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Bossuyt V, Provenzano E, Symmans WF, Webster F, Allison KH, Dang C, Gobbi H, Kulka J, Lakhani SR, Moriya T, Quinn CM, Sapino A, Schnitt S, Sibbering DM, Slodkowska E, Yang W, Tan PH, Ellis I. A dedicated structured data set for reporting of invasive carcinoma of the breast in the setting of neoadjuvant therapy: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2024; 84:1111-1129. [PMID: 38443320 DOI: 10.1111/his.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
AIMS The International Collaboration on Cancer Reporting (ICCR), a global alliance of major (inter-)national pathology and cancer organisations, is an initiative aimed at providing a unified international approach to reporting cancer. ICCR recently published new data sets for the reporting of invasive breast carcinoma, surgically removed lymph nodes for breast tumours and ductal carcinoma in situ, variants of lobular carcinoma in situ and low-grade lesions. The data set in this paper addresses the neoadjuvant setting. The aim is to promote high-quality, standardised reporting of tumour response and residual disease after neoadjuvant treatment that can be used for subsequent management decisions for each patient. METHODS The ICCR convened expert panels of breast pathologists with a representative surgeon and oncologist to critically review and discuss current evidence. Feedback from the international public consultation was critical in the development of this data set. RESULTS The expert panel concluded that a dedicated data set was required for reporting of breast specimens post-neoadjuvant therapy with inclusion of data elements specific to the neoadjuvant setting as core or non-core elements. This data set proposes a practical approach for handling and reporting breast resection specimens following neoadjuvant therapy. The comments for each data element clarify terminology, discuss available evidence and highlight areas with limited evidence that need further study. This data set overlaps with, and should be used in conjunction with, the data sets for the reporting of invasive breast carcinoma and surgically removed lymph nodes from patients with breast tumours, as appropriate. Key issues specific to the neoadjuvant setting are included in this paper. The entire data set is freely available on the ICCR website. CONCLUSIONS High-quality, standardised reporting of tumour response and residual disease after neoadjuvant treatment are critical for subsequent management decisions for each patient.
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Affiliation(s)
- Veerle Bossuyt
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Provenzano
- Department of Histopathology, Addenbrookes Hospital, Cambridge, UK
| | - W Fraser Symmans
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fleur Webster
- International Collaboration on Cancer Reporting, Surry Hills, NSW, Australia
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Chau Dang
- Memorial Sloan Kettering Cancer Center, West Harrison, NY, USA
| | - Helenice Gobbi
- Department of Surgical Clinic, Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Sunil R Lakhani
- Centre for Clinical Research, and Pathology Queensland, University of Queensland, Brisbane, Qld, Australia
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | - Cecily M Quinn
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stuart Schnitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - D Mark Sibbering
- University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
| | - Elzbieta Slodkowska
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Ian Ellis
- Department of Histopathology, Nottingham City Hospital, London, UK
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Alhudiri I, Nolan C, Ellis I, Elzagheid A, Green A, Chapman C. Expression of Cathepsin D in early-stage breast cancer and its prognostic and predictive value. Breast Cancer Res Treat 2024:10.1007/s10549-024-07293-y. [PMID: 38578521 DOI: 10.1007/s10549-024-07293-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Cathepsin D is a proteolytic enzyme that is normally localized in the lysosomes and is involved in the malignant progression of breast cancer. There are conflicting results regarding Cathepsin D significance as prognostic and predictor marker in breast cancer. This study aimed to evaluate the expression and prognostic significance of Cathepsin D in early-stage breast cancer. METHODS Expression of Cathepsin D was assessed by immunohistochemical staining of tissue microarrays, in a large well-characterized series of early-stage operable breast cancer (n = 954) from Nottingham Primary Breast Carcinoma Series between the period of 1988 and 1998 who underwent primary surgery. Correlation of Cathepsin D expression with clinicopathological parameters and prognosis was evaluated. RESULTS Cathepsin D expression was positive in 71.2% (679/954) of breast cancer tumours. Positive expression of Cathepsin D was significantly associated with high histological grade (p = 0.007), pleomorphism (p = 0.002), poor Nottingham Prognostic Index (NPI) score (p < 0.002), recurrence (p = 0.005) and distant metastasis (p < 0.0001). Kaplan-Meier analysis showed that Cathepsin D expression was significantly associated with shorter breast cancer-specific survival (p = 0.001), higher risk of recurrence (p = 0.001) and distant metastasis (p < 0.0001). ER-positive tumours expressing Cathepsin D and treated with tamoxifen demonstrated a significantly higher risk of distant metastasis. CONCLUSION Cathepsin D expression significantly predicts poor prognosis in breast cancer and is associated with variables of poor prognosis and shorter outcome. The strong association of Cathepsin D with aggressive tumour characteristics and poor outcomes warrants further research of its potential as a therapeutic target The results also suggest a possible interaction between Cathepsin D and tamoxifen therapy in ER-positive breast cancer which needs further investigation to elucidate the underlying mechanisms.
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Affiliation(s)
- Inas Alhudiri
- Breast Pathology Research Group, Nottingham Breast Cancer Research Centre, Biodiscovery Institute, Faculty of Medicine, The University of Nottingham, Nottingham, UK
- Genetic Engineering Department, Libyan Biotechnology Research Centre, Tripoli, Libya
| | - Christopher Nolan
- Breast Pathology Research Group, Nottingham Breast Cancer Research Centre, Biodiscovery Institute, Faculty of Medicine, The University of Nottingham, Nottingham, UK
| | - Ian Ellis
- Breast Pathology Research Group, Nottingham Breast Cancer Research Centre, Biodiscovery Institute, Faculty of Medicine, The University of Nottingham, Nottingham, UK
| | - Adam Elzagheid
- Genetic Engineering Department, Libyan Biotechnology Research Centre, Tripoli, Libya
| | - Andrew Green
- Breast Pathology Research Group, Nottingham Breast Cancer Research Centre, Biodiscovery Institute, Faculty of Medicine, The University of Nottingham, Nottingham, UK.
| | - Caroline Chapman
- Eastern Bowel Cancer Screening Hub, Nottingham University Hospitals, NHS Trust, Nottingham, UK
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Tatullo M, Ellis I, Islam M. Editorial: Tissue regeneration using dental stem cells. Front Cell Dev Biol 2024; 12:1401476. [PMID: 38586305 PMCID: PMC10995370 DOI: 10.3389/fcell.2024.1401476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Marco Tatullo
- Department of Translational Biomedicine and Neuroscience (DIBRAIN), University of Bari Aldo Moro, Bari, Italy
- School of Dentistry, University of Dundee, Dundee, United Kingdom
- MIRROR—Medical Institute for Regeneration and Repairing and Organ Replacement, Interdepartmental Center, University of Bari Aldo Moro, Bari, Italy
| | - Ian Ellis
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Mohammad Islam
- School of Dentistry, University of Dundee, Dundee, United Kingdom
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Coombes C, Angelou C, Al-Khalili Z, Hart W, Francescatti D, Wright N, Ellis I, Green A, Rakha E, Shousha S, Amrania H, Phillips CC, Palmieri C. Performance of a novel spectroscopy-based tool for adjuvant therapy decision-making in hormone receptor-positive breast cancer: a validation study. Breast Cancer Res Treat 2024:10.1007/s10549-023-07229-y. [PMID: 38244167 DOI: 10.1007/s10549-023-07229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Digistain Index (DI), measured using an inexpensive mid-infrared spectrometer, reflects the level of aneuploidy in unstained tissue sections and correlates with tumor grade. We investigated whether incorporating DI with other clinicopathological variables could predict outcomes in patients with early breast cancer. METHODS DI was calculated in 801 patients with hormone receptor-positive, HER2-negative primary breast cancer and ≤ 3 positive lymph nodes. All patients were treated with systemic endocrine therapy and no chemotherapy. Multivariable proportional hazards modeling was used to incorporate DI with clinicopathological variables to generate the Digistain Prognostic Score (DPS). DPS was assessed for prediction of 5- and 10-year outcomes (recurrence, recurrence-free survival [RFS] and overall survival [OS]) using receiver operating characteristics and Cox proportional hazards regression models. Kaplan-Meier analysis evaluated the ability of DPS to stratify risk. RESULTS DPS was consistently highly accurate and had negative predictive values for all three outcomes, ranging from 0.96 to 0.99 at 5 years and 0.84 to 0.95 at 10 years. DPS demonstrated statistically significant prognostic ability with significant hazard ratios (95% CI) for low- versus high-risk classification for RFS, recurrence and OS (1.80 [CI 1.31-2.48], 1.83 [1.32-2.52] and 1.77 [1.28-2.43], respectively; all P < 0.001). CONCLUSION DPS showed high accuracy and predictive performance, was able to stratify patients into low or high-risk, and considering its cost and rapidity, has the potential to offer clinical utility.
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Affiliation(s)
- Charles Coombes
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Christina Angelou
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Zamzam Al-Khalili
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - William Hart
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | | | | | - Ian Ellis
- Nottingham University Hospital, Nottingham, UK
| | | | - Emad Rakha
- Nottingham University Hospital, Nottingham, UK
| | - Sami Shousha
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Hemmel Amrania
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Chris C Phillips
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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Puente-Ruiz N, Ellis I, Bregu M, Chen C, Church HJ, Tylee KL, Gladston S, Hackett R, Oldham A, Virk S, Hendriksz C, Morris AA, Jones SA, Stepien KM. Long-term outcomes in two adult siblings with Fucosidosis - Diagnostic odyssey and clinical manifestations. Mol Genet Metab Rep 2023; 37:101009. [PMID: 38053939 PMCID: PMC10694746 DOI: 10.1016/j.ymgmr.2023.101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 12/07/2023] Open
Abstract
Fucosidosis (OMIN# 230000) is a rare lysosomal storage disorder (LSDs) caused by mutations in the FUCA1 gene, leading to alpha-L-fucosidase deficiency; it is inherited as an autosomal recessive trait. Fucosidosis represents a disease spectrum with a wide variety of clinical features, but most affected patients have slow neurologic deterioration. Many patients die young and the long-term clinical outcomes in adult patients are poorly documented. Here, we report the long-term follow up of two Caucasian siblings, a 31-year-old man and 25-year-old woman. We describe the clinical, biochemical, radiological and genetic findings in two siblings affected by Fucosidosis and the differences between them after 19-years follow up. The dermatological features of the younger sibling have been reported previously by Bharati et al. (2007). Both patients have typical features of Fucosidosis, such as learning difficulties, ataxia, and angiokeratomas with differing severity. Case 1 presents severe ataxia with greater limitation of mobility, multiple dysostoses, angiokeratomas on his limbs, retinal vein enlargement and increased tortuosity in the eye and gastrointestinal symptoms. Biochemical analysis demonstrated a deficiency of alpha-fucosidase in leucocytes. Case 2 has a greater number of angiokeratomas and has suffered three psychotic episodes. The diagnosis of Fucosidosis was confirmed in cultured skin fibroblast at the age of 12 years. Molecular analysis of the FUCA1 gene showed a heterozygous mutation c.998G > A p.(Gly333Asp), with a pathogenic exon 4 deletion in the other allele in both patients. Conclusion. Fucosidosis presents a wide clinical heterogeneity and intrafamilial variability of symptoms. Psychosis and gastrointestinal symptoms have not been reported previously in Fucosidosis.
