis) to endocrine therapy only or to chemotherapy plus endocrine (chemoendocrine) therapy. The primary objective was to determine the effect of chemotherapy on invasive disease-free survival and whether the effect was influenced by the recurrence score. Secondary end points included distant relapse-free survival. RESULTS A total of 5083 women (33.2% premenopausal and 66.8% postmenopausal) underwent randomization, and 5018 participated in the trial. At the prespecified third interim analysis, the chemotherapy benefit with respect to increasing invasive disease-free survival differed according to menopausal status (P = 0.008 for the comparison of chemotherapy benefit in premenopausal and postmenopausal participants), and separate prespecified analyses were conducted. Among postmenopausal women, invasive disease-free survival at 5 years was 91.9% in the endocrine-only group and 91.3% in the chemoendocrine group, with no chemotherapy benefit (hazard ratio for invasive disease recurrence, new primary cancer [breast cancer or another type], or death, 1.02; 95% confidence interval [CI], 0.82 to 1.26; P = 0.89). Among premenopausal women, invasive disease-free survival at 5 years was 89.0% with endocrine-only therapy and 93.9% with chemoendocrine therapy (hazard ratio, 0.60; 95% CI, 0.43 to 0.83; P = 0.002), with a similar increase in distant relapse-free survival (hazard ratio, 0.58; 95% CI, 0.39 to 0.87; P = 0.009). The relative chemotherapy benefit did not increase as the recurrence score increased. CONCLUSIONS Among premenopausal women with one to three positive lymph nodes and a recurrence score of 25 or lower, those who received chemoendocrine therapy had longer invasive disease-free survival and distant relapse-free survival than those who received endocrine-only therapy, whereas postmenopausal women with similar characteristics did not benefit from adjuvant chemotherapy. (Funded by the National Cancer Institute and others; RxPONDER ClinicalTrials.gov number, NCT01272037.).
Collapse
Affiliation(s)
- Kevin Kalinsky
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - William E Barlow
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Julie R Gralow
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Funda Meric-Bernstam
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Kathy S Albain
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Daniel F Hayes
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Nancy U Lin
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Edith A Perez
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Lori J Goldstein
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Stephen K L Chia
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Sukhbinder Dhesy-Thind
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Priya Rastogi
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Emilio Alba
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Suzette Delaloge
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Miguel Martin
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Catherine M Kelly
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Manuel Ruiz-Borrego
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Miguel Gil-Gil
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Claudia H Arce-Salinas
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Etienne G C Brain
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Eun-Sook Lee
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Jean-Yves Pierga
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Begoña Bermejo
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Manuel Ramos-Vazquez
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Kyung-Hae Jung
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Jean-Marc Ferrero
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Anne F Schott
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Steven Shak
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Priyanka Sharma
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Danika L Lew
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Jieling Miao
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Debasish Tripathy
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Lajos Pusztai
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| | - Gabriel N Hortobagyi
- From the Winship Cancer Institute at Emory University, Atlanta (K.K.); Southwest Oncology Group Statistics and Data Management Center (W.E.B., D.L.L., J.M.) and the University of Washington School of Medicine-Seattle Cancer Care Alliance (J.R.G.) - both in Seattle; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B., D.T., G.N.H.); Loyola University Chicago, Maywood, IL (K.S.A.); the University of Michigan, Ann Arbor (D.F.H., A.F.S.); Dana-Farber Cancer Institute, Boston (N.U.L.); Mayo Clinic, Jacksonville, FL (E.A.P.); Fox Chase Cancer Center, Philadelphia (L.J.G.), and the University of Pittsburgh, Pittsburgh (P.R.) - both in Pennsylvania; BC Cancer-Vancouver Cancer Centre, Vancouver (S.K.L.C.), and Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON (S.D.-T.) - both in Canada; UGCI Medical Oncology Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Malaga (E.A.), Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red Cáncer-Instituto de Salud Carlos III, Universidad Complutense, Madrid (M.M.), Hospital Universitario Virgen del Rocío, Seville (M.R.-B.), Institut Català d'Oncologia, Barcelona (M.G.-G.), Hospital Clínico Universitario de Valencia, Biomedical Research Institute Investigación del Hospital Clínico de la Comunidad Valenciana, Valencia (B.B.), and Centro Oncológico de Galicia, A Coruña (M.R.-V.) - all in Spain; Institut Gustave Roussy (S.D.) and Institut Curie (J.-Y.P.), Paris, Institut Curie-Centre Réné Huguenin, Saint-Cloud (E.G.C.B.), and Centre Antoine Lacassagne, Nice (J.-M.F.) - all in France; Mater Misericordiae University Hospital, Dublin (C.M.K.); Instituto Nacional de Cancerología de México, Mexico City (C.H.A.-S.); the National Cancer Center Korea, Goyang-si (E.-S.L.), and Asa Medical Center, University of Ulsan College of Medicine, Seoul (K.-H.J.) - both in South Korea; Exact Sciences, Redwood City, CA (S.S.); the University of Kansas Medical Center, Kansas City (P.S.); and Yale University, New Haven, CT (L.P.)
| |
Collapse
|
29
|
Duan F, Li J, Huang J, Hua X, Song C, Wang L, Bi X, Xia W, Yuan Z. Establishment and Validation of Prognostic Nomograms Based on Serum Copper Level for Patients With Early-Stage Triple-Negative Breast Cancer. Front Cell Dev Biol 2021; 9:770115. [PMID: 34901016 PMCID: PMC8657150 DOI: 10.3389/fcell.2021.770115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/25/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Altered copper levels have been observed in several cancers, but studies on the relationship between serum copper and early-stage triple-negative breast cancer (TNBC) remain scare. We sought to establish a predictive model incorporating serum copper levels for individualized survival predictions. Methods: We retrospectively analyzed clinicopathological information and baseline peripheric blood samples of patients diagnosed with early-stage TNBC between September 2005 and October 2016 at Sun Yat-sen University Cancer Center. The optimal cut-off point of serum copper level was determined using maximally selected log-rank statistics. Kaplan-Meier curves were used to estimate survival probabilities. Independent prognostic indicators associated with survival were identified using multivariate Cox regression analysis, and subsequently, prognostic nomograms were established to predict individualized disease-free survival (DFS) and overall survival (OS). The nomograms were validated in a separate cohort of 86 patients from the original randomized clinical trial SYSUCC-001 (SYSUCC-001 cohort). Results: 350 patients were eligible in this study, including 264 in the training cohort and 86 in the SYSUCC-001 cohort. An optimal cut-off value of 21.3 μmol/L of serum copper was determined to maximally divide patients into low- and high-copper groups. After a median follow-up of 87.1 months, patients with high copper levels had significantly worse DFS (p = 0.002) and OS (p < 0.001) than those with low copper levels in the training cohort. Multivariate Cox regression analysis revealed that serum copper level was an independent factor for DFS and OS. Further, prognostic models based on serum copper were established for individualized predictions. These models showed excellent discrimination [C-index for DFS: 0.689, 95% confidence interval (CI): 0.621-0.757; C-index for OS: 0.728, 95% CI: 0.654-0.802] and predictive calibration, and were validated in the SYSUCC-001 cohort. Conclusion: Serum copper level is a potential predictive biomarker for patients with early-stage TNBC. Predictive nomograms based on serum copper might be served as a practical tool for individualized prognostication.
