1
|
Püsküllüoğlu M, Swiderska K, Konieczna A, Streb J, Grela-Wojewoda A, Rudzinska A, Dobrzańska J, Pacholczak-Madej R, Mucha-Malecka A, Kunkiel M, Mitus JW, Jarząb M, Ziobro M. Clinical analysis of metaplastic breast carcinoma with distant metastases: A multi‑centre experience. Oncol Lett 2024; 27:198. [PMID: 38516685 PMCID: PMC10955678 DOI: 10.3892/ol.2024.14331] [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: 12/20/2023] [Accepted: 02/09/2024] [Indexed: 03/23/2024] Open
Abstract
Metaplastic breast cancer (BC-Mp), which includes a range of epithelial and mixed epithelial-mesenchymal tumours, are rare malignancies with an unfavourable prognosis. The limited literature on BC-Mp focuses mainly on retrospective data for radically treated patients. Notably absent are studies dedicated to the palliative treatment of BC-Mp with distant metastases. The present retrospective study investigated treatment modalities and prognosis in a multi-centre cohort of 31 female participants diagnosed with distant metastatic BC-Mp, including 7 patients with de novo metastatic disease. The median age of the patients was 61 years (range, 33-87 years), with 38.7% presenting local lymph node involvement. Lungs were the most common site for the metastatic disease (61.3%). Median Ki-67 index was 50% (range, 35-70%), and 80.7% of cases were classified as grade 3. Human epidermal growth factor receptor 2 (HER2)+ and estrogen receptor+ were detected in 12.9 and 6.5% of cases, respectively. A total of 62.4% of patients received first-line palliative systemic treatment. The 1- and 2-year overall survival (OS) were 38.5 and 19.2%, respectively. Receiving ≥1 line of palliative treatment was significantly associated with improved OS (P<0.001). Factors such as age, Ki-67 index, HER2 or hormonal status, presence of specific epithelial or mesenchymal components, location of metastases or chemotherapy regimen type did not influence OS. The present study provided insights into the clinicopathological profile, systemic treatment experience, prognostic factors and OS data of BC-Mp with distant metastases, emphasizing the imperative for clinical trials in this population.
Collapse
Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Katarzyna Swiderska
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Aleksandra Konieczna
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Oncology, University Hospital, 30-688 Krakow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Agnieszka Rudzinska
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | | | - Renata Pacholczak-Madej
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Gynaecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
- Department of Chemotherapy, The District Hospital, 34-200 Sucha Beskidzka, Poland
| | - Anna Mucha-Malecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Michał Kunkiel
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, 02-781 Warsaw, Poland
| | - Jerzy W. Mitus
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| | - Michał Jarząb
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 31-115 Krakow, Poland
| |
Collapse
|
2
|
Corso G, Criscitiello C, Nicosia L, Pesapane F, Vicini E, Magnoni F, Sibilio A, Zanzottera C, De Scalzi AM, Mannucci S, Marabelli M, Calvello M, Feroce I, Zagami P, Porta FM, Toesca A, Tarantino P, Nicolò E, Mazzarol G, La Vecchia C, Bonanni B, Leonardi MC, Veronesi P, Fusco N. Metaplastic breast cancer: an all-round multidisciplinary consensus. Eur J Cancer Prev 2023; 32:348-363. [PMID: 37021548 DOI: 10.1097/cej.0000000000000794] [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: 04/07/2023]
Abstract
Metaplastic breast cancer (MpBC) is a rare and aggressive histologic subtype of breast cancer (BC) characterized by the presence of at least two cellular types, commonly epithelial and mesenchymal components. Despite growing evidence that MpBC is a unique entity, it has long been treated as a variant of nonspecial type (NST) BC. MpBC typically shows the phenotype of triple-negative breast cancer (TNBC), but compared to NST-TNBC, it is a relatively chemorefractory tumor associated with worse outcomes. Therefore, there is an urgent need to develop management guidelines specifically for MpBC to improve the prognosis of patients with early MpBC. This expert consensus aims to guide diagnosis and standardize clinical management of early MpBC among treating physicians. We provide guidance on the challenging radiological and pathological diagnosis of MpBC. Evidence on the involvement of genetic predisposition in the development of MpBC is also explored. We emphasize the importance of a multidisciplinary approach for the treatment of patients with early MpBC. The optimal surgery and radiotherapy approach is presented, as well as the opportunity offered by novel therapeutic approaches to increase treatment response in this chemoresistant subtype. Appropriate management of patients with MpBC is critical to reduce the high risk of local and distant recurrence that characterizes this disease.