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Affiliation(s)
- Nuria Puente-Ruiz
- Adult Inherited Metabolic Diseases, Salford Royal NHS Foundation Trust, UK
- Department of Clinical Medicine, Marqués de Valdecilla University Hospital, López-Albo Post Residency Program, Santander, Spain
| | - Ian Ellis
- Clinical Genetics, Royal Liverpool Children Hospital, Alder Hey, Liverpool, UK
| | - Marsel Bregu
- Ophthalmology Department, Warrington Hospital, Warrington, UK
| | - Cliff Chen
- Clinical Neuropsychology Department, Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Heather J. Church
- Willink Metabolic Unit, St Mary's Hospital, Manchester Foundation Trust, Manchester, UK
| | - Karen L. Tylee
- Willink Metabolic Unit, St Mary's Hospital, Manchester Foundation Trust, Manchester, UK
| | | | - Richard Hackett
- Neurology Department, Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Andrew Oldham
- Adult Inherited Metabolic Diseases, Salford Royal NHS Foundation Trust, UK
| | - Surinder Virk
- Cardiology Department, Warrington Hospital, Warrington, UK
| | - Christian Hendriksz
- University of Pretoria, Steve Biko Academic Unit, Department of Paediatrics, Pretoria, South Africa
| | - Andrew A.M. Morris
- Willink Metabolic Unit, St Mary's Hospital, Manchester Foundation Trust, Manchester, UK
| | - Simon A. Jones
- Willink Metabolic Unit, St Mary's Hospital, Manchester Foundation Trust, Manchester, UK
| | - Karolina M. Stepien
- Adult Inherited Metabolic Diseases, Salford Royal NHS Foundation Trust, UK
- Division of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL, UK
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Saidy B, Vasan R, Durant R, Greener MR, Immanuel A, Green AR, Rakha E, Ellis I, Ball G, Martin SG, Storr SJ. Unravelling transcriptomic complexity in breast cancer through modulation of DARPP-32 expression and signalling pathways. Sci Rep 2023; 13:21163. [PMID: 38036593 PMCID: PMC10689788 DOI: 10.1038/s41598-023-48198-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023] Open
Abstract
DARPP-32 is a key regulator of protein-phosphatase-1 (PP-1) and protein kinase A (PKA), with its function dependent upon its phosphorylation state. We previously identified DKK1 and GRB7 as genes with linked expression using Artificial Neural Network (ANN) analysis; here, we determine protein expression in a large cohort of early-stage breast cancer patients. Low levels of DARPP-32 Threonine-34 phosphorylation and DKK1 expression were significantly associated with poor patient prognosis, while low levels of GRB7 expression were linked to better survival outcomes. To gain insight into mechanisms underlying these associations, we analysed the transcriptome of T47D breast cancer cells following DARPP-32 knockdown. We identified 202 differentially expressed transcripts and observed that some overlapped with genes implicated in the ANN analysis, including PTK7, TRAF5, and KLK6, amongst others. Furthermore, we found that treatment of DARPP-32 knockdown cells with 17β-estradiol or PKA inhibitor fragment (6-22) amide led to the differential expression of 193 and 181 transcripts respectively. These results underscore the importance of DARPP-32, a central molecular switch, and its downstream targets, DKK1 and GRB7 in breast cancer. The discovery of common genes identified by a combined patient/cell line transcriptomic approach provides insights into the molecular mechanisms underlying differential breast cancer prognosis and highlights potential targets for therapeutic intervention.
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Affiliation(s)
- Behnaz Saidy
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Richa Vasan
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Rosie Durant
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Megan-Rose Greener
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Adelynn Immanuel
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Andrew R Green
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Emad Rakha
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Ian Ellis
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Graham Ball
- Medical Technology Research Centre, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, CM1 1SQ, UK
| | - Stewart G Martin
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Sarah J Storr
- Nottingham Breast Cancer Research Centre, Biodiscovery Institute, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
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Islam M, Jones S, Ellis I. Role of Akt/Protein Kinase B in Cancer Metastasis. Biomedicines 2023; 11:3001. [PMID: 38002001 PMCID: PMC10669635 DOI: 10.3390/biomedicines11113001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
Metastasis is a critical step in the process of carcinogenesis and a vast majority of cancer-related mortalities result from metastatic disease that is resistant to current therapies. Cell migration and invasion are the first steps of the metastasis process, which mainly occurs by two important biological mechanisms, i.e., cytoskeletal remodelling and epithelial to mesenchymal transition (EMT). Akt (also known as protein kinase B) is a central signalling molecule of the PI3K-Akt signalling pathway. Aberrant activation of this pathway has been identified in a wide range of cancers. Several studies have revealed that Akt actively engages with the migratory process in motile cells, including metastatic cancer cells. The downstream signalling mechanism of Akt in cell migration depends upon the tumour type, sites, and intracellular localisation of activated Akt. In this review, we focus on the role of Akt in the regulation of two events that control cell migration and invasion in various cancers including head and neck squamous cell carcinoma (HNSCC) and the status of PI3K-Akt pathway inhibitors in clinical trials in metastatic cancers.
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Affiliation(s)
- Mohammad Islam
- Unit of Cell and Molecular Biology, School of Dentistry, University of Dundee, Park Place, Dundee DD1 4HR, UK; (S.J.); (I.E.)
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8
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Levitin MO, Rawlins LE, Sanchez-Andrade G, Arshad OA, Collins SC, Sawiak SJ, Iffland PH, Andersson MHL, Bupp C, Cambridge EL, Coomber EL, Ellis I, Herkert JC, Ironfield H, Jory L, Kretz PF, Kant SG, Neaverson A, Nibbeling E, Rowley C, Relton E, Sanderson M, Scott EM, Stewart H, Shuen AY, Schreiber J, Tuck L, Tonks J, Terkelsen T, van Ravenswaaij-Arts C, Vasudevan P, Wenger O, Wright M, Day A, Hunter A, Patel M, Lelliott CJ, Crino PB, Yalcin B, Crosby AH, Baple EL, Logan DW, Hurles ME, Gerety SS. Models of KPTN-related disorder implicate mTOR signalling in cognitive and overgrowth phenotypes. Brain 2023; 146:4766-4783. [PMID: 37437211 PMCID: PMC10629792 DOI: 10.1093/brain/awad231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023] Open
Abstract
KPTN-related disorder is an autosomal recessive disorder associated with germline variants in KPTN (previously known as kaptin), a component of the mTOR regulatory complex KICSTOR. To gain further insights into the pathogenesis of KPTN-related disorder, we analysed mouse knockout and human stem cell KPTN loss-of-function models. Kptn -/- mice display many of the key KPTN-related disorder phenotypes, including brain overgrowth, behavioural abnormalities, and cognitive deficits. By assessment of affected individuals, we have identified widespread cognitive deficits (n = 6) and postnatal onset of brain overgrowth (n = 19). By analysing head size data from their parents (n = 24), we have identified a previously unrecognized KPTN dosage-sensitivity, resulting in increased head circumference in heterozygous carriers of pathogenic KPTN variants. Molecular and structural analysis of Kptn-/- mice revealed pathological changes, including differences in brain size, shape and cell numbers primarily due to abnormal postnatal brain development. Both the mouse and differentiated induced pluripotent stem cell models of the disorder display transcriptional and biochemical evidence for altered mTOR pathway signalling, supporting the role of KPTN in regulating mTORC1. By treatment in our KPTN mouse model, we found that the increased mTOR signalling downstream of KPTN is rapamycin sensitive, highlighting possible therapeutic avenues with currently available mTOR inhibitors. These findings place KPTN-related disorder in the broader group of mTORC1-related disorders affecting brain structure, cognitive function and network integrity.