Collapse
Affiliation(s)
- Fangfang Duan
- Departments of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jianpei Li
- Departments of Clinical Laboratory Medicine, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiajia Huang
- Departments of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Hua
- Departments of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chenge Song
- Departments of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Wang
- Departments of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiwen Bi
- Departments of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen Xia
- Departments of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhongyu Yuan
- Departments of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
30
|
Dasgupta A, Bhardwaj D, DiCenzo D, Fatima K, Osapoetra LO, Quiaoit K, Saifuddin M, Brade S, Trudeau M, Gandhi S, Eisen A, Wright F, Look-Hong N, Sadeghi-Naini A, Curpen B, Kolios MC, Sannachi L, Czarnota GJ. Radiomics in predicting recurrence for patients with locally advanced breast cancer using quantitative ultrasound. Oncotarget 2021; 12:2437-2448. [PMID: 34917262 PMCID: PMC8664392 DOI: 10.18632/oncotarget.28139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background: The purpose of the study was to investigate the role of pre-treatment quantitative ultrasound (QUS)-radiomics in predicting recurrence for patients with locally advanced breast cancer (LABC). Materials and Methods: A prospective study was conducted in patients with LABC (n = 83). Primary tumours were scanned using a clinical ultrasound device before starting treatment. Ninety-five imaging features were extracted-spectral features, texture, and texture-derivatives. Patients were determined to have recurrence or no recurrence based on clinical outcomes. Machine learning classifiers with k-nearest neighbour (KNN) and support vector machine (SVM) were evaluated for model development using a maximum of 3 features and leave-one-out cross-validation. Results: With a median follow up of 69 months (range 7–118 months), 28 patients had disease recurrence (local or distant). The best classification results were obtained using an SVM classifier with a sensitivity, specificity, accuracy and area under curve of 71%, 87%, 82%, and 0.76, respectively. Using the SVM model for the predicted non-recurrence and recurrence groups, the estimated 5-year recurrence-free survival was 83% and 54% (p = 0.003), and the predicted 5-year overall survival was 85% and 74% (p = 0.083), respectively. Conclusions: A QUS-radiomics model using higher-order texture derivatives can identify patients with LABC at higher risk of disease recurrence before starting treatment.
Collapse
Affiliation(s)
- Archya Dasgupta
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Divya Bhardwaj
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Daniel DiCenzo
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Kashuf Fatima
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | | | - Karina Quiaoit
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | | | - Stephen Brade
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Maureen Trudeau
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Sonal Gandhi
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Frances Wright
- Department of Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Nicole Look-Hong
- Department of Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Ali Sadeghi-Naini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Physical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada.,Department of Electrical Engineering and Computer Sciences, Lassonde School of Engineering, York University, Toronto, Canada
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | | | - Gregory J Czarnota
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Physical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| |
Collapse
|
31
|
Hua X, Duan F, Huang J, Bi X, Xia W, Song C, Wang L, Jiang C, Yuan Z. A Novel Prognostic Model Based on the Serum Iron Level for Patients With Early-Stage Triple-Negative Breast Cancer. Front Cell Dev Biol 2021; 9:777215. [PMID: 34805180 PMCID: PMC8599954 DOI: 10.3389/fcell.2021.777215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/11/2021] [Indexed: 01/19/2023] Open
Abstract
The dysregulation of iron homeostasis has been explored in malignancies. However, studies focusing on the association between the serum iron level and prognosis of patients with early-stage triple-negative breast cancer (TNBC) are scarce. Accordingly, in current study, 272 patients with early-stage TNBC treated at Sun Yat-sen University Cancer Center (SYSUCC) between September 2005 and October 2016 were included as a training cohort, another 86 patients from a previous randomized trial, SYSUCC-001, were analyzed as a validation cohort (SYSUCC-001 cohort). We retrospectively collected their clinicopathological data and tested the serum iron level using blood samples at the diagnosis. In the training cohort, patients were divided into low-iron and high-iron groups according to the serum iron level cut-off of 17.84 μmol/L determined by maximally selected rank statistics. After a median follow-up of 87.10 months, patients with a low iron had a significantly longer median disease-free survival (DFS) of 89.13 [interquartile range (IQR): 66.88-117.38] months and median overall survival (OS) of 92.85 (IQR: 68.83-117.38) months than those in the high-iron group (median DFS: 75.25, IQR: 39.76-105.70 months, P = 0.015; median OS: 77.17, IQR: 59.38-110.28 months, P = 0.015). Univariate and multivariate Cox analysis demonstrated the serum iron level to be an independent predictor for DFS and OS. Then, a prognostic nomogram incorporating the serum iron level, T stage and N stage was developed for individualized prognosis predictions. It had good discriminative ability with a C-index of DFS (0.729; 95% CI 0.666-0.792) and OS (0.739; 95% CI 0.666-0.812), respectively. Furtherly, we validated the predictive model in the SYSUCC-001 cohort, which also showed excellent predictive performance with a C-index of DFS (0.735; 95% CI 0.614-0.855) and OS (0.722; 95% CI 0.577-0.867), respectively. All these suggested that the serum iron level might be a potential prognostic biomarker for patients with early-stage TNBC, the predictive model based on it might be served as a practical tool for individualized survival predictions.