Collapse
Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan
- European Cancer Prevention Organization (ECP)
| | - Carmen Criscitiello
- Department of Oncology and Hemato-Oncology, University of Milan
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
| | - Luca Nicosia
- Breast Imaging Division, Radiology Department, European Institute of Oncology (IEO), IRCCS, Milan
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, European Institute of Oncology (IEO), IRCCS, Milan
| | - Elisa Vicini
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
| | - Andrea Sibilio
- Division of Breast Surgery Forlì (Ravenna), AUSL Romagna, Ravenna
| | - Cristina Zanzottera
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | | | - Sara Mannucci
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Monica Marabelli
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Mariarosaria Calvello
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
- Division of Hematology, Clinica Moncucco, Lugano, Switzerland
| | - Irene Feroce
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | - Paola Zagami
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
- Department of Biomedical, Surgical and Dental Sciences
| | | | - Antonio Toesca
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo (TO), Italy
| | - Paolo Tarantino
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
- Division of Breast Oncology, Dana-Farber Cancer Institute, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Eleonora Nicolò
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO), IRCCS
| | - Giovanni Mazzarol
- Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, and
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), IRCCS, Milan
| | | | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS
- Department of Oncology and Hemato-Oncology, University of Milan
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Chartier S, Brochard C, Martinat C, Coussy F, Feron JG, Kirova Y, Cottu P, Marchiò C, Vincent-Salomon A. TROP2, androgen receptor, and PD-L1 status in histological subtypes of high-grade metaplastic breast carcinomas. Histopathology 2023; 82:664-671. [PMID: 36527253 DOI: 10.1111/his.14852] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
AIMS High-grade metaplastic breast carcinoma (HG-MBC) is a rare subtype of invasive breast carcinoma, mostly triple-negative. Metaplastic carcinomas are less responsive to neoadjuvant chemotherapy and are associated with a worse outcome than invasive carcinomas of no special type. METHODS Clinicopathological characteristics and immunophenotype were retrospectively assessed in a series of 65 patients diagnosed with HG-MBC between 2005 and 2017 at the Curie Institute (antibody panel: oestrogen receptor [ER], progesterone receptor [PR], androgen receptor [AR], human epidermal growth factor receptor 2 [HER2], programmed death ligand-1 [PD-L1], and trophoblast cell surface antigen 2 [TROP2]). RESULTS The median age at diagnosis was 59.5 years. Six (9%) patients had metastatic disease at diagnosis. Among the nonmetastatic patients receiving neoadjuvant therapy, 26% (5/19) achieved pathological complete response. Most tumours were pT1/pT2 (77%) and 12% were pN+. Histological subtypes (mixed, squamous, mesenchymal, and spindle cell) were 40%, 35.5%, 15.5%, and 9%, respectively. Tumour-infiltrating lymphocytes were low or moderate except when squamous differentiation was present. Most tumours were triple-negative (92%). AR and TROP2 were positive in 34% and 85% of the cases, respectively. PD-L1 was positive in tumour cells in 18% (cutoff: 1% of positive tumour cells) of the cases and in tumour-infiltrating immune cells in 40% (cutoff: 1% of tumour area) of the cases. Notably, spindle cell and mesenchymal metaplastic breast carcinomas were mostly PDL1-negative. Lastly, 21 (32.3%) cases were HER2-low, all being HER2 1+, with no HER2 2+. CONCLUSION Metaplastic breast carcinoma could benefit from tailored therapeutic strategies adapted to the phenotypic specificities of histological subtypes.