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Affiliation(s)
- Maria O Levitin
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Evox Therapeutics Limited, Oxford OX4 4HG, UK
| | - Lettie E Rawlins
- RILD Wellcome Wolfson Medical Research Centre, University of Exeter, Exeter EX2 5DW, UK
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter EX1 2ED, UK
| | | | - Osama A Arshad
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Stephan C Collins
- INSERM Unit 1231, Université de Bourgogne Franche-Comté, Dijon 21078, France
| | - Stephen J Sawiak
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 3EB, UK
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Phillip H Iffland
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Malin H L Andersson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Caleb Bupp
- Spectrum Health, Helen DeVos Children’s Hospital, Grand Rapids, MI 49503, USA
| | - Emma L Cambridge
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Eve L Coomber
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Ian Ellis
- Department of Clinical Genetics, Alder Hey Children’s Hospital, Liverpool L14 5AB, UK
| | - Johanna C Herkert
- Department of Genetics, University Medical Centre, University of Groningen, Groningen 9713 GZ, The Netherlands
| | - Holly Ironfield
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Logan Jory
- Haven Clinical Psychology Practice Ltd, Bude, Cornwall EX23 9HP, UK
| | | | - Sarina G Kant
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - Alexandra Neaverson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Open Targets, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Department of Genetics, University of Cambridge, Cambridge CB2 3EH, UK
| | - Esther Nibbeling
- Laboratory for Diagnostic Genome Analysis, Department of Clinical Genetics, Leiden University Medical Center, Leiden 3015 GD, The Netherlands
| | - Christine Rowley
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Institute of Metabolic Science, Cambridge University, Cambridge CB2 0QQ, UK
| | - Emily Relton
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Faculty of Health and Medical Science, University of Surrey, Guildford GU2 7YH, UK
| | - Mark Sanderson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Ethan M Scott
- New Leaf Center, Clinic for Special Children, Mount Eaton, OH 44659, USA
| | - Helen Stewart
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford OX3 7HE, UK
| | - Andrew Y Shuen
- London Health Sciences Centre, London, ON N6A 5W9, Canada
- Division of Medical Genetics, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5W9, Canada
| | - John Schreiber
- Department of Neurology, Children’s National Medical Center, Washington DC 20007, USA
| | - Liz Tuck
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - James Tonks
- Haven Clinical Psychology Practice Ltd, Bude, Cornwall EX23 9HP, UK
| | - Thorkild Terkelsen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Conny van Ravenswaaij-Arts
- Department of Genetics, University Medical Centre, University of Groningen, Groningen 9713 GZ, The Netherlands
| | - Pradeep Vasudevan
- Department of Clinical Genetics, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE1 7RH, UK
| | - Olivia Wenger
- New Leaf Center, Clinic for Special Children, Mount Eaton, OH 44659, USA
| | - Michael Wright
- Institute of Human Genetics, International Centre for Life, Newcastle upon Tyne NE1 7RU, UK
| | - Andrew Day
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Qkine Ltd., Cambridge CB5 8HW, UK
| | - Adam Hunter
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Minal Patel
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Christopher J Lelliott
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Institute of Metabolic Science, Cambridge University, Cambridge CB2 0QQ, UK
| | - Peter B Crino
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Binnaz Yalcin
- INSERM Unit 1231, Université de Bourgogne Franche-Comté, Dijon 21078, France
| | - Andrew H Crosby
- RILD Wellcome Wolfson Medical Research Centre, University of Exeter, Exeter EX2 5DW, UK
| | - Emma L Baple
- RILD Wellcome Wolfson Medical Research Centre, University of Exeter, Exeter EX2 5DW, UK
- Peninsula Clinical Genetics Service, Royal Devon University Healthcare NHS Foundation Trust, Exeter EX1 2ED, UK
| | - Darren W Logan
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Waltham Petcare Science Institute, Waltham on the Wolds LE14 4RT, UK
| | - Matthew E Hurles
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Open Targets, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Sebastian S Gerety
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
- Open Targets, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
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9
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Bailey O, Shand B, Ellis I. Class II composite restoration technique teaching: A randomised controlled crossover laboratory-based trial involving a novel ringless sectional matrix technique. Eur J Dent Educ 2023; 27:963-973. [PMID: 36539980 DOI: 10.1111/eje.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/11/2022] [Accepted: 10/30/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Objectives were to assess how different techniques (including a novel ringless sectional matrix approach) affect students' restorative outcomes, and their preferences for and preparedness to clinically implement new techniques with the aim of introducing appropriate techniques to the undergraduate curriculum. MATERIALS AND METHODS Students performed two class II composite restorations in plastic teeth using two sectional matrix techniques (separating ring vs. without [ringless]), and two composite restorative techniques (incremental vs. injection-moulded bulk-fill). Restorations were assessed on multiple parameters which were combined to rate them as "good" or not. Online surveys assessed students' preferences for and preparedness to clinically implement new techniques. RESULTS Contact area concavity (OR = 106, p < .001) and cervical marginal overhang (OR = 7.4, p < .001) were much more likely with the separating ring compared to the ringless sectional matrix technique. "Good" restorations were 29.5 times more likely when using ringless compared to separating ring techniques and 3.3 times more likely when using the injection-moulding bulk-fill compared to layered composite technique. A majority of students preferred the ringless to separating ring sectional matrix technique and the injection-moulding bulk-fill to layered composite technique. Large majorities felt prepared to implement the new techniques clinically with no or minimal guidance. CONCLUSIONS A classic sectional matrix technique with separating ring resulted in a much greater occurrence of contact area concavity and cervical marginal overhang than a novel ringless approach. When allied with student preferences and clinical preparedness, inclusion of the novel ringless approach in the undergraduate curriculum can be supported alongside bulk-fill injection-moulding techniques.
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Affiliation(s)
- Oliver Bailey
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Bonnie Shand
- Dental Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian Ellis
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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10
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Iftikhar A, Islam M, Shepherd S, Jones S, Ellis I. What is behind the lifestyle risk factors for head and neck cancer? Front Psychol 2022; 13:960638. [PMID: 36312160 PMCID: PMC9608174 DOI: 10.3389/fpsyg.2022.960638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
Lifestyle factors are known to be influential determinants of health. According to the World Health Organization (WHO), approximately one third of deaths involve unhealthy lifestyle habits. Among lifestyle risk factors for head and neck cancers (HNC), alcohol consumption and smoking have an undeniable role in the multifactorial aetiology of the disease. In recent years, the promotion of healthy lifestyle choices has gained significant attention as contributory to improving health and disease prevention. Interventions to tackle these risk factors are vitally important in disease prevention and progression. However, in order to effectively prevent the disease and reduce the risk factors, it is crucial to identify what upstream reasons lead to the adoption of these lifestyle risk factors in the first place. Stress being a constant aspect of modern-day life is known to contribute to alcohol and smoking practices. In this review paper, relevant literature was searched in PubMed database for stress, lifestyle factors, HNC and cancer to explore the role of stress and its associated biological pathways as an upstream factor in the adoption of lifestyle risk factors that cause HNC. It highlights the importance of stress pathways and the Hypothalamus Pituitary Adrenal (HPA) axis as a locus of interaction between stress, alcohol, smoking and cancer. Despite their widely accepted harmful effects, alcohol and smoking remain deeply rooted in contemporary life. A greater understanding of the impact of stress on lifestyle choices and an exploration of the mechanisms resulting in stress, alcohol- and smoking- related cancer may highlight opportunities for improved prevention measures through the modification of unhealthy lifestyle choices.
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Affiliation(s)
- Anem Iftikhar
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee,United Kingdom
| | - Mohammad Islam
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee,United Kingdom
| | - Simon Shepherd
- Department of Oral Surgery and Medicine, Dundee Dental Hospital, Dundee, Scotland, United Kingdom
| | - Sarah Jones
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee,United Kingdom
| | - Ian Ellis
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee,United Kingdom
- *Correspondence: Ian Ellis,
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11
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Katayama A, Starczynski J, Toss MS, Shaaban AM, Provenzano E, Quinn CM, Callagy G, Purdie CA, Millican-Slater R, Purnell D, Chagla L, Oyama T, Pinder SE, Chan S, Ellis I, Lee AHS, Rakha EA. The frequency and clinical significance of centromere enumeration probe 17 alterations in HER2 immunohistochemistry-equivocal invasive breast cancer. Histopathology 2022; 81:511-519. [PMID: 35879836 PMCID: PMC9545957 DOI: 10.1111/his.14728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
Background and aims Chromosome 17 alterations affect the assessment of HER2 gene amplification in breast cancer (BC), but its clinical significance remains unclear. This study aimed to identify the prevalence of centromere enumeration probe 17 (CEP17) alterations, and its correlation with response to neoadjuvant therapy (NAT) in BC patients with human epidermal growth factor receptor 2 (HER2) immunohistochemistry‐equivocal score. Methods and results A large BC cohort (n = 6049) with HER2 immunohistochemistry score 2+ and florescent in‐situ hybridisation (FISH) results was included to assess the prevalence of CEP17 alterations. Another cohort (n = 885) with available clinicopathological data was used to evaluate the effect of CEP17 in the setting of NAT. HER2‐amplified tumours with monosomy 17 (CEP17 copy number < 1.5 per nucleus), normal 17 (CEP17 1.5–< 3.0) and polysomy 17 (CEP17 ≥ 3.0) were observed in 16, 59 and 25%, respectively, compared with 3, 74 and 23%, respectively, in HER2‐non‐amplified tumours. There was no significant relationship between CEP17 alterations and pathological complete response (pCR) rate in both HER2‐amplified and HER2‐non‐amplified tumours. The independent predictors of pCR were oestrogen (ER) negativity in HER2‐amplified tumours [ER negative versus positive; odds ratio (OR) = 11.80; 95% confidence interval (CI) = 1.37–102.00; P = 0.02], and histological grade 3 in HER2 non‐amplified tumours (3 versus 1, 2; OR = 5.54; 95% CI = 1.61–19.00; P = 0.007). Conclusion The impacts of CEP17 alterations are not as strong as those of HER2/CEP17 ratio and HER2 copy number. The hormonal receptors status and tumour histological grade are more useful to identify BC patients with a HER2 immunohistochemistry‐equivocal score who would benefit from NAT.
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Affiliation(s)
- Ayaka Katayama
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK.,Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Jane Starczynski
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Edgebaston, Birmingham, UK
| | - Michael S Toss
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Abeer M Shaaban
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Edgebaston, Birmingham, UK.,Institute of Cancer and Genomic Sciences, The University of Birmingham, Edgebaston, Birmingham, UK
| | - Elena Provenzano
- Department of Histopathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Cecily M Quinn
- Department of Histopathology, St. Vincent's University Hospital, Dublin, and School of Medicine, University College Dublin, Ireland
| | - Grace Callagy
- Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, NUI, Galway, Ireland
| | - Colin A Purdie
- Department of Breast Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | | | - David Purnell
- Histopathology department, University Hospitals of Leicester, Leicester, UK
| | - Leena Chagla
- Burney Breast Unit , St Helens and Knowsley Teaching Hospital NHS Trust, UK
| | - Tetsunari Oyama
- Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sarah E Pinder
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Steve Chan
- Department of Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ian Ellis
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, City Hospital Nottingham, UK
| | - Andrew H S Lee
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, City Hospital Nottingham, UK
| | - Emad A Rakha
- Translational Medical Sciences Unit, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, City Hospital Nottingham, UK
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12
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Alzawi A, Iftikhar A, Shalgm B, Jones S, Ellis I, Islam M. Receptor, Signal, Nucleus, Action: Signals That Pass through Akt on the Road to Head and Neck Cancer Cell Migration. Cancers (Basel) 2022; 14:cancers14112606. [PMID: 35681586 PMCID: PMC9179418 DOI: 10.3390/cancers14112606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The ecosystem that surrounds a tumour, the microenvironment, has a huge impact on the spread of cancer, but its exact role in the molecular mechanism of spreading is still under scrutiny. This literature review aims to focus on the evidence published on the production of growth factors or proteins from the tumour microenvironment, which initiate signals in cancer cells. This review provides evidence that when Akt, a signalling protein, is activated by different growth factors such as epidermal growth factor, transforming growth factor α/β, vascular endothelial growth factor and nerve growth factor, head and neck cancer cell spreading is stimulated. In a nutshell, it demonstrates that the tumour microenvironment plays an important role in cancer spreading by synthesising and secreting growth factors and suggests that targeting growth-factor-activated Akt in combination therapy could be a valuable therapeutic approach in treating head and neck cancer patients. Abstract This review aims to provide evidence for the role of the tumour microenvironment in cancer progression, including invasion and metastasis. The tumour microenvironment is complex and consists of tumour cells and stromal-derived cells, in addition to a modified extracellular matrix. The cellular components synthesise growth factors such as EGF, TGFα and β, VEGF, and NGF, which have been shown to initiate paracrine signalling in head and neck cancer cells by binding to cell surface receptors. One example is the phosphorylation, and hence activation, of the signalling protein Akt, which can ultimately induce oral cancer cell migration in vitro. Blocking of Akt activation by an inhibitor, MK2206, leads to a significant decrease, in vitro, of cancer-derived cell migration, visualised in both wound healing and scatter assays. Signalling pathways have therefore been popular targets for the design of chemotherapeutic agents, but drug resistance has been observed and is related to direct tumour–tumour cell communication, the tumour–extracellular matrix interface, and tumour–stromal cell interactions. Translation of this knowledge to patient care is reliant upon a comprehensive understanding of the complex relationships present in the tumour microenvironment and could ultimately lead to the design of efficacious treatment regimens such as targeted therapy or novel therapeutic combinations.