Collapse
Affiliation(s)
- Xin Hua
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fangfang Duan
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiajia Huang
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiwen Bi
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen Xia
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chenge Song
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Wang
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chang Jiang
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhongyu Yuan
- Department of Medical Oncology, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
32
|
Li GQ, Yao J, Zhou P, Chen DX, Lian CL, Yang SP, Huang CH, Wu SG. Distribution, Chemotherapy Use, and Outcome of the 21-Gene Recurrence Score Between Chinese and White breast Cancer in the United States. Clin Breast Cancer 2021; 22:279-287. [PMID: 34896002 DOI: 10.1016/j.clbc.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the distribution, chemotherapy-decision making, and prognosis of the 21-gene recurrence score (RS) between Chinese breast cancer (BC) in the United States and White American (WA) BC. METHODS We identified early-stage and estrogen receptor-positive BC patients diagnosed between 2004 and 2015. Multivariate logistic regression, Kaplan-Meier analysis, and multivariate Cox proportional hazards models were used for statistical analyses. RESULTS A total of 67,486 patients were identified, including 66,215 (98.1%) WA patients and 1271 (1.9%) Chinese patients. Regarding the RS, 38,894 (57.6%) had low RS, 23,882 (35.4%) had intermediate RS, and 4710 (7.0%) had high RS. A similar distribution of RS was found between WA and Chinese BC (P = .280). The race was not the predictor associated with high RS. Similar trends of chemotherapy use were found in Chinese and WA BC. In WA BC, there were 4.1%, 31.5%, and 72.2% of patients receiving chemotherapy in low, intermediate, and high RS cohorts, respectively (P < .001). The proportion of chemotherapy use was 6.8%, 30.9%, and 74.0% in Chinese BC with low, intermediate, and high RS cohorts, respectively (P < 0.001). The multivariate prognostic analyses indicated that a higher RS was independently associated with an inferior breast cancer-specific survival. Similar trends were found among those with Chinese and WA BC. CONCLUSION Our results demonstrate similar distribution, chemotherapy use, and outcome of the 21-gene RS between Chinese and WA BC in the United States.
Collapse
Affiliation(s)
- Guan-Qiao Li
- Department of Breast Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People's Republic of China
| | - Jia Yao
- Department of Breast Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People's Republic of China
| | - Ping Zhou
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Dan-Xia Chen
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Shi-Ping Yang
- Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People's Republic of China
| | - Cai-Hong Huang
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen, People's Republic of China.
| | - San-Gang Wu
- Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.
| |
Collapse
|
33
|
Clinicopathological features and BRCA1 and BRCA2 mutation status in a prospective cohort of young women with breast cancer. Br J Cancer 2021; 126:302-309. [PMID: 34703009 DOI: 10.1038/s41416-021-01597-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Breast cancer in young women is more likely to have higher risk features and be associated with germline BRCA1/BRCA2 mutations. We present the clinicopathologic features of breast cancers in a prospective cohort of young women, and associations between surrogate molecular subtype and BRCA1/BRCA2 mutation status. METHODS Histopathological features, biomarker status, tumour stage and BRCA status were collected. Invasive tumours were categorised as luminal A-like (ER + and/or PR + , HER2-, grade 1/2), luminal B-like (ER + and/or PR + , HER2 + , or ER + and/or PR + , HER2-, and grade 3), HER2-enriched (ER/PR-, HER2 + ) or triple-negative. RESULTS In all, 57.3% (654/1143) of invasive tumours were high grade. In total, 32.9% were luminal A-like, 42.4% luminal B-like, 8.3% HER2-enriched, and 16.4% triple-negative. Among different age groups, there were no differences in molecular phenotype, stage, grade or histopathology. 11% (131) of tumours were from BRCA mutation carriers; 64.1% BRCA1 (63.1% triple-negative), and 35.9% BRCA2 (55.3% luminal B-like). DISCUSSION The opportunity to provide comparisons across young age groups, BRCA mutation status, surrogate molecular phenotype, and the identification of more aggressive hormone receptor-positive phenotypes in this population provides direction for future work to further understand and improve disparate outcomes for young women with luminal B-like cancers, particularly BRCA2-associated cancers, with potential implications for tailored prevention and treatment.
Collapse
|
34
|
Oda G, Nakagawa T, Uemura N, Mori H, Mori M, Fujioka T, Onishi I, Uetake H. Immediate breast reconstruction is oncologically safe for node-positive patients: Comparison using propensity score matching. Medicine (Baltimore) 2021; 100:e27184. [PMID: 34516518 PMCID: PMC8428751 DOI: 10.1097/md.0000000000027184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
The oncological safety of immediate breast reconstruction (IBR) in lymph node-positive patients is unclear. In the present study, the impact of IBR on recurrence based on data of patients with axillary lymph node metastases only was examined.The subjects were 232 patients who underwent breast surgery. The patients were grouped into 2 cohorts: non-IBR patients who underwent mastectomy with axillary lymph node dissection; and IBR patients with tissue expander or flap transfer and axillary lymph node dissection. The Non-IBR group included 165 patients, and the IBR group included 67 patients. For the comparison of oncological outcomes between the 2 groups, propensity score matching was performed. The propensity scores were calculated by logistic regression analysis, including age, tumor staging, human epidermal growth factor receptor 2 status, and estrogen receptor status. There was no difference in locoregional recurrence-free survival (LRRFS) between the non-IBR and IBR groups. The 5-year LRRFS rate was 78.9% in the non-IBR group and 85.1% in the IBR group. There was no difference in recurrence-free survival (RFS) between the non-IBR and IBR groups. The 5-year RFS rate was 75.6% in the non-IBR group and 78.8% in the IBR group. In all patients, the 5-year LRRFS rate was 77.3%, and the RFS rate was 70.5%. Multivariate Cox regression analysis to identify factors affecting RFS in all patients showed that estrogen receptor status and high nuclear grade were significant prognostic factors; IBR was irrelevant.This is the first report of an analysis using propensity score matching limited to node-positive breast cancer patients, and it showed that IBR is relatively safe in such patients.
