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Javed S, Mohamed Noor DA, Md Hanafiah NH, Javed U, Mustafa T, Rehman AU, Harun SN. Investigating the Association Between Type 2 Diabetes Mellitus and Pathological Responses Among Breast Cancer Patients Receiving Neoadjuvant Chemotherapy. J Surg Res 2024; 299:85-93. [PMID: 38718688 DOI: 10.1016/j.jss.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/01/2024] [Accepted: 04/01/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION The relationship between type 2 diabetes mellitus (T2DM) and pathological responses after neoadjuvant chemotherapy (NACT) is controversial. In this study, we aim to determine the association of pathological responses in breast cancer women with T2DM after receiving NACT. METHODS Medical records of breast cancer women with T2DM who received NACT from January 2016 to January 2021 at the medical center in the Gujranwala Institute of Nuclear Medicine and Radiotherapy, Pakistan, were identified and retrieved retrospectively. Variables, including pathological responses, diabetes status, and other clinical data, were collected. Patients were grouped as diabetic and nondiabetic based on the doctor's diagnosis or the diabetic's medication history recorded upon the breast cancer diagnosis. Factors influencing the pathological complete response (pCR) were determined using multivariate logistic regression utilizing IBM SPSS Statistics (version 20). RESULTS A total of 1372 patient files who received NACT and breast cancer surgery from January 2016 to January 2021 were selected. Out of 1372 breast cancer women receiving NACT, 345 (25.1%) had pre-existing diabetes, while 1027 (74.85%) were without pre-existing diabetes. The most common molecular subtypes of breast cancer were luminal A and B. Two hundred fifty-eight patients (18.8%) had a pCR after receiving NACT. The pCR in diabetic patients was 3.9%, and in nondiabetes, 14.9%. Most women had a pathological partial response (pPR) after the NACT 672 (48.9%). The pPR in diabetic patients was 11.0%, and in nondiabetic patients, it was 38.0%. In nondiabetics, the odds of achieving pPR increase more than pathological no response after the NACT with odd ratio: 1.71 (95% confidence interval: 1.24-2.37). The probability of pCR in patients with luminal B was 1.67 times higher than that in patients with triple-negative breast cancer with odd ratio: 1.67, 95% confidence interval (1.00-2.79), P = 0.05. CONCLUSIONS The results of the study show that T2DM may have an adverse impact on pCR and pPR following NACT and surgery. Further investigation is needed to explore how changes in blood glucose levels over time impact pathological responses.
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Affiliation(s)
- Saba Javed
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM Penang, Malaysia; Faculty of Pharmaceutical Sciences, Department of Pharmacy Practice, Government College University, Faisalabad, Pakistan
| | | | | | - Umar Javed
- Gujranwala Institute of Nuclear Medicine & Radiotherapy (GINUM), Gujranwala, Pakistan
| | - Tanveer Mustafa
- Gujranwala Institute of Nuclear Medicine & Radiotherapy (GINUM), Gujranwala, Pakistan
| | - Anees Ur Rehman
- Faculty of Pharmacy, Department of Pharmacy Practice, Bahauddin Zakariya University Multan, Punjab, Pakistan
| | - Sabariah Noor Harun
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM Penang, Malaysia.
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2
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Parikh PM, Bhattacharyya GS, Biswas G, Krishnamurty A, Doval D, Heroor A, Sharma S, Deshpande R, Chaturvedi H, Somashekhar SP, Babu G, Reddy GK, Sarkar D, Desai C, Malhotra H, Rohagi N, Bapna A, Alurkar SS, Krishna P, Deo SV, Shrivastava A, Chitalkar P, Majumdar SK, Vijay D, Thoke A, Udupa KS, Bajpai J, Rath GK, Dattatreya PS, Bondarde S, Patil S. Practical Consensus Recommendations for Optimizing Risk versus Benefit of Chemotherapy in Patients with HR Positive Her2 Negative Early Breast Cancer in India. South Asian J Cancer 2021; 10:213-219. [PMID: 34984198 PMCID: PMC8719963 DOI: 10.1055/s-0041-1742080] [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] [Indexed: 12/17/2022] Open
Abstract
Breast cancer is a public health challenge globally as well as in India. Improving outcome and cure requires appropriate biomarker testing to assign risk and plan treatment. Because it is documented that significant ethnic and geographical variations in biological and genetic features exist worldwide, such biomarkers need to be validated and approved by authorities in the region where these are intended to be used. The use of western guidelines, appropriate for the Caucasian population, can lead to inappropriate overtreatment or undertreatment in Asia and India. A virtual meeting of domain experts discussed the published literature, real-world practical experience, and results of opinion poll involving 185 oncologists treating breast cancer across 58 cities of India. They arrived at a practical consensus recommendation statement to guide community oncologists in the management of hormone positive (HR-positive) Her2-negative early breast cancer (EBC). India has a majority (about 50%) of breast cancer patients who are diagnosed in the premenopausal stage (less than 50 years of age). The only currently available predictive test for HR-positive Her2-negative EBC that has been validated in Indian patients is CanAssist Breast. If this test gives a score indicative of low risk (< 15.5), adjuvant chemotherapy will not increase the chance of metastasis-free survival and should not be given. This is applicable even during the ongoing COVID-19 pandemic.
