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Barbosa EM. Análise da porcentagem da DNA ploidia e de células em fase S, determinada por citometria de fluxo e por outras variáveis prognosticas em carcinomas primários de mama. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.1998v44n1.2797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Analisaram-se a DNA ploidia e a porcentagem de células em fase S, determinadas por citometria de fluxo, em biópsias de 69 carcinomas mamários. Outras variáveis prognosticas foram estudadas: 1. clínicas (raça, idade, estado menstruai, estadiamento, tamanho do tumor e a avaliação dos linfonodos axilares); 2. histológicas (comprometimento metastático dos linfonodos axilares, embolização de células neoplásicas em vasos linfáticos e sanguíneos, grau de diferenciação histológica, número de mitoses e necrose tumoral); 3. Bioquímicas (receptores de estradiol e progesterona). Cotejaram-se estas variáveis com o estudo da DNA ploidia e porcentagem de fase S. Notou-se haver uma associação significativa entre a DNA diploidia em pacientes com idade acima de 50 anos, tumores de tamanho ou igual a 2,0 cm, receptores de estradiol e receptores de progesterona. Observou-se também uma associação significativa entre a porcentagem de fase S >7,15 e pacientes na pré-menopausa, receptores de estradiol negativo e comprometimento metastático linfonodal. Constatou-se que as pacientes com tumores classificados como DNA aneuplóides, com fase S maior que 7,15, apresentaram metástases mais freqüentes e sobrevida menor que aquelas com tumores DNA diplóides e fase S menor que 7,15. Sob o ponto de vista do prognóstico pode-se constatar a importância do estudo do DNA, particularmente para o grupo pNO. Verificou-se a viabilidade de esta técnica ser realizada em nossa rotina para o estudo prognóstico do câncer de mama.
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Veenstra C, Pérez-Tenorio G, Stelling A, Karlsson E, Mirwani SM, Nordensköljd B, Fornander T, Stål O. Met and its ligand HGF are associated with clinical outcome in breast cancer. Oncotarget 2018; 7:37145-37159. [PMID: 27175600 PMCID: PMC5095065 DOI: 10.18632/oncotarget.9268] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/26/2016] [Indexed: 12/22/2022] Open
Abstract
Few biomarkers exist to predict radiotherapy response in breast cancer. In vitro studies suggest a role for Met and its ligand HGF. To study this suggested role, MET and HGF gene copy numbers were determined by droplet digital PCR in tumours from 205 pre-menopausal and 184 post-menopausal patients, both cohorts randomised to receive either chemo- or radiotherapy. MET amplification was found in 8% of the patients in both cohorts and HGF amplification in 7% and 6% of the patients in the pre- and post-menopausal cohort, respectively. Met, phosphorylated Met (pMet), and HGF protein expression was determined by immunohistochemistry in the pre-menopausal cohort. Met, pMet, and HGF was expressed in 33%, 53%, and 49% of the tumours, respectively. MET amplification was associated with increased risk of distant recurrence for patients receiving chemotherapy. For the pre-menopausal patients, expression of cytoplasmic pMet and HGF significantly predicted benefit from radiotherapy in terms of loco-regional recurrence. Similar trends were seen for MET and HGF copy gain. In the post-menopausal cohort, no significant association of benefit from radiotherapy with neither genes nor proteins was found. The present results do not support that inhibition of Met prior to radiotherapy would be favourable for pre-menopausal breast cancer, as previously suggested.
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Affiliation(s)
- Cynthia Veenstra
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping, Sweden
| | - Gizeh Pérez-Tenorio
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping, Sweden
| | - Anna Stelling
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping, Sweden
| | - Elin Karlsson
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping, Sweden
| | - Sanam Mirwani Mirwani
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping, Sweden
| | - Bo Nordensköljd
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping, Sweden
| | - Tommy Fornander
- Department of Oncology-Pathology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Olle Stål
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping, Sweden
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Affiliation(s)
- Adam P Levene
- Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK
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Sundquist M, Brudin L, Tejler G. Improved survival in metastatic breast cancer 1985-2016. Breast 2016; 31:46-50. [PMID: 27810699 DOI: 10.1016/j.breast.2016.10.005] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the last 25 years new treatment options in breast cancer have evolved. We wanted to determine whether the survival of; patients with metastatic breast cancer have improved during this period. METHODS Patients consecutively diagnosed with disseminated breast cancer 1985-2014 in the County of Kalmar, Sweden, were identified and followed to 2016. Survival was calculated for each successive 5 year interval. Separate analyses were performed for pts with ER and/or PR and HER2 positive tumours resp. RESULTS Median survival of the 784 patients increased successively from 13 to 33 months. Five year survival increased from 10 to 27%. Patients with high grade primary tumours had the shortest post recurrence survival time but their median survival increased significantly by time from 12 to 30 months, 3 year survival from 16 to 38% and 5 year from 5 to 20%. Median survival for patients with grade 2 tumours was 2 years and did not improve. Only 47 patients had grade 1 tumours and their median survival of 4 years did not change. Median survival for HER2 positive patients treated before the introduction of trastuzumab in year 2000 was 14 months and after 2000 29 months, 5 year survival improved from 2 to 31%. CONCLUSIONS Survival in metastatic breast cancer improved 1985-2016. For the first time a significant increase in survival time for patients with metastasis from fast-growing grade 3 tumours was seen. The most striking improvement was achieved in the HER2 positive subset.