Collapse
Affiliation(s)
- Goshi Oda
- Department of Specialized Surgery, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tsuyoshi Nakagawa
- Department of Specialized Surgery, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Noriko Uemura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Mio Mori
- Department of Radiology, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tomoyuki Fujioka
- Department of Radiology, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Iichiroh Onishi
- Department of Pathology, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Uetake
- Department of Specialized Surgery, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
35
|
Lu Y, Tong Y, Huang J, Lin L, Wu J, Fei X, Chen X, Shen K. Diverse Distribution and Gene Expression on the 21-Gene Recurrence Assay in Breast Cancer Patients with Locoregional Recurrence Versus Distant Metastasis. Cancer Manag Res 2021; 13:6279-6289. [PMID: 34408490 PMCID: PMC8364352 DOI: 10.2147/cmar.s314461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
Background It remains uncertain whether the 21-gene recurrence score (RS) of a primary tumor has selective prognostic value for locoregional recurrence (LRR) or distant metastasis (DM). The current study aimed to compare the distribution and single-gene expression on the RS panel in breast cancer patients with LRR versus DM. Methods Consecutive early breast cancer patients who had been operated on at the Comprehensive Breast Health Center, Ruijin Hospital from January 2009 to December 2016 were retrospectively reviewed. Patients were divided into LRR, DM, and no-recurrence groups according to the first reported recurrent event. Comparison and subgroup analysis of 21-gene RS, RS category, and single-gene expression on the RS panel were conducted among patients with different recurrence status. Results A total of 1,287 patients were included, with median follow-up of 61.5 months, and 27, 47, and 1,213 patients were classified as LRR, DM, and no recurrence groups, respectively. RS was significantly diversely distributed among the three groups (P<0.001). No-recurrence patients (median 22) presented much lower RS than LRR (median 39, P<0.001) and DM (median 30, P<0.001) patients. LRR patients had lower PR (P<0.001), BCL2 (P=0.010), and CEGP1 (P<0.001) expression, and DM patients had higher STMY3 (P=0.019) expression than no-recurrence patients. Moreover, CEGP1 expression was significantly lower in the LRR group than the DM one (P=0.028). Conclusion RS was differently distributed between recurrent and nonrecurrent patients. PR, BCL2, CEGP1, and STMY3 expression was associated with LRR and DM, while CEGP1 was lower in the LRR group than DM patients, warranting further clinical evaluation.
Collapse
Affiliation(s)
- Yujie Lu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yiwei Tong
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lin Lin
- Department of Clinical Laboratory, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| |
Collapse
|
36
|
Yu J, Lin C, Huang J, Hong J, Gao W, Zhu S, Lin L, Chen X, Huang O, He J, Zhu L, Chen W, Li Y, Wu J, Shen K. Efficacy of adjuvant chemotherapy stratified by age and the 21-gene recurrence score in estrogen receptor-positive breast cancer. BMC Cancer 2021; 21:707. [PMID: 34130640 PMCID: PMC8207606 DOI: 10.1186/s12885-021-08461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 21-gene recurrence score (RS) can predict chemotherapy benefit in estrogen receptor-positive, human epidermal growth factor receptor-2-negative (ER+/HER2-) early breast cancer patients. Age would influence the interaction between RS and chemotherapy effect. The current study aimed to determine RS thresholds which were predictive of chemotherapy benefit in young and old women, respectively. METHODS Patients diagnosed with pN0-1, ER+/HER2- breast cancer between 2009 and 2016 were retrospectively reviewed. Propensity score matching was performed according to chemotherapy usage. After stratifying patients with different cutoffs of age, the RS threshold indicating chemotherapy benefit in each age strata were determined by cox proportional hazard models. RESULTS A total of 1227 patients were included. The median age was 58 years and the median RS was 24. After matching, the RS thresholds suggesting chemotherapy benefit varied with age. For patients ≤55 years, chemotherapy benefit was observed in those having RS > 25 (P = 0.03), with 4-year invasive disease-free survival (IDFS) of 97.0 and 89.3% in patients receiving chemotherapy or not. While patients derived no benefit from chemotherapy if they had RS ≤25 (P = 0.66, 4-year IDFS: 95.3% vs. 94.6%). For patients > 55 years, adjuvant chemotherapy was associated with better prognosis in those with RS > 36 (P = 0.014, 4-year IDFS: 94.7% vs. 76.2%), but not in those having RS ≤36 (P = 0.13, 4-year IDFS: 92.3% vs. 95.8%). CONCLUSIONS Old patients need higher RS thresholds to demonstrate the chemotherapy benefit. Further efforts are warranted to investigate the association between age and predictive RS thresholds.
Collapse
Affiliation(s)
- Jing Yu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Caijin Lin
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Jin Hong
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Weiqi Gao
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Siji Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Lin Lin
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Ou Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Jianrong He
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Li Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Weiguo Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Yafen Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| |
Collapse
|
37
|
Furlanetto J, Marmé F, Seiler S, Thode C, Untch M, Schmatloch S, Schneeweiss A, Bassy M, Fasching PA, Strik D, Stickeler E, Schem C, Karn T, Grischke EM, Denkert C, van Mackelenbergh M, Müller V, Nekljudova V, Loibl S. Chemotherapy-induced ovarian failure in young women with early breast cancer: Prospective analysis of four randomised neoadjuvant/adjuvant breast cancer trials. Eur J Cancer 2021; 152:193-203. [PMID: 34116270 DOI: 10.1016/j.ejca.2021.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Young women receiving chemotherapy for early breast cancer (EBC) have a high probability for ovarian failure, defined by chemotherapy-induced amenorrhea (CIA) as a surrogate. CIA is insufficiently reliable and reproducible. We analysed chemotherapy-induced ovarian failure (CIOF) by assessing hormone parameters, CIA, and antral follicle count (AFC). METHODS Blood samples of women aged ≤45 years treated with anthracycline/taxane-based chemotherapy for EBC from four neoadjuvant/adjuvant trials were collected at baseline, at the end of treatment (EOT), and at 6, 12, 18, and 24 months after EOT. Centrally assessed oestradiol (cutoff <52.2 ng/L) and follicle-stimulating hormone (cutoff >12.4IU/L) were used to define CIOF for patients with baseline premenopausal hormone levels, anti-Müllerian hormone (AMH), and AFC to assess ovarian reserve. Further analyses included CIA, regain of premenopausal hormone levels, and disease-free survival (DFS) also in subgroups. RESULTS Six hundred ninety-six patients aged ≤45 years had premenopausal hormone levels at baseline. Overall, 85.1% (592/696) experienced CIOF at EOT, and 147 of 592 had further hormone measurements after EOT. Of those, 32.7% (48/147) regained premenopausal hormone levels after 6 months, 57.9% (66/114) regained premenopausal hormone levels after 12 months, 83.0% (73/88) regained premenopausal hormone levels after 18 months, and 89.2% (74/83) regained premenopausal hormone levels after 24 months. After 24 months, 72.4% (21/29) of patients without CIOF and 100% (14/14) with CIOF had low AMH levels. Four-year DFS without CIOF versus CIOF was 65.9% versus 84.6% (hazard ratio [HR] = 2.09, 95% confidence interval [CI]: 1.37-3.19; P < 0.001); in hormone receptor positive 61.8% versus 87.5% (HR = 2.69, 95% CI: 1.57-4.60; P < 0.001); in <30 years 68.3% versus 92.6% (HR = 4.87, 95% CI: 1.05-22.63; P = 0.026). CONCLUSION Most premenopausal women experienced CIOF after chemotherapy for EBC. After 2 years, nearly all regain premenopausal hormone levels. CIOF was associated with better DFS, especially in patients with hormone receptor-positive EBC or aged <30 years.