Collapse
Affiliation(s)
- Suzanne Chartier
- Department of Pathology, Hôpital Bicêtre, APHP, Université Paris Saclay, Le Kremlin-Bicêtre, France.,Department of Pathology, Institut Curie, Paris, France
| | | | | | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | - Youlia Kirova
- Department of Radiotherapy, Institut Curie, Paris, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Caterina Marchiò
- Department of Medical Sciences, University of Turin, Italy.,Pathology Unit, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy
| | | |
Collapse
|
4
|
Luo QQ, Luo NN. Case report and literature review on a large MBC with ulceration. Medicine (Baltimore) 2023; 102:e33131. [PMID: 36862895 PMCID: PMC9981360 DOI: 10.1097/md.0000000000033131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE Metaplastic breast cancer (MBC) is a rare tumor of the breast, and skin ulceration of breast tumors is a difficult clinical problem that reduces the patient's quality of life. PATIENT CONCERNS There are currently no Standard Treatment Guidelines for MBC at present, and the treatment for the skin ulceration of breast tumors is limited in clinics. DIAGNOSIS Here, we report the case of a patient with a large MBC and skin ulceration, accompanied by exudation and odor. INTERVENTION The combined treatment of albumin paclitaxel and carrelizumab (anti-PD-1 immunotherapy) was effective in reducing the tumor, but it increased the severity of the skin ulceration. After taking traditional Chinese medicine, the skin ulceration healed completely. Then the patient underwent a mastectomy and radiotherapy. OUTCOMES The patient has a high quality of life and was in good condition after the comprehensive treatment. LESSONS This suggests that traditional Chinese medicine may have a good auxiliary therapeutic effect on the skin ulceration of MBC.
Collapse
Affiliation(s)
- Qin-Qin Luo
- Traditional Chinese Medicine Department of Wuhan No.1 Hospital, China
| | - Na-Na Luo
- Traditional Chinese Medicine Department of Wuhan No.1 Hospital, China
- * Correspondence: Na-Na Luo, Nuclear Medicine Department of Hubei Cancer Hospital, China (e-mail: )
| |
Collapse
|
5
|
Zhu K, Chen Y, Guo R, Dai L, Wang J, Tang Y, Zhou S, Chen D, Huang S. Prognostic Factor Analysis and Model Construction of Triple-Negative Metaplastic Breast Carcinoma After Surgery. Front Oncol 2022; 12:924342. [PMID: 35814407 PMCID: PMC9261478 DOI: 10.3389/fonc.2022.924342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The study aimed to analyze the prognostic factors of patients with triple-negative (TN) metaplastic breast carcinoma (MpBC) after surgery and to construct a nomogram for forecasting the 3-, 5-, and 8-year overall survival (OS). Methods A total of 998 patients extracted from the Surveillance, Epidemiology, and End Results (SEER) database were assigned to either the training or validation group at random in a ratio of 7:3. The clinical characteristics of patients in the training and validation sets were compared, and multivariate Cox regression analysis was used to identify the independent risk variables for the OS of patients with TN MpBC after surgery. These selected parameters were estimated through the Kaplan–Meier (KM) curves using the log-rank test. The nomogram for predicting the OS was constructed and validated by performing the concordance index (C-index), receiver operating characteristics (ROC) curves with area under the receiver operating characteristic curves (AUC), calibration curves, and decision curve analyses (DCAs). Patients were then stratified as high-risk and low-risk, and KM curves were performed. Results Multivariate Cox regression analysis indicated that factors including age, marital status, clinical stage at diagnosis, chemotherapy, and regional node status were independent predictors of prognosis in patients with MpBC after surgery. Separate KM curves for the screened variables