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13
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Sudin E, Searjeant M, Partridge G, Phillips P, Hiller L, Snead D, Ellis I, Chen Y. Digital pathology: the effect of experience on visual search behavior. J Med Imaging (Bellingham) 2022; 9:035501. [PMID: 35572382 PMCID: PMC9082631 DOI: 10.1117/1.jmi.9.3.035501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/12/2022] [Indexed: 11/14/2022] Open
Abstract
Purpose: The introduction of whole slide imaging and digital pathology has enabled greater scrutiny of visual search behaviors among pathologists. We aim to investigate zooming and panning behaviors, external markers of visual processing capabilities, and the changes with experience. Approaches: Twenty digitized breast core needle biopsy histopathology slides were obtained from the circulating slides from the main digital pathology trial (IRAS number: 258799). These were presented to five pathologists with varying experience (1.5 to 40 years) whose examinations were recorded. Data of visual fixations were collected using eye-tracking cameras, and the magnification data and zooming behaviors were extracted in an objective fashion by an automated algorithm. The relationship between experience and metrics was analyzed using mixed-effects regression analyses. Results: There was a significant association between experience and both reading times ( p < 0.001 ) and a number of fixations ( p < 0.001 ), with these relationships being inversely proportional. The greater experience was also associated with greater diagnostic accuracy ( p = 0.033 ). We found that experience was significantly associated with greater use of magnification changes ( p < 0.001 ). Conversely, less experience showed a near significant association with the increased proportion of time spent panning ( p = 0.070 ). Conclusions: Fewer fixations needed to reach a diagnosis and quicker reading times are indicative of greater cognitive and visual processing capabilities with greater experience. These cognitive capabilities may be a prerequisite for the more frequent zooming changes that are more prevalent with increasing experience.
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Affiliation(s)
- Ellhia Sudin
- University of Nottingham, School of Medicine, Translational Medical Sciences, Nottingham
| | - Mitchell Searjeant
- University of Nottingham, School of Medicine, Translational Medical Sciences, Nottingham
| | - George Partridge
- University of Nottingham, School of Medicine, Translational Medical Sciences, Nottingham
| | - Peter Phillips
- University of Cumbria, Health and Medical Sciences Group, Lancaster
| | - Louise Hiller
- University of Warwick, Warwick Medical School, Coventry
| | - David Snead
- University Hospitals Coventry and Warwickshire NHS Trust, Department of Pathology, Coventry
| | - Ian Ellis
- University of Nottingham, School of Medicine, Translational Medical Sciences, Nottingham
| | - Yan Chen
- University of Nottingham, School of Medicine, Translational Medical Sciences, Nottingham
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14
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Goyal A, Mann GB, Fallowfield L, Duley L, Reed M, Dodwell D, Coleman RE, Fakis A, Newcombe R, Jenkins V, Whitham D, Childs M, Whynes D, Keeley V, Ellis I, Fairbrother P, Sadiq S, Monson K, Montgomery A, Tan W, Vale L, Homer T, Badger H, Haines RH, Lewis M, Megias D, Nabi Z, Singh P, Caraman A, Miles E. POSNOC-POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes. BMJ Open 2021; 11:e054365. [PMID: 34857578 PMCID: PMC8640630 DOI: 10.1136/bmjopen-2021-054365] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/03/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION ACOSOG-Z0011(Z11) trial showed that axillary node clearance (ANC) may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and whole breast radiotherapy (RT). A confirmatory study is needed to clarify the role of axillary treatment in women with ≤2 macrometastases undergoing BCS and groups that were not included in Z11 for example, mastectomy and those with microscopic extranodal invasion. The primary objective of POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy (POSNOC) is to evaluate whether for women with breast cancer and 1 or 2 macrometastases, adjuvant therapy alone is non-inferior to adjuvant therapy plus axillary treatment, in terms of 5-year axillary recurrence. METHODS AND ANALYSIS POSNOC is a pragmatic, multicentre, non-inferiority, international trial with participants randomised in a 1:1 ratio. Women are eligible if they have T1/T2, unifocal or multifocal invasive breast cancer, and 1 or 2 macrometastases at sentinel node biopsy, with or without extranodal extension. In the intervention group women receive adjuvant therapy alone, in the standard care group they receive ANC or axillary RT. In both groups women receive adjuvant therapy, according to local guidelines. This includes systemic therapy and, if indicated, RT to breast or chest wall. The UK Radiotherapy Trials Quality Assurance Group manages the in-built radiotherapy quality assurance programme. Primary endpoint is 5-year axillary recurrence. Secondary outcomes are arm morbidity assessed by Lymphoedema and Breast Cancer Questionnaire and QuickDASH questionnaires; quality of life and anxiety as assessed with FACT B+4 and State/Trait Anxiety Inventory questionnaires, respectively; other oncological outcomes; economic evaluation using EQ-5D-5L. Target sample size is 1900. Primary analysis is per protocol. Recruitment started on 1 August 2014 and as of 9 June 2021, 1866 participants have been randomised. ETHICS AND DISSEMINATION Protocol was approved by the National Research Ethics Service Committee East Midlands-Nottingham 2 (REC reference: 13/EM/0459). Results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN54765244; NCT0240168Cite Now.
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Affiliation(s)
- Amit Goyal
- Department of Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - G Bruce Mann
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Breast Cancer Trials, Newcastle, New South Wales, Australia
| | - Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, Brighton, UK
| | - David Dodwell
- Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Robert E Coleman
- Department of Oncology and Metabolism, Weston Park Hospital, Sheffield, UK
| | - Apostolos Fakis
- Research and Development, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Robert Newcombe
- Department of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Valerie Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Diane Whitham
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Margaret Childs
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - David Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | - Vaughan Keeley
- Lymphoedema Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Ian Ellis
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Shabina Sadiq
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Kathryn Monson
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Heath Badger
- Breast Cancer Trials, Newcastle, New South Wales, Australia
| | | | - Mickey Lewis
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Daniel Megias
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK
| | - Zohal Nabi
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK
| | - Preetinder Singh
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK
| | - Andrei Caraman
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK
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15
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Batra RN, Lifshitz A, Vidakovic AT, Chin SF, Sati-Batra A, Sammut SJ, Provenzano E, Ali HR, Dariush A, Bruna A, Murphy L, Purushotham A, Ellis I, Green A, Garrett-Bakelman FE, Mason C, Melnick A, Aparicio SAJR, Rueda OM, Tanay A, Caldas C. DNA methylation landscapes of 1538 breast cancers reveal a replication-linked clock, epigenomic instability and cis-regulation. Nat Commun 2021; 12:5406. [PMID: 34518533 PMCID: PMC8437946 DOI: 10.1038/s41467-021-25661-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022] Open
Abstract
DNA methylation is aberrant in cancer, but the dynamics, regulatory role and clinical implications of such epigenetic changes are still poorly understood. Here, reduced representation bisulfite sequencing (RRBS) profiles of 1538 breast tumors and 244 normal breast tissues from the METABRIC cohort are reported, facilitating detailed analysis of DNA methylation within a rich context of genomic, transcriptional, and clinical data. Tumor methylation from immune and stromal signatures are deconvoluted leading to the discovery of a tumor replication-linked clock with genome-wide methylation loss in non-CpG island sites. Unexpectedly, methylation in most tumor CpG islands follows two replication-independent processes of gain (MG) or loss (ML) that we term epigenomic instability. Epigenomic instability is correlated with tumor grade and stage, TP53 mutations and poorer prognosis. After controlling for these global trans-acting trends, as well as for X-linked dosage compensation effects, cis-specific methylation and expression correlations are uncovered at hundreds of promoters and over a thousand distal elements. Some of these targeted known tumor suppressors and oncogenes. In conclusion, this study demonstrates that global epigenetic instability can erode cancer methylomes and expose them to localized methylation aberrations in-cis resulting in transcriptional changes seen in tumors.
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Affiliation(s)
- Rajbir Nath Batra
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Aviezer Lifshitz
- Department of Computer Science and Applied Mathematics, and Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | | | - Suet-Feung Chin
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ankita Sati-Batra
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Stephen-John Sammut
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elena Provenzano
- Cancer Research UK Cambridge Centre, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - H Raza Ali
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ali Dariush
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Alejandra Bruna
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Leigh Murphy
- Research Institute in Oncology and Hematology, Winnipeg, Manitoba, Canada
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Ian Ellis
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Andrew Green
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Francine E Garrett-Bakelman
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Chris Mason
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Ari Melnick
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Samuel A J R Aparicio
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Oscar M Rueda
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Amos Tanay
- Department of Computer Science and Applied Mathematics, and Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel.
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK.
- Department of Oncology, University of Cambridge, Cambridge, UK.
- Cancer Research UK Cambridge Centre, Cambridge, UK.
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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16
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Iftikhar A, Islam M, Shepherd S, Jones S, Ellis I. Is RAS the Link Between COVID-19 and Increased Stress in Head and Neck Cancer Patients? Front Cell Dev Biol 2021; 9:714999. [PMID: 34336866 PMCID: PMC8320172 DOI: 10.3389/fcell.2021.714999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
The COVID-19 pandemic emerged as a largely unexplained outbreak of pneumonia cases, in Wuhan City, China and rapidly spread across the world. By 11th March 2020, WHO declared it as a global pandemic. The resulting restrictions, to contain its spread, demanded a momentous change in the lifestyle of the general population as well as cancer patients. This augmented negative effects on the mental health of patients with head and neck cancer (HNC), who already battle with the stress of cancer diagnosis and treatment. The causative agent of COVID-19, SARS-CoV2, gains entry through the Angiotensin converting enzyme 2 (ACE2) receptor, which is a component of the Renin Angiotensin System (RAS). RAS has been shown to influence cancer and stress such that it can have progressive and suppressive effects on both. This review provides an overview of SARS-CoV2, looks at how the RAS provides a mechanistic link between stress, cancer and COVID-19 and the probable activation of the RAS axis that increase stress (anxiogenic) and tumor progression (tumorigenic), when ACE2 is hijacked by SARS-CoV2. The mental health crises brought about by this pandemic have been highlighted in many studies. The emerging links between cancer and stress make it more important than ever before to assess the stress burden of cancer patients and expand the strategies for its management.