Collapse
Affiliation(s)
| | | | | | - Christian Thode
- Amedes MVZ Wagnerstibbe für Laboratoriumsmedizin, Medizinische Mikrobiologie und Immunologie, Göttingen, Germany
| | | | | | | | - Martina Bassy
- Amedes MVZ Wagnerstibbe für Laboratoriumsmedizin, Medizinische Mikrobiologie und Immunologie, Göttingen, Germany
| | | | | | | | | | | | | | - Carsten Denkert
- Institut für Pathologie Philipps-Universität Marburg, Germany
| | - Marion van Mackelenbergh
- Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Schleswig-Holstein, Germany
| | | | | | | |
Collapse
|
38
|
A Systemic Inflammation Response Score for Prognostic Prediction of Breast Cancer Patients Undergoing Surgery. J Pers Med 2021; 11:jpm11050413. [PMID: 34069272 PMCID: PMC8156296 DOI: 10.3390/jpm11050413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Systemic inflammatory response is related to the occurrence, progression, and prognosis of cancers. In this research, a novel systemic inflammation response score (SIRS) was calculated, and its prognostic value for postoperative stage I-III breast cancer (BC) patients was analyzed. Methods: 1583 BC patients were included in this research. Patients were randomly divided into a training cohort (n = 1187) and validation cohort (n = 396). SIRS was established in the training cohort based on independent prognostic hematological indicator, its relationship between prognosis and clinical features was analyzed. Then, a nomogram consisted of SIRS and clinical features was established, its performance was examined by calibration plots and receiver operating characteristic curve analysis. Results: The SIRS was an independent prognostic indicator for BC patients, and a high-SIRS was related to multifocality, advanced N stage, and worse prognosis. Incorporating SIRS into a nomogram could accurately predict the prognosis of BC patients, the results of receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of nomogram was up to 0.806 in training cohort and 0.905 in the validation cohort. Conclusion: SIRS was associated with the prognosis of patients with breast cancer. Nomogram based on SIRS can accurately predict the prognosis of breast cancer patients.
Collapse
|
39
|
Mano MS, Oliveira LJC, Hanna SA. Integrating Adjuvant Radiation with Post-Neoadjuvant Therapies in Early Breast Cancer. Curr Oncol Rep 2021; 23:58. [PMID: 33770260 DOI: 10.1007/s11912-021-01050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Because of the strong prognostic value of pathologic complete response (pCR) in early breast cancer (EBC), patients who fail to achieve this outcome have increasingly been eligible to a new treatment modality, namely post-neoadjuvant systemic therapy (PNT). However, adjuvant radiation therapy (RT) retains a crucial role in EBC, and also needs to be timely administered to patients. To address how modern PNT optimally integrates with adjuvant RT is therefore the purpose of this review. RECENT FINDINGS How PNT administration optimally integrates with adjuvant RT has varied depending on the type of systemic therapy employed. The introduction of novel "targeted" agents has created new challenges, as for many of them limited information is available on the feasibility of concurrent systemic and RT administration or their optimal sequencing. PNT and RT are both of utmost importance to the management of EBC and need to be timely and safely administered to patients. The optimal strategy to integrate these modalities may vary according to the type of PNT agent and other factors.
Collapse
Affiliation(s)
- Max S Mano
- Centro Paulista de Oncologia (CPO) - Unidade Faria Lima Endereço, Av. Brigadeiro Faria Lima, 4300 Grupo Oncoclínicas (GOC), São Paulo, SP, 04538-132, Brazil.
| | - Leandro Jonata C Oliveira
- Centro Paulista de Oncologia (CPO) - Unidade Faria Lima Endereço, Av. Brigadeiro Faria Lima, 4300 Grupo Oncoclínicas (GOC), São Paulo, SP, 04538-132, Brazil
| | - Samir A Hanna
- Department of Radiation Oncology - Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Oncology Center, São Paulo, 01308-050, Brazil
| |
Collapse
|
40
|
Identification and Complete Validation of Prognostic Gene Signatures for Human Papillomavirus-Associated Cancers: Integrated Approach Covering Different Anatomical Locations. J Virol 2021; 95:JVI.02354-20. [PMID: 33361419 DOI: 10.1128/jvi.02354-20] [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: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
Human papillomavirus (HPV) infects squamous epithelium and is a major cause of cervical cancer (CC) and a subset of head and neck cancers (HNC). Virus-induced tumorigenesis, molecular alterations, and related prognostic markers are expected to be similar between the two cancers, but they remain poorly understood. We present integrated molecular analysis of HPV-associated tumors from TCGA and GEO databases and identify prognostic biomarkers. Analysis of gene expression profiles identified common upregulated genes and pathways of DNA replication and repair in the HPV-associated tumors. We established 34 prognostic gene signatures with a universal cutoff value in TCGA-CC using Elastic Net Cox regression analysis. We were able to externally validate our results in the TCGA-HNC and several GEO data sets, and demonstrated prognostic power in HPV-associated HNC, but not in HPV-negative cancers. The HPV-related prognostic and predictive indicator did not discriminate other cancers, except bladder urothelial carcinoma. These results identify and completely validate a highly selective prognostic system and its cross-usefulness in HPV-associated cancers, regardless of the tumor's anatomical subsite.IMPORTANCE Persistent infection with high-risk HPV interferes with cell function regulation and causes cell mutations, which accumulate over the long term and eventually develop into cancer. Results of pathway enrichment analysis presumably showed this accumulation of intracellular damage during the chronic HPV-infected state. We used highly advanced statistical methods to identify the most appropriate genes and coefficients and developed the HPV-related prognostic and predictive indicator (HPPI) risk scoring system. We applied the same cutoff value to training and validation sets and demonstrated good prognostic performance in both data sets, and confirmed a consistent trend in external validation. Moreover, HPPI presented significant validation results for bladder cancer suspected to be related to HPV. This suggested that our risk scoring system based on the prognostic gene signature could play an important role in the development of treatment strategies for patients with HPV-related cancer.