revealed the same statistical results as with Cox regression analysis. A prediction model was created and virtualized via nomogram based on these findings. For the training and validation cohorts, the C-index of the nomogram was 0.730 and 0.719, respectively. The AUC values of the 3-, 5-, and 8-year OS were 0.758, 0.757, and 0.785 in the training group, and 0.736, 0.735, and 0.736 for 3, 5, and 8 years in the validation group, respectively. The difference in the OS between the real observation and the forecast was quite constant according to the calibration curves. The generated clinical applicability of the nomogram was further demonstrated by the DCA analysis. In all the training and validation sets, the KM curves for the different risk subgroups revealed substantial differences in survival probabilities (P <0.001). Conclusion The study showed a nomogram that was built from a parametric survival model based on the SEER database, which can be used to make an accurate prediction of the prognosis of patients with TN MpBC after surgery.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Dedian Chen
- *Correspondence: Sheng Huang, ; Dedian Chen,
| | - Sheng Huang
- *Correspondence: Sheng Huang, ; Dedian Chen,
| |
Collapse
|
6
|
Hammood ZD, Salih AM, kakamad FH, Salih RQ, Mohammed SH, Sharif HM, Salih KM. Metaplastic breast carcinoma with invasive and high-grade ductal carcinoma in situ; a rare case with review of literature. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
蔡 文, 庄 严, 陈 建, 王 宏. [Effect of postmastectomy radiotherapy on survival outcomes of patients with metaplastic breast cancer]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1733-1740. [PMID: 34916202 PMCID: PMC8685700 DOI: 10.12122/j.issn.1673-4254.2021.11.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the effect of postmastectomy radiotherapy (PMRT) on the overall survival (OS) and breast cancer-specific survival (BCSS) of patients with metaplastic breast cancer (MpBC) in comparison with those of patients with invasive ductal breast carcinoma (IDC). METHODS We selected the patients with pathologically confirmed MpBC and IDC who either received PMRT or not from the archived cases (from January, 1998 to December, 2016) in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. In total, 31 982 patients were selected, including 308 patients with MpBC and PMRT, 629 with MpBC and PMRT, and 31 045 with IDC and PMRT. All the included patients were above 18 years of age without distant metastases or a second primary cancer and underwent radical surgery. Baseline characteristics of the patients were compared among the 3 subgroups, and multivariate Cox regression and Kaplan-Meier analyses were performed for analyzing the prognostic factors of MpBC, OS, and BCSS. RESULTS The majority (81.2%) of patients with MpBC were older than 50 years, had pathological grade III (68%), and were negative for ER (75.9%) and PR (79.8%) and in stage T2-3 (71.3%) and N0-1 (85.6%). Multivariate Cox regression analysis showed that age, T stage, N stage, PMRT, and chemotherapy were significantly associated with the prognosis of patients with MpBC (P < 0.05), while pathological grade, ER status, or PR status did not significantly affect the prognosis (P>0.05). Kaplan-Meier analysis showed that the patients with MpBC and PMRT had better OS (HR=1.394, 95% CI: 1.125-1.727; P < 0.05) and BCSS (HR=1.390, 95% CI: 1.074-1.800; P < 0.05) than those with MpBC who did not receive PMRT; but after PMRT, the patients with MpBC had worse OS (HR=1.626, 95%CI: 1.386-1.908; P < 0.001) and BCSS (HR=1.710, 95% CI: 1.418-2.062; P < 0.001) as compared with those with IDC. CONCLUSION MpBC has unique clinicopathological features. In patients with MpBC, age, T stage, N stage, radiotherapy and chemotherapy are all the prognostic factors affecting the survival outcomes, and PMRT can improve the OS and BCSS of the patients.