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Affiliation(s)
- Marie Sundquist
- Kalmar County Breast Centre, Surgery, County Hospital, Kalmar, Sweden.
| | - Lars Brudin
- Dep of Physiology, County Hospital, Kalmar, Sweden.
| | - Göran Tejler
- Kalmar County Breast Centre, Surgery, Västervik Hospital, Sweden.
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Abstract
Background: Multiparameter flow cytometry is a robust and reliable method for determining tumour DNA content applicable to formalin-fixed paraffin-embedded (FFPE) tissue. This study examined the clinical and pathological associations of DNA content in primary breast cancer using an improved multiparametric technique. Methods: The FFPE tissue from 201 primary breast cancers was examined and the cancers categorised according to their DNA content using multiparametric flow cytometry incorporating differential labelling of stromal and tumour cell populations. Mathematical modelling software (ModFit 3.2.1) was used to calculate the DNA index (DI) and percentage S-phase fraction (SPF%) for each tumour. Independent associations with clinical and pathological parameters were sought using backward stepwise Binary Logistic Regression (BLR) and Cox's Regression (CR) analysis. Results: Tumours were grouped into four categories based on the DI of the tumour cell population. Low DI tumours (DI=0.76–1.14) associated with progesterone receptor-positive status (P=0.012, BLR), intermediate DI (DI=1.18–1.79) associated with p53 mutant tumours (P=0.001, BLR), high DI (DI⩾1.80) tumours with human epidermal growth factor receptor 2 (HER2)-positive status (P=0.004, BLR) and ‘multiploid tumours' (two or more tumour DNA peaks) did not show any significant associations. Tumours with high SPF% (⩾10%) independently associated with poor overall survival (P=0.027, CR). Conclusion: Multiparametric flow analysis of FFPE tissue can accurately assess tumour DNA content. Tumour sub-populations associated with biomarkers of prognosis or likely response to therapy. The alterations in DNA content present the potential for greater understanding of the mechanisms underlying clinically significant biomarker changes in primary breast cancer.
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Affiliation(s)
- Adam P Levene
- Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX, UK
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Prasad AR, Divine G, Zarbo RJ. Two-color, cytokeratin-labeled dna flow cytometric analysis of 332 breast cancers: lack of prognostic value with 12-year follow-up. Arch Pathol Lab Med 2001; 125:364-74. [PMID: 11231485 DOI: 10.5858/2001-125-0364-tccldf] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT DNA flow cytometry of breast cancer is a proposed tumor marker of prognostic significance that is of controversial clinical utility because of lack of standardization and confirmatory studies. OBJECTIVE To evaluate the prognostic significance of the more informative technique of multiparametric 2-color DNA flow cytometry as recommended by the 1992 DNA Cytometry Consensus Conference. DESIGN Three hundred thirty-two breast carcinomas with 7 to 12 years of follow-up were prospectively analyzed as fresh tumors that were mechanically dissociated into whole cell suspensions. These suspensions were dual fluorescence-labeled with propidium iodide (DNA) and antibodies to cytokeratin (epithelium) and leukocyte common antigen (internal leukocyte control) for gated analysis of subpopulations. Multicycle software with histogram-dependent algorithms employing background, aggregate, and debris correction were used in DNA and cell-cycle quantitation. Data were analyzed according to the DNA Flow Cytometry Consensus Conference recommendations. RESULTS DNA ploidy and proliferation stratified into 3 categories were not predictive of overall or disease-free survival. Sixty-five percent of tumors were nondiploid, and 35.4% were diploid. Two hundred six tumors were able to be evaluated for synthesis-phase fraction (SPF) analysis, with 74 of 206 cases in the low range (<13.4%), 36.4% in the intermediate range (>13.5 to <25.4%), and 27.6% in the high SPF (>25.5%) category. Aneuploid tumors tended to have a higher SPF. Univariate survival analysis showed prognostic significance of the following: tumor size, stage, TNM components, vascular invasion, nuclear grade, and histologic grade. Only T classification, presence of positive axillary lymph nodes, and distant metastases were significant independent predictors of survival in multivariate Cox regression models. Age and hormone receptor status showed no prognostic significance. Synthesis-phase fraction was significantly correlated with tumor size, stage, T classification, nuclear and histologic grade, presence of estrogen or progesterone receptors, and axillary lymph node status. None of the histologic parameters showed any significant association with DNA aneuploidy, except for high nuclear and histologic grade and the absence of estrogen receptors. CONCLUSIONS Despite the use of state-of-the-art processing and flow cytometry analytic techniques, DNA ploidy and proliferation measurements were not predictive of survival in any stage of breast cancer. However, select histopathologic parameters and TNM stage were significant predictors of survival in univariate and multivariate analyses. We conclude that DNA ploidy and proliferation measurements do not provide significant prognostic information for clinicians to integrate into therapeutic decision making for patients with breast cancer.