Collapse
|
41
|
Abstract
PURPOSE OF REVIEW The present review summarizes recent original publications addressing the topic of risk-adapted adjuvant therapy in early breast cancer (EBC). As neoadjuvant therapy has become a standard for triple negative and HER2+ EBC, it focusses on luminal EBC. RECENT FINDINGS Gene expression assays have become standard of care in luminal EBC, at least for patients with node negative disease. Two prospective randomized clinical trials, TAILORx (Oncotype DX) and MINDACT (MammaPrint) have presented additional analyses underlining the clinical utility of the tests. In times of COVID-19, immunohistochemically determined ER, PR, and Ki67 and early Ki67 response to endocrine therapy can be used to safely allocate patients for preoperative endocrine therapy and delay surgeries if resources are scarce. In patients with luminal high-risk disease, adding a CDK 4/6 inhibitor (abemaciclib) improves patient outcome already after short-term follow-up. SUMMARY Determination of recurrence risk will remain important in luminal EBC for optimal therapy decisions. In the future, risk-adapted treatment concepts will include decision making for chemotherapy but also for endocrine-based approaches.
Collapse
Affiliation(s)
- Nadia Harbeck
- Breast Center, Dept OB&GYN and CCCMunich , LMU University Hospital, Munich, Germany
| |
Collapse
|
42
|
Zhu Y, Wang T, Tong Y, Chen X, Shen K. 21-Gene Recurrence Assay Associated With Favorable Metabolic Profiles in HR-Positive, HER2-Negative Early-Stage Breast Cancer Patients. Front Endocrinol (Lausanne) 2021; 12:725161. [PMID: 34456877 PMCID: PMC8385488 DOI: 10.3389/fendo.2021.725161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Comprehensive investigations of the associations between 21-gene recurrence assay and metabolic profiles in Chinese breast cancer patients are limited. METHODS We evaluated the relations of the 21-gene recurrence risk score (RS) and the expression of cancer-related genes with metabolic factors and biomarkers of insulin and the insulin-like growth factor (IGF) axis, and examined the interactions between the 21-gene RS and these metabolic profiles on breast cancer recurrence in Chinese women with HR-positive, HER2-negative early-stage breast cancer. RESULTS The 21-gene RS was inversely associated with body mass index ([BMI]β: -0.178 kg/m2; P=0.040), the homeostasis model assessment of insulin resistance index ([HOMA-IR] β: -0.031; P=0.042), insulin (β: -0.036 uIU/ml; P=0.009), and C-peptide (β: -0.021 ug/L; P=0.014) and was positively associated with high-density lipoprotein cholesterol (β: 0.025 mmol/L; P=0.004), which were driven by the relation patterns between specific cancer-related genes and these metabolic profiles. Each 10-unit increase in the 21-gene RS was associated with 28% (95% CI: 5-47%) higher risk of breast cancer recurrence; this association was also observed in patients with favorable metabolic profiles in relevant to an absence of obesity, insulin resistance, hyperglycemia, hypertension, or dyslipidemia (28-44% higher risk) and among women with a low level of insulin, C-peptide, or the IGF1/IGFBP3 ratio (41-155% higher risk). CONCLUSIONS The 21-gene RS was related to favorable metabolic profiles including lower BMI, HOMA-IR, insulin, and C-peptide, and higher HDL in Chinese breast cancer patients, and its prognostic impact on breast cancer recurrence was more likely to present among patients with relatively favorable metabolic profiles.
Collapse
Affiliation(s)
- Yifei Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Shanghai National Clinical Research Center for Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwei Tong
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Xiaosong Chen, ; Kunwei Shen,
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Xiaosong Chen, ; Kunwei Shen,
| |
Collapse
|
43
|
Liu R, Xiao Z, Hu D, Luo H, Yin G, Feng Y, Min Y. Cancer-Specific Survival Outcome in Early-Stage Young Breast Cancer: Evidence From the SEER Database Analysis. Front Endocrinol (Lausanne) 2021; 12:811878. [PMID: 35116010 PMCID: PMC8805172 DOI: 10.3389/fendo.2021.811878] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Young women with breast cancer are determined to present poorer survival compare with elderly patients. Therefore, identifying the clinical prognostic factors in young women with early-stage (T1-2N0-1M0) breast cancer is pivotal for surgeons to make better postoperative management. METHODS The clinicopathological characteristics of female patients with early-stage breast cancer from the Surveillance, Epidemiology, and End Results program between Jan 2010 and Dec 2015 were retrospectively reviewed and analyzed. Univariate and multivariate Cox regression analyses were used to determine the potential risk factors of cancer-specific survival in young women with early-stage breast cancer. The nomogram was constructed and further evaluated by an internal validation cohort. The Kaplan-Meier survival curves were used to estimate cancer-specific survival probability and the cumulative incidence. RESULTS Six variables including race, tumor location, grade, regional lymph node status, tumor subtype, and size were identified to be significantly associated with the prognosis of young women with early-stage breast cancer during the postoperative follow-up. A nomogram for predicting the 3-, 5- year cancer-specific survival probability in this subpopulation group was established with a favorable concordance index of 0.783, supported by an internal validation cohort with the AUC of 0.722 and 0.696 in 3-, 5- year cancer-specific survival probability, respectively. CONCLUSIONS The first predictive nomogram containing favorable discrimination is successfully established and validated for predicting the 3-, 5- year cancer-specific survival probability in young women with early-stage breast cancer during the postoperative follow-up. This model would help clinicians to make accurate treatment decisions in different clinical risk population.
Collapse
Affiliation(s)
- Rui Liu
- Department of Oncology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhesi Xiao
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haojun Luo
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Feng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yu Min, ; Yang Feng,
| | - Yu Min
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yu Min, ; Yang Feng,
| |
Collapse
|
44
|
Affiliation(s)
- Harold J Burstein
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School - all in Boston
| |
Collapse
|
45
|
Poorvu PD, Gelber SI, Zheng Y, Ruddy KJ, Tamimi RM, Peppercorn J, Schapira L, Borges VF, Come SE, Lambertini M, Rosenberg SM, Partridge AH. Pregnancy after breast cancer: Results from a prospective cohort of young women with breast cancer. Cancer 2020; 127:1021-1028. [PMID: 33259061 DOI: 10.1002/cncr.33342] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/12/2020] [Accepted: 11/02/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Many young women with newly diagnosed breast cancer are interested in future pregnancies. Prospective data regarding fertility interest and reproductive patterns after diagnosis are needed to counsel patients. METHODS The Young Women's Breast Cancer Study is a multicenter, prospective cohort of women who were diagnosed with breast cancer at age ≤40 years between 2006 and 2016. Women complete surveys at baseline, every 6 months for 3 years, then annually. Here, the authors describe fertility interest and pregnancies within 5 years of diagnosis for women with stage 0 through III breast cancer. RESULTS Of 1026 eligible participants, 368 (36%) reported interest in future biologic children at least once within 5 years after diagnosis, including 16% at 5 years after diagnosis. Among 130 women who attempted to become pregnant, 90 (69.2%) conceived; and, among 896 women who did not attempt to conceive, 18 (2.0%) became pregnant, with a total of 152 pregnancies resulting in 91 live births. Factors associated with pregnancy included younger versus older age at diagnosis (aged ≤30 vs 36-40 years: odds ratio [OR], 6.63; 95% CI, 3.18-13.83; P < .0001; aged 31-35 vs 36-40 years: OR, 5.86; 95% CI, 3.37-10.17; P < .0001) and being nulliparous versus parous (OR, 2.66; 95% CI, 1.56-4.53; P = .001). The receipt of endocrine therapy versus no endocrine therapy (OR, 0.35; 95% CI, 0.20-0.59; P = .001) was inversely associated with pregnancy. CONCLUSIONS Many women remain interested in future fertility in the 4 years after a breast cancer diagnosis, indicating that longitudinal fertility discussions are needed. Although a minority of those interested in having children attempted to become pregnant in the first 5 years, most who attempted to conceive did so and had live births.