Collapse
Affiliation(s)
- 文娟 蔡
- 南方医科大学南方医院放疗科,广东 广州 510515Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 严 庄
- 南方医科大学公共卫生学院生物统计学系,广东省热带广东省热带病研究重点实验室,广东 广州 510515Department of Biostatistics, School of Public Health, Southern Medical University, Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangzhou 510515, China
| | - 建辉 陈
- 南方医科大学南方医院放疗科,广东 广州 510515Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 宏梅 王
- 南方医科大学南方医院放疗科,广东 广州 510515Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
8
|
Kumar U, Hu Y, Masrour N, Castellanos-Uribe M, Harrod A, May ST, Ali S, Speirs V, Coombes RC, Yagüe E. MicroRNA-495/TGF-β/FOXC1 axis regulates multidrug resistance in metaplastic breast cancer cells. Biochem Pharmacol 2021; 192:114692. [PMID: 34298004 DOI: 10.1016/j.bcp.2021.114692] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Abstract
Triple-negative metaplastic breast carcinoma (MBC) poses a significant treatment challenge due to lack of targeted therapies and chemotherapy resistance. We isolated a novel MBC cell line, BAS, which showed a molecular and phenotypic profile different from the only other metaplastic cell model, HS578T cells. To gain insight behind chemotherapeutic resistance, we generated doxorubicin (HS-DOX, BAS-DOX) and paclitaxel (HS-TX, BAS-TX) resistant derivatives of both cell lines. Drug sensitivity assays indicated a truly multidrug resistant (MDR) phenotype. Both BAS-DOX and BAS-TX showed up-regulation of FOXC1 and its experimental down-regulation re-sensitized cells to doxorubicin and paclitaxel. Experimental modulation of FOXC1 expression in MCF-7 and MDA-MB-231 cells corroborated its role in MDR. Genome-wide expression analyses identified gene expression signatures characterized by up-regulation of TGFB2, which encodes cytokine TGF-β2, in both BAS-DOX and BAS-TX cells. Pharmacological inhibition of the TGF-β pathway with galunisertib led to down-regulation of FOXC1 and increase in drug sensitivity in both BAS-DOX and BAS-TX cells. MicroRNA (miR) expression analyses identified high endogenous miR-495-3p levels in BAS cells that were downregulated in both BAS MDR cells. Transient expression of miR-495-3p mimic in BAS-DOX and BAS-TX cells caused downregulation of TGFB2 and FOXC1 and re-sensitized cells to doxorubicin and paclitaxel, whereas miR-495-3p inhibition in BAS cells led to increase in resistance to both drugs and up-regulation of TGFB2 and FOXC1. Together, these data suggest interplay between miR-495-3p, TGF-β2 and FOXC1 regulating MDR in MBC and open the exploration of novel therapeutic strategies.
Collapse
Affiliation(s)
- Uttom Kumar
- Division of Cancer, Imperial College Faculty of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Yunhui Hu
- The 3(rd) Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, Huan Hu Xi Road, Ti Yuan Bei, He Xi District, Tianjin 300060, PR China; GeneNet Pharmaceuticals Co. Ltd., Ting Jiang Road, Bei Chen District, Tianjin, 300410, PR China
| | - Nahal Masrour
- Division of Cancer, Imperial College Faculty of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Marcos Castellanos-Uribe
- Nottingham Arabidopsis Stock Centre, University of Nottingham, Sutton Bonington campus, Loughborough LE12 5RD, UK
| | - Alison Harrod
- Epigenetics and Genome Stability Team, The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
| | - Sean T May
- Nottingham Arabidopsis Stock Centre, University of Nottingham, Sutton Bonington campus, Loughborough LE12 5RD, UK
| | - Simak Ali
- Division of Cancer, Imperial College Faculty of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Valerie Speirs
- Institute of Medical Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB24 2XD, UK
| | - R Charles Coombes
- Division of Cancer, Imperial College Faculty of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Ernesto Yagüe
- Division of Cancer, Imperial College Faculty of Medicine, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK.