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Affiliation(s)
| | | | | | | | - Ian Ellis
- Unit of Cell and Molecular Biology, The Dental School, University of Dundee, Dundee, United Kingdom
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17
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Alkhadar H, Macluskey M, White S, Ellis I. PERINEURAL INVASION IN ORAL SQUAMOUS CELL CARCINOMA: INCIDENCE, CLINICAL IMPACT AND MOLECULAR INSIGHT. Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Rakha E, Mihai R, Abbas A, Bennett R, Campora M, Morena P, Toss M, Ellis I. Diagnostic concordance of phyllodes tumour of the breast. Histopathology 2021; 79:607-618. [PMID: 33966296 DOI: 10.1111/his.14397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/16/2021] [Accepted: 05/09/2021] [Indexed: 02/06/2023]
Abstract
AIMS Phyllodes tumours (PT) are rare and distinct breast tumours, which span a morphological continuum. Classification into benign, borderline and malignant categories reflects their biology and clinical behaviour and is essential to guide management. This study aims to assess the diagnostic agreement of PT using the UK National Health Service Breast Screening Programme (NHSBSP) breast pathology external quality assurance (EQA) scheme data. METHODS AND RESULTS Twenty-six PTs were identified in the EQA scheme, which were diagnosed by an average of 607 participants/circulation. Data on diagnostic categories were collected and representative slides were reviewed. The level of concordance between reporting pathologists was assessed. There were 14 benign, six borderline and six malignant PT. The overall rate of diagnosis agreement was 86% when analysed as benign lesions, borderline PT and malignant lesions, which decreased to 79% when diagnosed as PT (irrespective of grade) and to 63% when the diagnosis was further refined to PT categories (benign, borderline and malignant PTs). The highest agreement rate was observed in malignant PT (86%) and the lowest in borderline PT (42%). Malignant heterologous elements, stromal overgrowth and leaf-like architecture are features associated with higher concordance rates. Lower-priority features were stromal expansion, clefting and multinodularity. CONCLUSION The concordance of PT diagnosis, as an entity, is high, but its classification into benign, borderline and malignant has variable agreement levels, with borderline tumours having the lowest concordance rate. More research to refine the diagnostic criteria for categorisation of PT is warranted to improve concordance between pathologists.
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Affiliation(s)
- Emad Rakha
- Department of Histopathology, University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Raluca Mihai
- Department of Histopathology, University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Areeg Abbas
- Department of Histopathology, University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Rachel Bennett
- Department of Histopathology, University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Michela Campora
- Department of Histopathology, University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Philippa Morena
- Department of Histopathology, University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Michael Toss
- Department of Histopathology, University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Ian Ellis
- Department of Histopathology, University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
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19
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Rakha E, Tan PH, Ellis I, Quinn C. Adenomyoepithelioma of the breast: a proposal for classification. Histopathology 2021; 79:465-479. [PMID: 33829532 DOI: 10.1111/his.14380] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 12/11/2022]
Abstract
Breast lesions with a prominent myoepithelial cell component constitute a heterogeneous group of benign and malignant neoplastic proliferations. These lesions are often dual epithelial-myoepithelial, but may be purely myoepithelial cell in nature. Benign epithelial-myoepithelial lesions typically maintain the morphology and immunophenotype of the normal bilayer epithelial myoepithelial structures. However, the distinction between the two cell components is not always clear-cut in malignant lesions in which the histogenesis of myoepithelial cells remains uncertain. Neoplastic biphasic epithelial-myoepithelial lesions of the breast include adenomyoepithelioma (AME), pleomorphic adenoma and adenoid cystic carcinoma. Four histological patterns of classical AME have been described: tubular, lobulated, spindle-cell and adenosis variants. Overlapping patterns occur and some AMEs display an intraductal papillary pattern that may represent a fifth variant. AME can be benign or malignant. Classical AME may show atypical features, which are not sufficient for the diagnosis of malignancy (atypical AME). Atypical AME is recognised as a lesion of uncertain malignant potential with limited metastatic capability. Based on the histological features, we propose a classification of malignant AME (M-AME) into three variants: M-AME in situ, M-AME invasive and AME with invasive carcinoma. In this review, we provide an overview of myoepithelial lesions of the breast focusing on the classification of AME to improve not only the consistency of reporting but also help to guide further management decision-making.
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Affiliation(s)
- Emad Rakha
- Department of Histopathology, University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Ian Ellis
- Department of Histopathology, University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Cecily Quinn
- Department of Histopathology, St Vincent's University Hospital, University College, Dublin, Ireland
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20
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Mihai R, Callagy G, Qassid OL, Loughlin MO, Al-Hilfi L, Abbas A, Campora M, Hodi Z, Ellis I, Lee AHS, Rakha EA. Correlations of morphological features and surgical management with clinical outcome in a multicentre study of 241 phyllodes tumours of the breast. Histopathology 2021; 78:871-881. [PMID: 33325544 DOI: 10.1111/his.14316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/12/2020] [Indexed: 12/27/2022]
Abstract
AIMS Phyllodes tumours (PTs) represent an unusual but complex group of breast lesions with a tendency to recur locally and, less commonly, metastasise. On core biopsies, their appearances can be difficult to discriminate from those of other fibroepithelial lesions, which may compromise their surgical management. The aims of this study were to assess the preoperative diagnosis of PTs and to evaluate the impacts of surgical management and morphological features on their behaviour. METHODS AND RESULTS We combined datasets from three centres over two decades, including core biopsies, excision specimens, and follow-up. Core biopsy results were compared with final excision specimens. The relationships of surgical procedure and morphological features with local recurrence (LR) and metastasis were assessed. Two hundred and forty-one PTs were studied. Core biopsy resulted in a diagnosis of possible or definite PT in 76% of cases. Malignant tumours were more likely to be larger, occurred at an older age, and were surgically more challenging, with difficulties being encountered in achieving negative margins. There were 12 cases (5%) that showed LR alone, and another six cases (2.5%) that had distant metastases. Morphological features associated with adverse outcome were grade of PT, increased mitotic counts, necrosis, infiltrative margins, stromal atypia, and heterologous components. Both LR and metastatic behaviour correlated with larger size and distance to margins. CONCLUSIONS Our results suggest that excision margins have a significant impact on LR of PT, whereas metastatic behaviour is influenced by tumour biology. We add to the evidence base on histological features of tumours that contribute to long-term outcomes of PT patients.
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Affiliation(s)
- Raluca Mihai
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Grace Callagy
- Discipline of Pathology, NUI Galway, Lambe Institute for Translational Research, Galway, Ireland
| | | | - Mark O Loughlin
- Discipline of Pathology, NUI Galway, Lambe Institute for Translational Research, Galway, Ireland
| | | | - Areeg Abbas
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Michela Campora
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Zsolt Hodi
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Ian Ellis
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Andrew H S Lee
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Emad A Rakha
- Department of Histopathology, The University of Nottingham and the Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
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21
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Abstract
Lymphocytic infiltration is often seen in breast cancer and has been suggested as a marker of host anti-tumor response but its importance in prognosis remains controversial. Our recent study demonstrated an association between tumor-infiltrating CD8+ T lymphocytes in invasive breast cancer and better prognosis.
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Affiliation(s)
- Sahar Mahmoud
- Clinical Pathology Department; Faculty of Medicine; Mansoura University; Mansoura, Egypt
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22
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Iftikhar A, Islam M, Shepherd S, Jones S, Ellis I. Cancer and Stress: Does It Make a Difference to the Patient When These Two Challenges Collide? Cancers (Basel) 2021; 13:cancers13020163. [PMID: 33418900 PMCID: PMC7825104 DOI: 10.3390/cancers13020163] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Head and neck cancers are the sixth most common cancer in the world. The burden of the disease has remained challenging over recent years despite the advances in treatments of other malignancies. The very use of the word malignancy brings about a stress response in almost all adult patients. Being told you have a tumour is not a word anyone wants to hear. We have embarked on a study which will investigate the effect of stress pathways on head and neck cancer patients and which signalling pathways may be involved. In the future, this will allow clinicians to better manage patients with head and neck cancer and reduce the patients’ stress so that this does not add to their tumour burden. Abstract A single head and neck Cancer (HNC) is a globally growing challenge associated with significant morbidity and mortality. The diagnosis itself can affect the patients profoundly let alone the complex and disfiguring treatment. The highly important functions of structures of the head and neck such as mastication, speech, aesthetics, identity and social interactions make a cancer diagnosis in this region even more psychologically traumatic. The emotional distress engendered as a result of functional and social disruption is certain to negatively affect health-related quality of life (HRQoL). The key biological responses to stressful events are moderated through the combined action of two systems, the hypothalamus–pituitary–adrenal axis (HPA) which releases glucocorticoids and the sympathetic nervous system (SNS) which releases catecholamines. In acute stress, these hormones help the body to regain homeostasis; however, in chronic stress their increased levels and activation of their receptors may aid in the progression of cancer. Despite ample evidence on the existence of stress in patients diagnosed with HNC, studies looking at the effect of stress on the progression of disease are scarce, compared to other cancers. This review summarises the challenges associated with HNC that make it stressful and describes how stress signalling aids in the progression of cancer. Growing evidence on the relationship between stress and HNC makes it paramount to focus future research towards a better understanding of stress and its effect on head and neck cancer.
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23
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Katayama A, Miligy IM, Shiino S, Toss MS, Eldib K, Kurozumi S, Quinn CM, Badr N, Murray C, Provenzano E, Callagy G, Martyn C, Millican-Slater R, Purdie C, Purnell D, Pinder SE, Oyama T, Shaaban AM, Ellis I, Lee AHS, Rakha EA. Predictors of pathological complete response to neoadjuvant treatment and changes to post-neoadjuvant HER2 status in HER2-positive invasive breast cancer. Mod Pathol 2021; 34:1271-1281. [PMID: 33526875 PMCID: PMC8216906 DOI: 10.1038/s41379-021-00738-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/16/2023]
Abstract
The response of human epidermal growth factor receptor2 (HER2)- positive breast cancer (BC) patients to anti-HER2 targeted therapy is significant. However, the response is not uniform and a proportion of HER2-positive patients do not respond. This study aims to identify predictors of response in the neoadjuvant treatment and to assess the discordance rate of HER2 status between pre- and post-treatment specimens in HER2-positive BC patients. The study group comprised 500 BC patients treated with neoadjuvant chemotherapy (NACT) and/or neoadjuvant anti-HER2 therapy and surgery who had tumours that were 3+ or 2+ with HER2 immunohistochemistry (IHC). HER2 IHC 2+ tumours were classified into five groups by fluorescence in situ hybridisation (FISH) according to the 2018 ASCO/CAP guidelines of which Groups 1, 2 and 3 were considered HER2 amplified. Pathological complete response (pCR) was more frequent in HER2 IHC 3+ tumours than in HER2 IHC 2+/HER2 amplified tumours, when either in receipt of NACT alone (38% versus 13%; p = 0.22) or neoadjuvant anti-HER2 therapy (52% versus 20%; p < 0.001). Multivariate logistic regression analysis showed that HER2 IHC 3+ and histological grade 3 were independent predictors of pCR following neoadjuvant anti-HER2 therapy. In the HER2 IHC 2+/HER2 amplified tumours or ASCO/CAP FISH Group 1 alone, ER-negativity was an independent predictor of pCR following NACT and/or neoadjuvant anti-HER2 therapy. In the current study, 22% of HER2-positive tumours became HER2-negative by IHC and FISH following neoadjuvant treatment, the majority (74%) HER2 IHC 2+/HER2 amplified tumours. Repeat HER2 testing after neoadjuvant treatment should therefore be considered.