Collapse
Affiliation(s)
- Philip D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shari I Gelber
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yue Zheng
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kathryn J Ruddy
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Jeffrey Peppercorn
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Virginia F Borges
- Department of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Steven E Come
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy.,Medical Oncology Clinic, IRCCS San Maritino Polyclinic Hospital, Genoa, Italy
| | - Shoshana M Rosenberg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
46
|
Sella T, Gelber SI, Poorvu PD, Kim HJ, Dominici L, Guzman-Arocho YD, Collins L, Ruddy KJ, Tamimi RM, Peppercorn JM, Schapira L, Borges VF, Come SE, Warner E, Snow C, Jakubowski DM, Russell CA, Winer EP, Rosenberg SM, Partridge AH. Response to neoadjuvant chemotherapy and the 21-gene Breast Recurrence Score test in young women with estrogen receptor-positive early breast cancer. Breast Cancer Res Treat 2020; 186:157-165. [PMID: 33150547 DOI: 10.1007/s10549-020-05989-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The 21-gene Breast Recurrence Score test predicts benefit from adjuvant chemotherapy in estrogen receptor-positive, HER2-negative (ER+/HER2-) breast cancer (BC). We examined whether the 21-gene assay predicts response to neoadjuvant chemotherapy (NCT). METHODS We identified patients with stage I-III ER+/HER2- BC treated with NCT from the Young Women's Breast Cancer Study, a prospective cohort of women diagnosed with BC at age ≤40 years. The 21-gene assay was performed on tumor specimens removed prior to NCT either as part of clinical care or retrospectively for research. Pathological complete response (pCR) was defined as ypT0/is ypN0. The relationship between Recurrence Score result and pCR was evaluated using logistic regression modeling. RESULTS 76 women received NCT for ER+/HER2- BC and were eligible for this analysis. Median age at diagnosis was 37 years (range 24-40). Scores ranged between 5 and 77 with 50% >25 and 5% <11. Median Recurrence Score result was significantly higher among tumors achieving pCR vs. non-pCR response (61.5 vs. 23, pwilcoxon = 0.0005). pCR rate in patients with scores >25 was 21% (8/38) vs. 5% in patients with scores <25 (2/38) (p = 0.09), with both pCRs in the <25 group in patients with scores between 21 and 25. In multivariable analysis, only Recurrence Score result was significantly associated with pCR (OR: 1.07, 95%CI 1.01-1.12, p = 0.01). CONCLUSIONS In young women with ER+/HER2- BC who received NCT, higher pretreatment Recurrence Score result was associated with an increased likelihood of pCR. Gene expression profile assays may have a role in decision making in young women in need of neoadjuvant therapy.
Collapse
Affiliation(s)
- Tal Sella
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Shari I Gelber
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Philip D Poorvu
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Laura Dominici
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Divison of Breast Surgery Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Yaileen D Guzman-Arocho
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Laura Collins
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Rulla M Tamimi
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey M Peppercorn
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Steven E Come
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ellen Warner
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Craig Snow
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | | | | | - Eric P Winer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Shoshana M Rosenberg
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
47
|
Cheng R, Kong X, Wang X, Fang Y, Wang J. Oncotype DX Breast Recurrence Score Distribution and Chemotherapy Benefit Among Women of Different Age Groups With HR-Positive, HER2-Negative, Node-Negative Breast Cancer in the SEER Database. Front Oncol 2020; 10:1583. [PMID: 33194568 PMCID: PMC7663955 DOI: 10.3389/fonc.2020.01583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: To explore the distribution of Oncotype DX Breast Recurrence Score (RS), the proportion of receiving chemotherapy, and the relationship between RS and chemotherapy benefit according to detailed age groups in women with hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-negative (HR+/HER2−/N0) breast cancer. Methods: This was an extensive, comprehensive, population-based retrospective study. Data on individuals with breast cancer were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program. The cohort was divided into five groups by age (≤ 35, 36–50, 51–65, 66–80, >80 years). RS distribution and chemotherapy proportion among different age groups were analyzed, and the overall survivals between patients receiving chemotherapy and those not/unknown were compared in each age group. Results: The study cohort comprised 49,539 patients and the largest age group was 51–65 years. The percentage of patients with low-risk RS (0–10) increased with age, whereas those with intermediate-risk RS (11–25) decreased with age (except for the group of 36–50 years, which had the highest rate of intermediate-risk RS). The age group ≤35 years has the greatest rate of high-risk RS (26–100). The proportion of receiving chemotherapy decreased with age in all RS risk categories. Overall survival was benefited by chemotherapy only in the age group of 66–80 years with intermediate- and high-risk RS, and chemotherapy seemed to do more harm than good for patients older than 80 years. Conclusions: In the present study, we identified the distribution of RS, the proportion of receiving chemotherapy, and the relationship between RS and chemotherapy benefit according to a detailed age grouping for women with HR+/HER2−/N0 breast cancer, which may help in making individualized clinical decisions.