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Affiliation(s)
- A R Prasad
- Department of Pathology, Henry Ford Hospital, Detroit, Mich, USA
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Abstract
During the past decade, more than 300 articles, abstracts, and book chapters have been published about S-phase fraction (SPF) determined by DNA flow cytometry and its clinical utility for patients with breast cancer. However, the use of SPF for making treatment decisions for breast cancer patients remains controversial. After reviewing 273 published articles, we conclude: 1) Despite different techniques and cutpoints, correlations between SPF and other prognostic markers are relatively consistent across studies; higher SPF is generally associated with worse tumor grade, absence of steroid receptors, larger tumors, and positive axillary lymph nodes. 2) Higher SPF is generally associated with worse disease-free and overall survival in both univariate and multivariate analyses; SPF values from laboratories that have conducted validation studies can be used, in combination with other factors, to estimate the prognosis of patients with primary breast cancer. 3) There is considerable variability among laboratories regarding assay methodology, cell-cycle analysis techniques, and cutpoints for classifying and interpreting SPF; use of SPF values from different laboratories is problematic, and there remains a need for standardization of these processes and well-designed confirmation studies. We conclude that measurement of SPF does have clinical utility for patients with breast cancer, but standardization and quality control must be improved before it can be routinely used in community settings.
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Affiliation(s)
- C R Wenger
- Division of Medical Oncology, University of Texas Health Science Center at San Antonio, 78284-7884, USA
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Zanon C, Durando A, Geuna M, Clara R, Mobiglia A, Massobrio M, Palestro G, Pourshayesteh A. Flow cytometry in breast cancer: prognostic and surgical indications of the sparing of axillary lymph node dissection. Am J Clin Oncol 1998; 21:392-7. [PMID: 9708640 DOI: 10.1097/00000421-199808000-00015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The lymph node status is still regarded as the most important prognostic factor in breast cancer. However, the utility of axillary lymph node dissection in clinically node-negative patients with breast cancer as a therapeutic approach rather than a pathologic staging procedure has been recently discussed. DNA index (DI) and S-phase fraction (SPF), evaluated by flow cytometric analysis, are two prognostic factors used especially in the assessment of the adjuvant therapy in stage N0 tumors. By studying a large number of cases, the authors aimed to assess the potential role of flow cytometry in predicting lymph node status. Two hundred eleven patients with breast cancer were included. Each tumor specimen was freshly analyzed by flow cytometry to assess DI and SPF. The authors also evaluated TNM status of patients, estrogen- and progesterone-receptor (ER and Pgr) status, and histologic grades. A group of patients with negative axillary lymph nodes was identified by means of association of tumor size of 2 cm or less, DI of 1, and SPF less than 7%. The ER and PgR status as well as histologic grade were significantly more favorable in this group of patients. These findings indicate that association of DI, SPF value, and tumor size may be predictive of axillary lymph node status in breast cancer.
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Affiliation(s)
- C Zanon
- Service of Esophageal and Oncological Surgery, University of Turin, Italy
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Vavruch L, Nordenskjöld B, Carstensen J, Eneström S. Prognostic value of flow cytometry and correlation to some conventional prognostic factors: a retrospective study of archival specimens of 134 astrocytomas. J Neurosurg 1996; 85:146-51. [PMID: 8683265 DOI: 10.3171/jns.1996.85.1.0146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The S-phase fraction and the DNA ploidy type in 134 astrocytomas (18 Grade II, 46 Grade III, and 70 Grade IV astrocytomas) were studied using flow cytometry in a retrospective study of archival tumor specimens. A high grade of malignancy was associated with both a high S-phase fraction (p < 0.0001) and an aneuploid DNA pattern (p < 0.0001). There was no aneuploid DNA pattern found in the fibrillary astrocytomas (World Health Organization (WHO) Grade II); where-as the aneuploid pattern was observed in 80% of all the glioblastomas multiforme (WHO Grade IV). The age and gender of the patients were not significantly related to the flow cytometry parameters. The survival of patients with Grade II or III astrocytomas was significantly longer when their tumors exhibited a tetraploid DNA pattern or had a low S-phase fraction. In patients with Grade IV tumors, there was no correlation between length of survival and either the DNA ploidy or the S-phase fraction. In a multivariate Cox regression analysis of data obtained in patients with Grade II and III astrocytomas, age, grade of malignancy, DNA ploidy, and S-phase fraction were independent prognostic factors.
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Affiliation(s)
- L Vavruch
- Department of Spinal Surgery, University Hospital, Linköping, Sweden
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d'Agnano I, Bucci B, Mottolese M, Benevolo M, Conti L, Botti C, Vecchione A, Casillo S, Zupi G. DNA ploidy, cell kinetics, and epidermal growth factor receptor and HER2/neu oncoprotein expression in primary operable breast cancer. Ann N Y Acad Sci 1996; 784:472-81. [PMID: 8651601 DOI: 10.1111/j.1749-6632.1996.tb16266.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- I d'Agnano
- Istituto di Tecnologie Biomediche, CNR, Rome, Italy
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