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Affiliation(s)
| | | | - Ghanshyam Biswas
- Medical Oncology, Sparsh Hospital & Critical Care, Bhubaneswar, India
| | | | - Dinesh Doval
- Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Anil Heroor
- Surgical Oncology, Fortis Hospital, Mumbai, India
| | - Sanjay Sharma
- Surgical Oncology, Asian Cancer Institute, Mumbai, India
| | | | | | - S. P. Somashekhar
- Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, Bangalore, India
| | - Govind Babu
- Medical Oncology, HCG Cancer Hospital, Bengaluru, India
| | | | - Diptendra Sarkar
- Surgical Oncology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
| | - Chirag Desai
- Medical Oncology, Vedanta Institute of Medical Sciences, Ahmedabad, India
| | | | - Nitesh Rohagi
- Medical Oncology, Max Institute of Cancer Care, Delhi, India
| | - Ajay Bapna
- Medical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, India
| | | | - Prasad Krishna
- Medical Oncology, Mangalore Institute of Oncology, Mangalore, India
| | - S. V.S. Deo
- Surgical Oncology, All India Institute of Medical Sciences, Delhi, India
| | | | - Prakash Chitalkar
- Medical Oncology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, India
| | | | | | - Aniket Thoke
- Radiation Oncology, Sanjeevani CBCC USA Cancer Hospital, Raipur, India
| | - K. S. Udupa
- Medical Oncology, Kasturba Medical College, Manipal, India
| | - Jyoti Bajpai
- Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - G. K. Rath
- Radiation Oncology, DR. B.R.A. Institute Rotary Cancer Hospital, Delhi, India
| | | | | | - Shekhar Patil
- Medical Oncology, HCG Cancer Hospital, Bengaluru, India
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3
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Ho PJ, Cook AR, Binte Mohamed Ri NK, Liu J, Li J, Hartman M. Impact of delayed treatment in women diagnosed with breast cancer: A population-based study. Cancer Med 2020; 9:2435-2444. [PMID: 32053293 PMCID: PMC7131859 DOI: 10.1002/cam4.2830] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/02/2019] [Accepted: 12/26/2019] [Indexed: 01/07/2023] Open
Abstract
The impact of timely treatment on breast cancer‐specific survival may differ by tumor stage. We aim to study the impact of delayed first treatment on overall survival across different tumor stages. In addition, we studied the impact of delayed adjuvant treatments on survival in patients with invasive nonmetastatic breast cancer who had surgery ≤90 days postdiagnosis. This population‐based study includes 11 175 breast cancer patients, of whom, 2318 (20.7%) died (median overall survival = 7.9 years). To study the impact of delayed treatment on survival, hazard ratios and corresponding 95% confidence intervals were estimated using Cox proportional‐hazards models. The highest proportion of delayed first treatment (>30 days postdiagnosis) was in patients with noninvasive breast cancer (61%), followed by metastatic breast cancer (50%) and invasive nonmetastatic breast cancer (22%). Delayed first treatment (>90 vs ≤30 days postdiagnosis) was associated with worse overall survival in patients with invasive nonmetastatic (HR: 2.25, 95% CI 1.55‐3.28) and metastatic (HR: 2.09, 95% CI 1.66‐2.64) breast cancer. Delayed adjuvant treatment (>90 vs 31‐60 days postsurgery) was associated with worse survival in patients with invasive nonmetastatic (HR: 1.50, 95% CI 1.29‐1.74). Results for the Cox proportional‐hazards models were similar for breast cancer‐specific death. A longer time to first treatment (31‐90 days postdiagnosis) may be viable for more extensive diagnostic workup and patient‐doctor decision‐making process, without compromising survival. However, patients’ preference and anxiety status need to be considered.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems, Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems, Singapore, Singapore
| | - Nur Khaliesah Binte Mohamed Ri
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems, Singapore, Singapore
| | - Jenny Liu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health Systems, Singapore, Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health Systems, Singapore, Singapore
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4
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Domagala P, Hybiak J, Rys J, Byrski T, Cybulski C, Lubinski J. Pathological complete response after cisplatin neoadjuvant therapy is associated with the downregulation of DNA repair genes in BRCA1-associated triple-negative breast cancers. Oncotarget 2018; 7:68662-68673. [PMID: 27626685 PMCID: PMC5356581 DOI: 10.18632/oncotarget.11900] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/26/2016] [Indexed: 11/25/2022] Open
Abstract