| |
Collapse
|
9
|
Yilmaz Y, Atahan K, Tosun F, Sezgin G, Cin N, Haciyanli S, Kamer E. Metaplastic Breast Carcinoma: Analysis of 44 Cases. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
10
|
Trapani D, Giugliano F, Uliano J, Zia VAA, Marra A, Viale G, Ferraro E, Esposito A, Criscitiello C, D'amico P, Curigliano G. Benefit of adjuvant chemotherapy in patients with special histology subtypes of triple-negative breast cancer: a systematic review. Breast Cancer Res Treat 2021; 187:323-337. [PMID: 34043122 DOI: 10.1007/s10549-021-06259-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Breast cancer (BC) is a leading cause of morbidity, disability, and mortality in women, worldwide; triple-negative BC (TNBC) is a subtype traditionally associated with poorer prognosis. TNBC special histology subtypes present distinct clinical and molecular features and sensitivity to antineoplastic treatments. However, no consensus has been defined on the best adjuvant therapy. The aim of the review is to study the evidence from literature to inform the choice of adjuvant treatments in this setting. METHODS We systematically searched literature assessing the benefit of adjuvant chemotherapy in patients with TNBC special histotypes (PROSPERO: CRD42020153818). RESULTS We screened 6404 records (15 included). All the studies estimated the benefit of different chemotherapy regimens, in retrospective cohorts (median size: 69 patients (range min-max: 17-5142); median follow-up: 51 months (range: 21-268); mostly in Europe and USA). In patients with early-stage adenoid cystic TNBC, a marginal role of chemotherapy was reported. Similar for apocrine TNBC. Medullary tumors exhibited an intrinsic good prognosis with a limited role of chemotherapy, suggested to be modulated by the presence of tumor-infiltrating lymphocytes. A significant impact of chemotherapy on the overall survival was estimated in patients with metaplastic TNBC. Limitations were related to the retrospective design of all the studies and heterogeneous treatments received by the patients. CONCLUSIONS There is potential opportunity to consider treatment de-escalation and less intense therapies in some patients with early, special histology-type TNBC. International efforts are indispensable to validate prospective clinical decision models.
Collapse
Affiliation(s)
- D Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - F Giugliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - J Uliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - V A A Zia
- Division of Medical Oncology, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04037-004, Brazil
| | - A Marra
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - G Viale
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - E Ferraro
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - A Esposito
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - C Criscitiello
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - P D'amico
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy
| | - G Curigliano
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hematology (DIPO), University of Milan "La Statale", Via Festa Del Perdono 1, 20122, Milan, Italy.
| |
Collapse
|
11
|
Youssef I, Lee A, Kukunoor S, Taiwo E, Luhrs CA, Schreiber D. Patterns of Care and Survival of Metastatic Metaplastic Breast Cancer Patients. Cureus 2020; 12:e10339. [PMID: 33150115 PMCID: PMC7605212 DOI: 10.7759/cureus.10339] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Metaplastic breast cancer (MBC) is a rare, aggressive variant of breast cancer, usually triple negative disease and chemotherapy refractory. Despite this, the standard of care remains the same as invasive ductal breast cancer. We sought to analyze patterns of care and outcomes among patients with metastatic MBC. Methods: Patients over 18 years diagnosed with metastatic MBC from 2004-2015 were identified in the National Cancer Database (NCDB). Clinical and demographic details were compared between two groups (chemotherapy vs no chemotherapy). Logistic regression was performed to assess for predictors of receiving chemotherapy. The Kaplan-Meier method was used to assess overall survival (OS) and Cox regression analysis was used to assess the impact of covariates on OS. Results: There were 7,580 patients with MBC of which 417 (5.5%) presented with metastatic disease. Median age was 65 years (interquartile range (IQR) 54-76) and median follow up for living patients was 48 months (IQR 31-77). One hundred and fifty-six (37.4%) patients received chemotherapy. On multivariable logistic regression analyses, treatment at an academic facility was associated with an increased likelihood of receiving chemotherapy (OR 3.14, 95% CI 1.95-5.03, p<0.001) while age ≥65 years (OR 0.54, 95% CI 0.34-0.86, p=0.009) and receipt of hormonal therapy (OR 0.35, 95% CI 0.15-0.85, p=0.021) were associated with a decreased likelihood of receiving chemotherapy. On multivariable Cox regression analysis, higher Charlson-Deyo score (hazard ratio (HR) 1.35-1.78, p<0.05) was associated with worse survival while receipt of chemotherapy (HR 0.76, 95% CI 0.59-0.99, p=0.041) and having insurance (HR 0.34-0.47, p<0.05) were associated with improved survival. Patients who received chemotherapy had improved median (twelve versus eight months), one-year (51% versus 38%), and two-year (35% versus 21%) OS, as compared to those who did not receive chemotherapy (p=0.006). Conclusions: In this study of MBC patients, there was a survival benefit with palliative chemotherapy in the setting of metastatic disease. As expected, treatment was most often given to younger patients.