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Affiliation(s)
- Ayaka Katayama
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.256642.10000 0000 9269 4097Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Islam M. Miligy
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.411775.10000 0004 0621 4712Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Sho Shiino
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.272242.30000 0001 2168 5385Department of Breast Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Michael S. Toss
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - Karim Eldib
- grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Sasagu Kurozumi
- grid.411731.10000 0004 0531 3030Department of Breast Surgery, International University of Health and Welfare, Narita, Japan ,grid.256642.10000 0000 9269 4097Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Cecily M. Quinn
- grid.412751.40000 0001 0315 8143Department of Histopathology, St. Vincent’s University Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Nahla Badr
- grid.411775.10000 0004 0621 4712Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt ,grid.6572.60000 0004 1936 7486Institute of Cancer and Genomic Sciences, The University of Birmingham, Edgebaston, Birmingham, UK
| | - Ciara Murray
- grid.412751.40000 0001 0315 8143Department of Histopathology, St. Vincent’s University Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Elena Provenzano
- grid.5335.00000000121885934Department of Histopathology, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Grace Callagy
- grid.6142.10000 0004 0488 0789Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
| | - Cian Martyn
- grid.6142.10000 0004 0488 0789Discipline of Pathology, School of Medicine, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
| | | | - Colin Purdie
- grid.416266.10000 0000 9009 9462Department of Breast Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Dave Purnell
- grid.269014.80000 0001 0435 9078Histopathology department, University Hospitals of Leicester, Leicester, UK
| | - Sarah E. Pinder
- grid.13097.3c0000 0001 2322 6764Division of Cancer Studies, King’s College London, Guy’s Hospital, London, UK
| | - Tetsunari Oyama
- grid.256642.10000 0000 9269 4097Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Abeer M. Shaaban
- grid.6572.60000 0004 1936 7486Institute of Cancer and Genomic Sciences, The University of Birmingham, Edgebaston, Birmingham, UK
| | - Ian Ellis
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Andrew H. S. Lee
- grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Emad A. Rakha
- grid.412920.c0000 0000 9962 2336Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, University of Nottingham, Nottingham, UK ,grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
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Alkhadar H, Macluskey M, White S, Ellis I, Gardner A. Comparison of machine learning algorithms for the prediction of five-year survival in oral squamous cell carcinoma. J Oral Pathol Med 2020; 50:378-384. [PMID: 33220109 DOI: 10.1111/jop.13135] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM Machine learning analyses of cancer outcomes for oral cancer remain sparse compared to other types of cancer like breast or lung. The purpose of the present study was to compare the performance of machine learning algorithms in the prediction of global, recurrence-free five-year survival in oral cancer patients based on clinical and histopathological data. METHODS Data were gathered retrospectively from 416 patients with oral squamous cell carcinoma. The data set was divided into training and test data set (75:25 split). Training performance of five machine learning algorithms (Logistic regression, K-nearest neighbours, Naïve Bayes, Decision tree and Random forest classifiers) for prediction was assessed by k-fold cross-validation. Variables used in the machine learning models were age, sex, pain symptoms, grade of lesion, lymphovascular invasion, extracapsular extension, perineural invasion, bone invasion and type of treatment. Variable importance was assessed and model performance on the testing data was assessed using receiver operating characteristic curves, accuracy, sensitivity, specificity and F1 score. RESULTS The best performing model was the Decision tree classifier, followed by the Logistic Regression model (accuracy 76% and 60%, respectively). The Naïve Bayes model did not display any predictive value with 0% specificity. CONCLUSIONS Machine learning presents a promising and accessible toolset for improving prediction of oral cancer outcomes. Our findings add to a growing body of evidence that Decision tree models are useful in models in predicting OSCC outcomes. We would advise that future similar studies explore a variety of machine learning models including Logistic regression to help evaluate model performance.
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Affiliation(s)
- Huda Alkhadar
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Michaelina Macluskey
- Department of Oral Surgery, Medicine and Pathology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Sharon White
- Department of Oral Surgery, Medicine and Pathology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Ian Ellis
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Alexander Gardner
- Department of Restorative Dentistry, Dundee Dental School, University of Dundee, Dundee, UK
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Duffy S, Vulkan D, Cuckle H, Parmar D, Sheikh S, Smith R, Evans A, Blyuss O, Johns L, Ellis I, Sasieni P, Wale C, Myles J, Moss S. Annual mammographic screening to reduce breast cancer mortality in women from age 40 years: long-term follow-up of the UK Age RCT. Health Technol Assess 2020; 24:1-24. [PMID: 33141657 PMCID: PMC7681269 DOI: 10.3310/hta24550] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There remains disagreement on the long-term effect of mammographic screening in women aged 40-49 years. OBJECTIVES The long-term follow-up of a randomised controlled trial that offered annual mammography to women aged 40-49 years. The estimation of the effect of these mammograms on breast cancer and other-cause mortality, and the effect on incidence, with implications for overdiagnosis. DESIGN An individually randomised controlled trial comparing offering annual mammography with offering usual care in those aged 40-48 years, and thus evaluating the effect of annual screening entirely taking place before the age of 50 years. There was follow-up for an average of 23 years for breast cancer incidence, breast cancer death and death from other causes. We analysed the mortality and incidence data by Poisson regression and estimated overdiagnosis formally using Markov process models. SETTING Twenty-three screening units in England, Wales and Scotland within the NHS Breast Screening Programme. PARTICIPANTS Women aged 39-41 years were recruited between 1990 and 1997. After exclusions, a total of 53,883 women were randomised to undergo screening (the intervention group) and 106,953 women were randomised to have usual care (the control group). INTERVENTIONS The intervention group was invited to an annual breast screen with film mammography, two view at first screen and single view thereafter, up to and including the calendar year of their 48th birthday. The control group received no intervention. Both groups were invited to the National Programme from the age of 50 years, when screening is offered to all women in the UK. MAIN OUTCOME MEASURES The main outcome measures were mortality from breast cancers diagnosed during the intervention phase of the trial (i.e. before the first National Programme screen at 50 years), mortality from all breast cancers diagnosed after randomisation, all-cause mortality, mortality from causes other than breast cancer, and the incidence of breast cancer. RESULTS There was a statistically significant 25% reduction in mortality from breast cancers diagnosed during the intervention phase at 10 years' follow-up (relative rate 0.75, 95% confidence interval 0.58 to 0.97; p = 0.03). No reduction was observed thereafter (relative rate 0.98, 95% confidence interval 0.79 to 1.22). Overall, there was a statistically non-significant 12% reduction (relative rate 0.88, 95% confidence interval 0.74 to 1.03; p = 0.1). The absolute benefit remained approximately constant over time, at one death prevented per 1000 women screened. There was no effect of intervention on other-cause mortality (relative rate 1.02, 95% confidence interval 0.97 to 1.07; p = 0.4). The intervention group had a higher incidence of breast cancer than the control group during the intervention phase of the trial, but incidence equalised immediately on the first National Programme screen at the age of 50-52 years. LIMITATIONS There was 31% average non-compliance with screening and three centres had to cease screening for resource and capacity reasons. CONCLUSIONS Annual mammographic screening at the age of 40-49 years resulted in a relative reduction in mortality, which was attenuated after 10 years. It is likely that digital mammography with two views at all screens, as practised now, could improve this further. There was no evidence of overdiagnosis in addition to that which already results from the National Programme carried out at later ages. FUTURE WORK There is a need for research on the effects of modern mammographic protocols and additional imaging in this age group. TRIAL REGISTRATION Current Controlled Trials ISRCTN24647151. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 55. See the NIHR Journals Library website for further project information. Other funding in the past has been received from the Medical Research Council, Cancer Research UK, the Department of Health and Social Care, the US National Cancer Institute and the American Cancer Society.
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Affiliation(s)
- Stephen Duffy
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Daniel Vulkan
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Howard Cuckle
- Department of Obstetrics and Gynaecology, Tel Aviv University, Tel Aviv, Israel
| | - Dharmishta Parmar
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Shama Sheikh
- Cancer Prevention Group, King's College London, London, UK
| | - Robert Smith
- Cancer Screening, American Cancer Society, Atlanta, GA, USA
| | - Andrew Evans
- Division of Cancer Research, University of Dundee, Dundee, UK
| | - Oleg Blyuss
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Louise Johns
- Cancer Prevention Group, King's College London, London, UK
| | - Ian Ellis
- Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Peter Sasieni
- Cancer Prevention Group, King's College London, London, UK
| | - Chris Wale
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Jonathan Myles
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Sue Moss
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
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26
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Tan PH, Ellis I, Allison K, Brogi E, Fox SB, Lakhani S, Lazar AJ, Morris EA, Sahin A, Salgado R, Sapino A, Sasano H, Schnitt S, Sotiriou C, van Diest P, White VA, Lokuhetty D, Cree IA. The 2019 World Health Organization classification of tumours of the breast. Histopathology 2020; 77:181-185. [PMID: 32056259 DOI: 10.1111/his.14091] [Citation(s) in RCA: 314] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/29/2020] [Accepted: 02/10/2020] [Indexed: 12/13/2022]
Affiliation(s)
| | - Ian Ellis
- University of Nottingham and Nottingham University Hospitals, Nottingham, UK
| | | | - Edi Brogi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Fox
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - Sunil Lakhani
- University of Queensland and Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, Australia
| | | | | | - Aysegul Sahin
- University of Texas MD Anderson Cancer, Houston, TX, USA
| | | | - Anna Sapino
- Department of Medical Sciences, University of Torino, Torino, Italy
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | - Stuart Schnitt
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christos Sotiriou
- Institut Jules Bordet (Université Libre de Bruxelles), Brussels, Belgium
| | - Paul van Diest
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | - Ian A Cree
- International Agency for Research on Cancer, Lyon, France
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27
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Alkhadar H, Macluskey M, White S, Ellis I. Perineural invasion in oral squamous cell carcinoma: Incidence, prognostic impact and molecular insight. J Oral Pathol Med 2020; 49:994-1003. [PMID: 32533593 DOI: 10.1111/jop.13069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The objective of this study was to characterise the incidence and prognostic correlation of perineural invasion (PNI) in oral squamous cell carcinoma and determine whether nerve growth factor and its receptor tyrosine Kinase A expression could be used as biological markers for PNI. METHODS A retrospective review of pathology reports of 430 patients with oral squamous cell carcinoma who were treated from 1992 to 2014 in Tayside, Scotland, was carried out. The expression of nerve growth factor and tyrosine kinase A was assessed with immunohistochemistry in 132 tissue sections of oral squamous cell carcinoma. RESULTS Perineural invasion was identified in 17.4% of oral squamous cell carcinomas. High expression of nerve growth factor and tyrosine kinase A was seen in 84% and 92% of oral squamous cell carcinoma, respectively. Tumours with PNI expressed nerve growth factor and tyrosine kinase A with a greater frequency than tumours without PNI. PNI and high expression of nerve growth factor were significantly associated with pain. PNI was significantly associated with stage IV tumours and poor disease-specific survival. CONCLUSIONS A higher level of expression of nerve growth factor and tyrosine kinase A may predict PNI and therefore may be considered as biological markers for PNI in oral squamous cell carcinoma. PNI and nerve growth factor overexpression may contribute to the pain generation in oral cancer patients. PNI and nerve growth factor expression can predict the aggressiveness and prognosis of oral squamous cell carcinoma patients.