Collapse
Affiliation(s)
- Ran Cheng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
48
|
Weiser R, Haque W, Polychronopoulou E, Hatch SS, Kuo YF, Gradishar WJ, Klimberg VS. The 21-gene recurrence score in node-positive, hormone receptor-positive, HER2-negative breast cancer: a cautionary tale from an NCDB analysis. Breast Cancer Res Treat 2020; 185:667-676. [PMID: 33070279 DOI: 10.1007/s10549-020-05971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The 21-gene recurrence score assay (RS) has not been prospectively validated to predict adjuvant chemotherapy benefit in hormone receptor-positive (HR+), HER2-negative (HER2-), node-positive breast cancer patients. Nevertheless, de-escalation based on RS has been demonstrated and partially advocated by retrospective data. The purpose of this study was to identify subgroups of node-positive patients with low to intermediate RS who still benefit from adjuvant chemotherapy. METHODS The National Cancer Database was used to identify 28,591 women with stage I-III, T1-T3, N1, HR+, HER2- breast cancer and a RS ≤ 25 between 2010 and 2016. Univariate and multivariate analyses were used to identify variables correlating with chemotherapy use and 5-year survival. Subgroup analysis was performed to discern patients in whom the use of adjuvant chemotherapy correlated with better survival. RESULTS A 35% decline in chemotherapy use was observed from 2010 to 2016. Patients with younger age, higher RS, larger tumors and more positive lymph nodes, and those treated by mastectomy, axillary lymph node dissection and radiation, were more likely to receive chemotherapy. Chemotherapy use was associated with an improved 5-year survival (HR = 1.63, 95% CI 1.28-2.07). Upon subgroup analysis, this association was lost in patients > 70 years and those with a RS ≤ 11, while patients ≤ 70 with a RS of 12-25 treated with chemotherapy had an absolute 5-year survival advantage of 3.0% (HR = 1.91, 95% CI 1.42-2.57). CONCLUSION Clinicians should be cautious when considering omission of adjuvant chemotherapy in patients ≤ 70 years, with HR+, HER2-, N1 tumors and a RS 12-25, at least until the results of the anticipated RxPONDER trial become available.
Collapse
Affiliation(s)
- Roi Weiser
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Efstathia Polychronopoulou
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Sandra S Hatch
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - William J Gradishar
- Department of Medicine & Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - V Suzanne Klimberg
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.
| |
Collapse
|
49
|
Buqué A, Perez-Lanzón M, Petroni G, Humeau J, Bloy N, Yamazaki T, Sato A, Kroemer G, Galluzzi L. MPA/DMBA-driven mammary carcinomas. Methods Cell Biol 2020; 163:1-19. [PMID: 33785159 DOI: 10.1016/bs.mcb.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The polycyclic aromatic hydrocarbon 7,12-dimethylbenz[a]anthracene (DMBA, D) administered per os to wild-type female mice bearing slow-release medroxyprogesterone (MPA, M) pellets s.c. drives the formation of mammary carcinomas that recapitulate numerous immunobiological features of human luminal B breast cancer. In particular, M/D-driven mammary carcinomas established in immunocompetent C57BL/6 female mice (1) express hormone receptors, (2) emerge by evading natural immunosurveillance and hence display a scarce immune infiltrate largely polarized toward immunosuppression, (3) exhibit exquisite sensitivity to CDK4/CDK6 inhibitors, and (4) are largely resistant to immunotherapy with immune checkpoint blockers targeting PD-1. Thus, M/D-driven mammary carcinomas evolving in immunocompetent female mice stand out as a privileged preclinical platform for the study of luminal B breast cancer. Here, we provide a detailed protocol for the establishment of M/D-driven mammary carcinomas in wild-type C57BL/6 female mice. This protocol can be easily adapted to generate M/D-driven mammary carcinomas in female mice with most genetic backgrounds (including genetically-engineered mice).
Collapse
Affiliation(s)
- Aitziber Buqué
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Maria Perez-Lanzón
- Equipe Labellisée par la Ligue Contre le Cancer, Université de Paris, Sorbonne Université, Institut Universitaire de France, INSERM U1138, Centre de Recherche des Cordeliers, Paris, France; Faculté de Médecine, Université de Paris Sud, Paris-Saclay, Le Kremlin-Bicêtre, France; Metabolomics and Cell Biology Platforms, Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
| | - Giulia Petroni
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Juliette Humeau
- Equipe Labellisée par la Ligue Contre le Cancer, Université de Paris, Sorbonne Université, Institut Universitaire de France, INSERM U1138, Centre de Recherche des Cordeliers, Paris, France; Faculté de Médecine, Université de Paris Sud, Paris-Saclay, Le Kremlin-Bicêtre, France; Metabolomics and Cell Biology Platforms, Gustave Roussy Comprehensive Cancer Institute, Villejuif, France
| | - Norma Bloy
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Takahiro Yamazaki
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Ai Sato
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Guido Kroemer
- Equipe Labellisée par la Ligue Contre le Cancer, Université de Paris, Sorbonne Université, Institut Universitaire de France, INSERM U1138, Centre de Recherche des Cordeliers, Paris, France; Metabolomics and Cell Biology Platforms, Gustave Roussy Comprehensive Cancer Institute, Villejuif, France; Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Suzhou Institute for Systems Medicine, Chinese Academy of Sciences, Suzhou, China; Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden.
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States; Sandra and Edward Meyer Cancer Center, New York, NY, United States; Caryl and Israel Englander Institute for Precision Medicine, New York, NY, United States.
| |
Collapse
|
50
|
Villarreal-Garza C, Ferrigno AS, De la Garza-Ramos C, Barragan-Carrillo R, Lambertini M, Azim HA. Clinical utility of genomic signatures in young breast cancer patients: a systematic review. NPJ Breast Cancer 2020; 6:46. [PMID: 33062888 PMCID: PMC7519162 DOI: 10.1038/s41523-020-00188-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
Risk stratification by genomic signatures has been shown to improve prognostication and guide treatment decisions among patients with hormone-sensitive breast cancer. However, their role in young women has not been fully elucidated. In this review, a systematic search was conducted for published articles and abstracts from major congresses that evaluated the use of genomic signatures in young breast cancer patients. A total of 71 studies were analyzed, including 561,188 patients of whom 27,748 (4.9%) were young. Women aged ≤40 years were subjected to genomic testing at a similar rate to older women but had a higher proportion of intermediate- to high-risk tumors when classified by EndoPredict (p = 0.04), MammaPrint (p < 0.01), and Oncotype DX (p < 0.01). In young women with low genomic risk, 6-year distant recurrence-free survival was 94%, while 5-year overall survival was nearly 100%. Nonetheless, young patients classified as low-risk had a higher tendency to receive chemotherapy compared to their older counterparts. In conclusion, genomic tests are useful tools for identifying young patients in whom chemotherapy omission is appropriate.
Collapse
Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Cynthia De la Garza-Ramos
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Regina Barragan-Carrillo
- Department of Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genoa, Italy
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| |
Collapse
|