Collapse
Affiliation(s)
- Irini Youssef
- Medical Oncology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Anna Lee
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sparsha Kukunoor
- Medical Oncology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Evelyn Taiwo
- Hematology and Oncology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Carol A Luhrs
- Medical Oncology, State University of New York (SUNY) Downstate Medical Center/New York Harbor Healthcare System, Brooklyn, USA
| | - David Schreiber
- Radiation Oncology, Summit Medical Group, Berkeley Heights, USA
| |
Collapse
|
12
|
Jung SY, Jung KW, Ha J, Won YJ, Kim YA, Kwon Y, Kong SY, Lee ES. Different Patterns of Conditional Survival of Breast Cancer Patients by Age and Histologic Types: Evidence from the Korean Nationwide Registry. Cancer Epidemiol Biomarkers Prev 2019; 28:1169-1176. [PMID: 31028082 DOI: 10.1158/1055-9965.epi-18-1072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/11/2018] [Accepted: 04/18/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Conditional relative survival (CRS), which is the survival estimate of patients who have already survived for a certain period of time after diagnosis, could provide more relevant information on the current prognosis of cancer survivors than the standard 5-year relative survival (RS). This study aimed to estimate the 5-year CRS of Korean breast cancer patients. METHODS We identified 145,083 breast cancer cases diagnosed between 2002 and 2013 in the Korea Central Cancer Registry. The CRS was estimated for every year after diagnosis, according to sex, age, histologic type, and stage. RESULTS The 5-year RS at diagnosis was 90.8%, and the 10-year RS was 85.7%. The 5-year CRS was 91.0% and 94.3% at 1 year and 5 years after diagnosis, respectively. Very young and very old patients had worse 5-year CRS after 5 years of survival than those of other age groups (92.2% in the <40-year and 92.6% in the ≥70-year groups vs. 95.4% in 40-49-year, 94.3% in 50-59-year, and 93.7% in 60-69-year groups). The 5-year CRS of metaplastic carcinoma increased from 82.0% at diagnosis to 95.2% at 5 years after diagnosis, compared with that of lobular carcinoma (from 93.1% to 92.5%). Hardly any excess mortality (5-year CRS ≥ 95%) was seen within 7 years after diagnosis. CONCLUSIONS This study shows that the CRS of breast cancer survivors in Korea has increased, but varies by sex, age, stage, and histologic type. IMPACT These findings provide more detailed information to breast cancer survivors and clinicians.