Pathologic complete response (pCR) after neoadjuvant chemotherapy is considered a suitable surrogate marker of treatment efficacy in patients with triple-negative breast cancers (TNBCs). However, the molecular mechanisms underlying pCR as a result of such treatment remain obscure. Using real-time PCR arrays we compared the expression levels of 120 genes involved in the main mechanisms of DNA repair in 43 pretreatment biopsies of BRCA1-associated TNBCs exhibiting pCR and no pathological complete response (non-pCR) after neoadjuvant chemotherapy with cisplatin. Altogether, 25 genes were significantly differentially expressed between tumors exhibiting pCR and non-pCR, and these genes were downregulated in the pCR group compared to the non-pCR group. A difference in expression level greater than 1.5-fold was detected for nine genes: MGMT, ERCC4, FANCB, UBA1, XRCC5, XPA, XPC, PARP3, and RPA1. The non-homologous end joining and nucleotide excision repair pathways of DNA repair showed the most significant relevance. Expression profile of DNA repair genes associated with pCR was different in the node-positive (20 genes with fold change >1.5) and node-negative (only 3 genes) subgroups. Although BRCA1 germline mutations are the principal defects in BRCA1-associated TNBC, our results indicate that the additional downregulation of other genes engaged in major pathways of DNA repair may play a decisive role in the pathological response of these tumors to cisplatin neoadjuvant chemotherapy. The results suggest that patients with node-positive BRCA1-associated TNBCs that do not exhibit pCR after cisplatin neoadjuvant chemotherapy may be candidates for subsequent therapy with PARP inhibitors, whereas UBA1 may be a potential therapeutic target in node-negative subgroup.
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Affiliation(s)
- Pawel Domagala
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Jolanta Hybiak
- Department of Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Janusz Rys
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Centre & Institute of Oncology, Krakow Branch, Krakow, Poland
| | - Tomasz Byrski
- Department of Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Cezary Cybulski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
| | - Jan Lubinski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland
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5
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Díaz-Expósito R, Martí-Bonmatí L, Burgués O, Casáns-Tormo I, Bermejo-de Las Heras B, Julve-Parreño A, Caballero-Garate A. Selective sentinel node biopsy after intratumour administration of radiotracer in breast cancer patients treated with neoadjuvant chemotherapy in relation to the level of tumour response. Rev Esp Med Nucl Imagen Mol 2016; 35:358-364. [PMID: 27246292 DOI: 10.1016/j.remn.2016.04.005] [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: 02/10/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective was to analyse the accuracy of the sentinel node biopsy, taking into consideration the scintigraphy detection rate after the intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy. MATERIALS AND METHODS The study included 60 patients with a diagnosis of invasive breast carcinoma, stage T1-T3, who received treatment with neoadjuvant chemotherapy, and were subsequently subjected to breast surgery and sentinel node biopsy after intra-tumour administration of the radiopharmaceutical. RESULTS Scintigraphic detection of some sentinel node was achieved in 55/60 patients (91.6%). When those cases that received a second injection of the radiopharmaceutical, performed peri-areolarly due to a lack of tracer migration, were excluded, the detection rate dropped to 70% (42/60). When the detection of sentinel node, or its absence, was compared in those 42 patients, no differences were found with age, laterality-location of the lesion, size pre- and post-neoadjuvant chemotherapy, histological grade, or immunohistochemical profile. There were significant differences when comparing the groups according to the degree of pathological tumour response, both with the Miller-Payne system (non-detection 44.4%-detection 16.7%, p = 0.003) as well as the residual cancer burden (72.2%-28.6%, p<0.01). CONCLUSIONS The scintigraphic detection of the sentinel node after intratumoural administration of the radiopharmaceutical in patients with breast cancer who received neoadjuvant chemotherapy was below the optimal value, and sometimes a further, peri-areolar, injection was necessary, probably in relation to an alteration in the lymphatic drainage pathways. There was a significant inverse relationship between the detection of the sentinel node and level of pathological tumour response.