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Affiliation(s)
- Huda Alkhadar
- Department of Oral Surgery, Medicine and Pathology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Michaelina Macluskey
- Department of Oral Surgery, Medicine and Pathology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Sharon White
- Department of Oral Surgery, Medicine and Pathology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Ian Ellis
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, UK
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Hickey TE, Selth L, Chia KM, Milioli H, Roden D, Laven-Law G, Jindal S, Hui M, Ebrahimie E, birrell S, Stelloo S, Caldon E, Findlay-Schultz J, Abdel_Fatah T, Ellis I, Zwart W, Palmieri C, Sartorius CA, Swarbrick A, Lim E, Carroll JS, Tilley WD. OR05-06 The Androgen Receptor Is a Tumour Suppressor in Estrogen Receptor Positive Breast Cancer. J Endocr Soc 2020. [PMCID: PMC7209210 DOI: 10.1210/jendso/bvaa046.982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is strong interest in targeting the androgen receptor (AR) in estrogen receptor (ER) positive breast cancer, but widespread confusion exits as to what therapeutic strategy - agonism or antagonism - is appropriate. Current understanding of AR predominantly stems from the field of prostate cancer, where AR is the key oncogenic driver and therapeutic target. An ensuing assumption is that AR promotes malignancy in breast cancer and should be therapeutically antagonised. However, compelling pre-clinical data to support this assumption is lacking. Since estrogen stimulates and androgen inhibits the development of normal breast tissue, we hypothesized that AR acts as a tumour suppressor in the breast and that AR agonism is the appropriate therapeutic strategy for ER-driven breast cancer. We tested this hypothesis using a large suite of cell line and patient-derived explant (PDE) and xenograft (PDX) models of breast cancer, including those that were resistant to current therapies and those harbouring genomic anomalies of ESR1 associated with treatment-resistant disease. Across the diverse models we found compelling evidence that AR agonism, but not antagonism, potently and durably inhibited tumour growth. A signature of AR activity derived from the xenograft models positively predicted disease survival in multiple large clinical cohorts of ER+ breast cancer, out-performing other breast cancer-specific prognostic signatures. We also show that an AR agonist can be combined with current ER target therapies such as Tamoxifen or a CDK4/6 inhibitor to maximize growth inhibition. Mechanistically, agonist-bound AR opposed ER signalling by repositioning ER and the co-activator p300 in the chromatin landscape, resulting in down-regulation of cell cycle genes. Introduction of an AR DNA binding mutant had no effect on ER signalling or estrogen-stimulated growth in breast cancer cells. As part of this study, we have generated consensus AR cistromes representing ER+ breast cancer cell lines and ER+ tumours that provide a new understanding of AR activity and clearly show differences to those associated with prostate cancer cell lines and tumours. In conclusion, our data provides a compelling biological rationale for AR agonism as a therapeutic strategy in multiple, clinically relevant contexts of ER-positive breast cancer. These findings should dispel widespread confusion over the role of AR in ER-driven breast cancer, an issue that currently hinders progress in leveraging modern AR-targeted therapies (e.g. selective androgen receptor modulators) that lack the undesirable side-effects of androgens for clinical benefit.
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Affiliation(s)
| | - Luke Selth
- DRMCRL, University of Adelaide, Adelaide, Australia
| | | | | | - Daniel Roden
- Garvan Inst of Medical Research, Sydney, Australia
| | | | | | - Mun Hui
- Garvan Inst of Medical Research, Sydney, Australia
| | | | | | - Suzan Stelloo
- Oncode Institute, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - Ian Ellis
- University of Nottingham, Nottingham, United Kingdom
| | - Wilbert Zwart
- Oncode Institute, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - Elgene Lim
- Garvan Inst of Medical Research, Sydney, Australia
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Abdel-Fatah TMA, Chen X, Li R, Giannotti E, Auer D, Walker J, Lim J, Pockley AG, Ball G, Rakhah E, Ellis I, Chan A, Chan S. Abstract P3-07-02: Developing a robust multidimensional molecular, pathological and radiological prognostic index (MPRPI) to evaluate the response to neoadjuvant chemotherapy (NACT) and predict clinical outcome of breast cancer (BC). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-07-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recently neoadjuvant chemotherapy (NACT) is regarded as a potential standard approach whenever chemotherapy is indicated in principle and is considered as the preferred treatment approach for stage II/III triple-negative and HER2-positive BC. However, there is an urgent need to develop a more sensitive and robust test that can assess the response for NACT and guide the optimum adjuvant therapy. Aim: Our aim is to identify molecular, radiological and histopathologic criteria that could grade response to NACT and to develop a robust prognostic index that accurately predict clinical outcome of the subsequent adjuvant therapy. Method: Comprehensive histopathological and radiological assessment of consecutive series of 850 BC [T2-4, N0-3, M0] have been centrally carried out at the Nottingham University Hospital (NUH). Furthermore, the immunohistochemistry expression of Ki67 and SPAG5 proliferation biomarkers and the histological evaluation of tumour infiltration lymphocytes (TILs) had been examined in all patients while both volumetric and texture changes detected by magnetic resonance imaging (MRI) were available for 400 cases. Oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) were assessed according to the most recent American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines. The results were validated in an external cohort of 250 cases. The patient’s characteristics and treatment options are the same between the centres: (68%) has received anthracycline plus Taxane (AC+T) NACT and 32% of patients have received NACT Anthracycline only (AC). Neoadjuvant HER2 targeting agents (Trastuzumab) or (Trastuzumab + Petruzumab) had been prescribed to 16% of patients in addition to AC+T followed by adjuvant Trastuzumab (total=18 cycles). All pre-NACT ER+ patients were given at least 5 year of adjuvant endocrine therapy. The primary end point was disease free survival (DFS). The median follow up was 72 months. Results: Using multivariate Cox proportional hazards models with backward stepwise exclusion for DFS, we found the presence of TILs [(HR (95% CI): 0.68 (0.48-0.94; P=0.022], high SPAG5 expression in post-surgical tumour tissue [(HR (95% CI): 2.58 (1.19-5.63), p=0.017)], the reduction in the primary tumour volume measured by MRI (>30%) [(HR(95% CI): 0.38 (0.16-0.89), p=0.026)], presence of Lymphovascular invasion [(HR(95% CI): 2.92 (1.33-6.40), p=0.008)], presence of chemotherapy induced fibrosis [(HR(95% CI): 0.41 (0.19-0.91), p=0.029)] and the high histological grade [(HR(95% CI): 2.62 (1.19-5.74), p=0.016)] showed statistical significant association with DFS. A prognostic index was calculated using the aforementioned factors after adjusting for both NACT and adjuvant therapy. The receiver-operating characteristic (ROC) curves indicated that this model is a good prognostic test [AUC = 0.854 (95% CI) = 0.777-.0.931; p= 0.00000001] and it outperformed residual cancer burden (RCB score) [AUC = 0. 711 (95% CI) = 0.612-.0.810; P= 0.0003]; and other NACT response grading systems including Miller-Payne system, Clinical-Pathologic Scoring System (CPS) and CPS-ER histological grade (CPS-EG) systems. Conclusion: A prognostic test with high sensitivity and specificity for assessing response to Neo-ACT has been developed and applying this test could guide the choice of the optimal adjuvant therapy.
Citation Format: Tarek M. a. Abdel-Fatah, Xin Chen, Ruizhe Li, Elisabetta Giannotti, Dorothee Auer, Jennifer Walker, Jun Lim, A. Graham Pockley, Graham Ball, Emad Rakhah, Ian Ellis, Arlene Chan, Stephen Chan. Developing a robust multidimensional molecular, pathological and radiological prognostic index (MPRPI) to evaluate the response to neoadjuvant chemotherapy (NACT) and predict clinical outcome of breast cancer (BC) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-02.