Collapse
Affiliation(s)
- So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang, Korea.,Cancer Healthcare Research Branch, Research Institute, National Cancer Center, Goyang, Korea
| | - Kyu-Won Jung
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
| | - Johyun Ha
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Young Ae Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Youngmee Kwon
- Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Sun-Young Kong
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy.,Translational Cancer Research Branch, Research Institute, National Cancer Center, Goyang, Korea.,Department of Laboratory Medicine, Center for Diagnostic Oncology, Hospital, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Korea.,Immunotherapeutics Branch, Research Institute, National Cancer Center, Goyang, Korea.,National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
| |
Collapse
|
13
|
Li X, Liu J, Shi PF, Fu P. Katanin P80 expression correlates with lymph node metastasis and worse overall survival in patients with breast cancer. Cancer Biomark 2019; 23:363-371. [PMID: 30223388 DOI: 10.3233/cbm-181369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the correlation of katanin P80 expression with clinicopathological features and overall survival (OS) in surgical breast cancer (BC) patients. METHODS Four hundred and fourteen BC patients underwent surgery were analyzed in this retrospective cohort study. Katanin P80 expression was examined by immunofluorescence assay. The median follow-up duration was 118.0 months (quantiles: 99.0-140.5 months), the last follow-up date was Jul 1st 2017. RESULTS Eighty-five patients (20.5%) with katanin P80 positive expression and 329 patients (79.5%) with katanin P80 negative expression were observed in this research. Katanin P80 positive expression was correlated with higher N stage (p< 0.001) and TNM stage (p< 0.001). K-M curve and log-rank test revealed that katanin P80 positive patients presented with shorter OS compared with katanin P80 negative patients (p< 0.001). Multivariate Cox's regression analysis disclosed that katanin P80 positive expression (p< 0.001) and histologic grade (p< 0.001) could independently predict unfavorable OS. Furthermore, subgroups analysis was performed, which illuminated that katanin P80 positive expression was correlated with shorter OS in all subgroups divided by molecular subtyping and TNM stage (all p< 0.05) except in TNM stage I subgroup (p= 0.573). CONCLUSION Katanin P80 expression positively correlated with lymph node metastasis and could abe a novel biomarker for prognosis in BC patients.
Collapse
Affiliation(s)
- Xun Li
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Peng-Fei Shi
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Peng Fu
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
14
|
Salemis NS. Metaplastic carcinoma of the breast with mesenchymal differentiation (carcinosarcoma). A unique presentation of an aggressive malignancy and literature review. Breast Dis 2018; 37:169-175. [PMID: 29504519 DOI: 10.3233/bd-170313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Metaplastic carcinoma of the breast with mesenchymal differentiation (MCMD), previously known as carcinosarcoma, is a very rare and aggressive tumor that has been recently classified as a subtype of metaplastic breast carcinoma. It accounts for 0.08%-0.2% of all breast cancers, with only a few cases reported in the literature. Histologically, MCMD is characterized by a biphasic pattern of malignant epithelial and sarcomatous components without evidence of a transition zone between the two elements. We herein describe a unique case of metaplastic carcinoma of the breast with chondrosarcomatous differentiation in a postmenopausal woman who presented with a large, rapidly growing, ulcerated, bleeding mass and signs of impending sepsis. Metaplastic breast carcinomas (MBC) are rare and aggressive tumors. They are characterized by larger size, lower rates of axillary node involvement, higher rates of triple negativity and distal metastases, earlier local recurrence and poorer survival compared with classic invasive breast cancer. Because of the rarity of MBC, the optimal treatment has not been well defined. Surgery is the main curative treatment modality since MBC has shown a suboptimal response to standard chemotherapy. Patients with MBC may be appropriate candidates for novel targeted therapies.
Collapse
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/diagnosis
- Breast Neoplasms/drug therapy
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Chemotherapy, Adjuvant
- Diagnosis, Differential
- Disease-Free Survival
- Female
- Humans
- Mastectomy
- Metaplasia/pathology
- Middle Aged
- Mixed Tumor, Malignant/diagnosis
- Mixed Tumor, Malignant/drug therapy
- Mixed Tumor, Malignant/pathology
- Mixed Tumor, Malignant/surgery
- Neoplasm Staging
- Receptor, ErbB-2/metabolism
Collapse
|