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Affiliation(s)
- R Díaz-Expósito
- Facultativo especialista, Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - L Martí-Bonmatí
- Facultativo especialista, Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - O Burgués
- Facultativo especialista, Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Valencia, España
| | - I Casáns-Tormo
- Facultativo especialista, Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, España
| | - B Bermejo-de Las Heras
- Facultativo especialista, Servicio de Oncología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Julve-Parreño
- Facultativo especialista, Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Caballero-Garate
- Facultativo especialista, Servicio de Cirugía General, Hospital Clínico Universitario de Valencia, Valencia, España
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6
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Selective sentinel node biopsy after intratumour administration of radiotracer in breast cancer patients treated with neoadjuvant chemotherapy in relation to the level of tumor response. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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7
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Yang Y, Im SA, Keam B, Lee KH, Kim TY, Suh KJ, Ryu HS, Moon HG, Han SW, Oh DY, Han W, Kim TY, Park IA, Noh DY. Prognostic impact of AJCC response criteria for neoadjuvant chemotherapy in stage II/III breast cancer patients: breast cancer subtype analyses. BMC Cancer 2016; 16:515. [PMID: 27444430 PMCID: PMC4955253 DOI: 10.1186/s12885-016-2500-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/04/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is a standard treatment for stage II/III breast cancer patients, and response to NAC is a useful prognostic marker. Since its introduction, 6-8 cycles of NAC has become the standard regimen to improve the outcome of these patients. The purpose of this study is to evaluate the prognostic impact of the American Joint Committee on Cancer (AJCC) response criteria and this tool's usefulness in four different breast cancer subtypes. METHODS We conducted a retrospective cohort study of clinical stage II/III breast cancer patients who received NAC of more than 6 cycles. Response after NAC and the clinicopathological factors were reviewed. AJCC response criteria for NAC were adopted from the AJCC Manual, 7th edition: complete response (CR), partial response (PR), and no response (NR). RESULTS A total of 183 patients were enrolled; 22 (12.0 %), 123 (67.2 %), and 38 (20.8 %) patients showed CR, PR, and NR, respectively. The AJCC response was significantly associated with relapse-free survival (RFS) (P < 0.001), whereas pathologic CR (pCR), the current gold standard for response evaluation for NAC, was not (P = 0.140). AJCC response was a significant prognostic factor for RFS in all four breast cancer subtypes, namely luminal A (P = 0.006), luminal B (P = 0.001), HER-2 enriched (P = 0.039), and triple-negative breast cancer (P = 0.035). CONCLUSIONS The AJCC response criteria represent a simple and easily reproducible tool for response evaluation of NAC patients and a useful clinical prognostic marker for RFS. These criteria also have a prognostic impact in all four breast cancer subtypes, including luminal A in which pCR has a limited role.
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Affiliation(s)
- Yaewon Yang
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. .,Cancer Research Institute, Seoul National University, Seoul, Korea.
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. .,Cancer Research Institute, Seoul National University, Seoul, Korea.
| | - Koung Jin Suh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Han Suk Ryu
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - In Ae Park
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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8
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Kim H, Youk J, Yang Y, Kim TY, Min A, Ham HS, Cho S, Lee KH, Keam B, Han SW, Oh DY, Ryu HS, Han W, Park IA, Kim TY, Noh DY, Im SA. Prognostic implication of serum hepatocyte growth factor in stage II/III breast cancer patients who received neoadjuvant chemotherapy. J Cancer Res Clin Oncol 2015; 142:707-14. [PMID: 26577828 DOI: 10.1007/s00432-015-2072-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/02/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE In stage II/III breast cancer, neoadjuvant chemotherapy (NAC) is a standard treatment. Although several biomarkers are used to predict prognosis in breast cancer, there is no reliable predictive biomarker for NAC success. Recently, the hepatocyte growth factor (HGF) and cMet signaling pathway demonstrated to be involved in breast cancer tumor progression, and its potential as a biomarker is under active investigation. In this study, we assessed the potential of serum HGF as a prognostic biomarker for NAC efficacy. METHODS Venous blood samples were drawn from patients diagnosed with stage II/III breast cancer and treated with NAC in Seoul National University Hospital from August 2004 to November 2009. Serum HGF level was determined using an ELISA system. We reviewed the medical records of the patients and investigated the association of HGF level with patients' clinicopathologic characteristics. RESULTS A total of 121 female patients (median age = 45 years old) were included. Median level of HGF was 934 pg/ml (lower quartile: 772, upper quartile: 1145 pg/ml). Patients with higher HGF level than median value were significantly more likely to have clinically detectable regional node metastasis (p = 0.017, Fisher's exact test). Patients with complete and partial response according to the American Joint Committee on Cancer 7th Edition criteria tended to have higher HGF level (p = 0.105 by t test). Patients with an HGF level higher than the upper quartile value had longer relapse-free survival than the other patients (106 vs. 85 months, p = 0.008). CONCLUSIONS High serum HGF levels in breast cancer patients are associated with clinically detectable regional node metastasis and, paradoxically, with longer relapse-free survival in stage II/III breast cancer.
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Affiliation(s)
- Hyori Kim
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea
| | - Jeonghwan Youk
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Yaewon Yang
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Tae-Yong Kim
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea. .,Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea.
| | - Ahrum Min
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea
| | - Hye-Seon Ham
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea
| | - Seongcheol Cho
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Kyung-Hun Lee
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea.,Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Bhumsuk Keam
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea.,Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Sae-Won Han
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea.,Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Do-Youn Oh
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea.,Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Wonshik Han
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea.,Department of Surgery, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - In Ae Park
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea.,Department of Pathology, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Tae-You Kim
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea.,Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Dong-Young Noh
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea.,Department of Surgery, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National University College of Medicine, 101 Daehakro, Jongro-gu, Seoul, 110-799, Korea. .,Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul, 110-744, Korea.
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9
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Go SI, Keam B, Kim TM, Lee SH, Kim DW, Kim HJ, Wu HG, Chung DH, Heo DS. Clinical significance of downstaging in patients with limited-disease small-cell lung cancer. Clin Lung Cancer 2013; 15:e1-6. [PMID: 24356090 DOI: 10.1016/j.cllc.2013.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 08/28/2013] [Accepted: 09/03/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND We investigated the effect of downstaging on OS in LD-SCLC patients treated with first-line treatment. PATIENTS AND METHODS We retrospectively reviewed 210 LD-SCLC patients who were treated with first-line treatment at Seoul National University Hospital between April 1999 and November 2012. Compared with initial tumor, node, metastases (TNM) stage, cases that showed a lower TNM stage after treatment were defined as 'downstaging.' The relationship between downstaging and OS was analyzed, and a subgroup analysis on the responders was performed. RESULTS After first-line treatment, 78 (37.1%) patients achieved complete response, 97 (46.2%) achieved PR, and 35 (16.7%) experienced stable disease or progressive disease. A hundred and fifty one patients (71.9%) showed downstaging of their diseases, and the remaining 59 patients (28.1%) showed no change or upstaging. The median OS for patients achieving downstaging and no change/upstaging were 32.8 months and 13.1 months, respectively (P < .001). Of the 97 patients who achieved PR, the OS was significantly longer in patients who showed downstaging than those who did not (25.8 months vs. 13.8 months, respectively; P = .004). In multivariate analyses, female sex, downstaging, lower initial TNM stage, and prophylactic cranial irradiation were independent good prognostic factors for OS. CONCLUSION Downstaging might be an independent good prognostic factor in LD-SCLC. Specifically, downstaging is expected to be useful for stratification of patients achieving PR. Further prospective studies are warranted to verify whether patients who achieved PR without downstaging can be candidates for consolidation treatments after first-line treatment.
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Affiliation(s)
- Se-Il Go
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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