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Affiliation(s)
| | - Xin Chen
- 2School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Ruizhe Li
- 2School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Elisabetta Giannotti
- 3Radiology Department, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Dorothee Auer
- 4Radiology Department, University of Nottingham, Nottingham, United Kingdom
| | - Jennifer Walker
- 1Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Jun Lim
- 1Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - A. Graham Pockley
- 5John van Geest Cancer Research Centre, School of Science and Technology, Nottingham, United Kingdom
| | - Graham Ball
- 6School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Emad Rakhah
- 7Histopathology Department, Nottingham City Hospital, Nottingham, Nottingham, United Kingdom
| | - Ian Ellis
- 7Histopathology Department, Nottingham City Hospital, Nottingham, Nottingham, United Kingdom
| | - Arlene Chan
- 8Breast Cancer Research Centre-WA & Curtin University, Perth, Australia
| | - Stephen Chan
- 1Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
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Abdel-Fatah TMA, Webb R, Walker J, Lim J, Pockley AG, Ball G, Griffiths M, Ellis I, Rakhah E, Hodi Z, Lee A, Chan A, Chan S. Abstract P5-06-06: Clinically significant changes of receptors status (ER, PR and HER2) after receiving neoadjuvant chemotherapy (NACT) in breast cancer (BC) predicts the prognosis and guides the choice of the optimal adjuvant therapy (AT): Retesting of the receptor status should be mandatory. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-06-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: NACT is a standard option for BC (T2-4, N0-3, M0) and certain BC phenotypes. The choice of AT based on the pre-NACT biomarkers status may not be optimum for individual patient because dynamic phenotypic changes induced by NACT may alter the response to treatment. Aim: The aim of this study is to determine the incidence of changes in the receptor status (ER, PR and HER2) and other proliferation biomarkers (Ki67 and SPAG5) before and after NACT and to assess the clinical significance of such changes. Methods Immunohistochemistry staining of ER, PR, HER2, Ki67 and SPAG5 in pre and post NACT tumors tissues from a consecutive series of 850 of BC (T2-4, N0-3, M0) treated at the Nottingham University Hospital (NUH) from 2000 to 2018, have been centrally evaluated according to ASCO guidelines. All cases with conversion in HER2 status had also been retested by HER2-FISH. The results were validated in an external cohort of 250 cases. Treatment options and patients characteristics are the same between the centres: (68%) received anthracycline plus Taxane (AC+T) NACT and 32% of patients have received NACT Anthracycline only (AC). Neoadjuvant HER2 targeting agents (Trastuzumab) or (Trastuzumab + Petruzumab) had been prescribed to 16% of patients in addition to AC+T followed by adjuvant Trastuzumab (total=18 cycles). All pre-NACT ER+ patients were given at least 5 year of adjuvant endocrine therapy (ET). In 2013 NUH started a prospective audit of retesting of receptor status in all post NACT surgical tumour samples. The results of the tests were presented to the weekly tumour board meeting and any change in the receptor status (ER and HER2) from negative (in the pre NACT core biopsies) to positive (in the post NACT surgical specimen) being considered for additional AT (ET for ER+ and Trastuzumab for HER2+ cases).The primary end points for this study are the % changes of biomarker changes and the disease free survival (DFS). The median follow up was 72 months. Results In pre NACT core biopsies 32% and 68% were HER2+ and HER2-; respectively. Twelve percent (12%) of the pre NACT HER2- tumours had a conversion to HER2+ in the post NACT surgical specimens. In this group of patients who subsequently received adjuvant Trastuzumab, 95% 3-year DFS was reported; which was similar to those patients who achieved pCR (3-year DFS; 90%) and was superior to cases which remained HER- in post NACT specimens (3-year DFS; 41%); (p<0.0001). Furthermore, similar group of patients with pre NACT HER- tumour before the 2013 audit, who did not receive Trastuzumab for the change to post NACT HER2+ receptors, has inferior 3-year DFS to those received adjuvant Trastuzumab based on the conversion (HR (95% CI)= 7.40 (1.04-52.86); p=0.046). In pre NACT HER2+ BC, 20% of cases had been converted into HER2- in the post NACT surgical specimens. These patients had better 3y-DFS (94%) compared to those who remained HER2+ in post NACT specimens (3y-DFS=70%; HR (95% CI)= 0.86 (0.77-0.97); p=0.01). Furthermore those patients who received neoadjuvant HER2 targeting therapy had statistically higher incidence of post HER2- conversion (p=0.005) and lower level of post NACT proliferation markers (Ki67 and SPAG5); p=0.01. In pre NACT ER+/PR+ patients, those who has converted into ER+/PR- in post NACT specimens had shorter 5-year DFS (40%) in spite of receiving ET, compared to those who remained ER+/PR+ in post NACT specimen [5-DFS= 72%]; HR (95% CI)= 1.98 (1.18-3.31); p=0.009). Conclusion: To our knowledge, this is the first report, which showed the significant clinical benefit of adjuvant therapy, based on the re-testing of the standard receptors status.
Citation Format: Tarek M. a. Abdel-Fatah, Rebekah Webb, Jennifer Walker, Jun Lim, A. Graham Pockley, Graham Ball, Matthew Griffiths, Ian Ellis, Emad Rakhah, Zsolt Hodi, Andrew Lee, Arlene Chan, Stephen Chan. Clinically significant changes of receptors status (ER, PR and HER2) after receiving neoadjuvant chemotherapy (NACT) in breast cancer (BC) predicts the prognosis and guides the choice of the optimal adjuvant therapy (AT): Retesting of the receptor status should be mandatory [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-06-06.
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Affiliation(s)
| | - Rebekah Webb
- 1Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Jennifer Walker
- 1Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Jun Lim
- 1Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - A. Graham Pockley
- 2John van Geest Cancer Research Centre, School of Science and Technology, Nottingham, United Kingdom
| | - Graham Ball
- 3School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Matthew Griffiths
- 3School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Ian Ellis
- 4Histopathology Department, Nottingham City Hospital, Nottingham, Nottingham, United Kingdom
| | - Emad Rakhah
- 4Histopathology Department, Nottingham City Hospital, Nottingham, Nottingham, United Kingdom
| | - Zsolt Hodi
- 4Histopathology Department, Nottingham City Hospital, Nottingham, Nottingham, United Kingdom
| | - Andrew Lee
- 4Histopathology Department, Nottingham City Hospital, Nottingham, Nottingham, United Kingdom
| | - Arlene Chan
- 5Breast Cancer Research Centre-WA & Curtin University, Perth, Australia
| | - Stephen Chan
- 1Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
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Alkhadar H, Macluskey M, White S, Ellis I. Nerve growth factor-induced migration in oral and salivary gland tumour cells utilises the PI3K/Akt signalling pathway: Is there a link to perineural invasion? J Oral Pathol Med 2019; 49:227-234. [PMID: 31782565 DOI: 10.1111/jop.12979] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/27/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aims of this study were to investigate the role of nerve growth factor on perineural invasion in oral and salivary gland tumour cell lines and whether there is an involvement of PI3K/Akt pathway. MATERIALS AND METHODS Four cell lines were investigated: HSG and TYS (salivary gland tumours), SAS-H1 (oral squamous cell carcinoma) and HaCaT (human skin keratinocyte). Initially, Boyden chamber assay was done to examine the effect of different concentration of nerve growth factor on cell migration. Western blot/ immunofluorescence techniques were used to investigate the phosphorylation status of the Akt pathway within the cells in response to nerve growth factor. The effect of this growth factor and the addition of an Akt inhibitor on cell morphology and migration were also examined using scatter/scratch assays. RESULTS Nerve growth factor triggered the PI3K/Akt pathway in oral and salivary tumour cells and induced oral and salivary tumour cell scattering and migration. Inhibitor assays confirmed that oral and salivary gland tumour cell scattering and migration is Akt dependent. CONCLUSIONS Nerve growth factor can stimulate scattering and migration in cells derived from oral and salivary gland tumours, thereby potentially enhancing perineural invasion. Phosphorylated Akt controls cancer cell migration and scattering. Blocking the Akt pathway may inhibit cell migration and therefore perineural invasion and metastasis.
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Affiliation(s)
- Huda Alkhadar
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Michaelina Macluskey
- Department of Oral Surgery, Medicine and Pathology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Sharon White
- Department of Oral Surgery, Medicine and Pathology, Dundee Dental School, University of Dundee, Dundee, UK
| | - Ian Ellis
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, UK
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Ostrowski PJ, Zachariou A, Loveday C, Beleza-Meireles A, Bertoli M, Dean J, Douglas AGL, Ellis I, Foster A, Graham JM, Hague J, Hilhorst-Hofstee Y, Hoffer M, Johnson D, Josifova D, Kant SG, Kini U, Lachlan K, Lam W, Lees M, Lynch S, Maitz S, McKee S, Metcalfe K, Nathanson K, Ockeloen CW, Parker MJ, Pierson TM, Rahikkala E, Sanchez-Lara PA, Spano A, Van Maldergem L, Cole T, Douzgou S, Tatton-Brown K. The CHD8 overgrowth syndrome: A detailed evaluation of an emerging overgrowth phenotype in 27 patients. Am J Med Genet C Semin Med Genet 2019; 181:557-564. [PMID: 31721432 DOI: 10.1002/ajmg.c.31749] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/10/2019] [Accepted: 10/11/2019] [Indexed: 12/31/2022]
Abstract
CHD8 has been reported as an autism susceptibility/intellectual disability gene but emerging evidence suggests that it additionally causes an overgrowth phenotype. This study reports 27 unrelated patients with pathogenic or likely pathogenic CHD8 variants (25 null variants, two missense variants) and a male:female ratio of 21:6 (3.5:1, p < .01). All patients presented with intellectual disability, with 85% in the mild or moderate range, and 85% had a height and/or head circumference ≥2 standard deviations above the mean, meeting our clinical criteria for overgrowth. Behavioral problems were reported in the majority of patients (78%), with over half (56%) either formally diagnosed with an autistic spectrum disorder or described as having autistic traits. Additional clinical features included neonatal hypotonia (33%), and less frequently seizures, pes planus, scoliosis, fifth finger clinodactyly, umbilical hernia, and glabellar hemangioma (≤15% each). These results suggest that, in addition to its established link with autism and intellectual disability, CHD8 causes an overgrowth phenotype, and should be considered in the differential diagnosis of patients presenting with increased height and/or head circumference in association with intellectual disability.
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Affiliation(s)
- Philip J Ostrowski
- South West Thames Regional Genetics Service, St George's University NHS Foundation Trust, London, UK
| | - Anna Zachariou
- Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Chey Loveday
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | | | - Marta Bertoli
- Northern Genetics Service, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Dean
- North of Scotland Medical Genetic Service, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Andrew G L Douglas
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK.,Human Development and Health, Duthie Building, University of Southampton, Southampton, UK
| | - Ian Ellis
- Department of Clinical Genetics, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Alison Foster
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.,West Midlands Regional Genetics Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - John M Graham
- David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California.,Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jennifer Hague
- East of England Regional Medical Genetics Service, Addenbrooke's Hospital, Cambridge, UK
| | | | - Mariette Hoffer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Diana Johnson
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Dragana Josifova
- Clinical Genetics Department, Guy's and St. Thomas NHS Trust, London, UK
| | - Sarina G Kant
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Usha Kini
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Katherine Lachlan
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Wayne Lam
- Department of Clinical Genetics, Western General Hospital, Edinburgh, UK
| | - Melissa Lees
- Clinical Genetics Unit, Great Ormond Street Hospital, London, UK
| | - Sally Lynch
- Temple Street Children's Hospital, Dublin, Ireland
| | - Silvia Maitz
- Pediatric Genetics Unit, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Shane McKee
- Northern Ireland Regional Genetics Centre, Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, UK
| | - Kay Metcalfe
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Katherine Nathanson
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charlotte W Ockeloen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michael J Parker
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Tyler M Pierson
- Department of Pediatrics and Neurology, and the Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Elisa Rahikkala
- Department of Clinical Genetics, PEDEGO Research Unit and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pedro A Sanchez-Lara
- David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California.,Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alice Spano
- Pediatric Genetics Unit, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Lionel Van Maldergem
- Centre de Génétique Humaine, Université de Franche-Comté, Besançon, France.,Clinical Investigation Center 1431, National Institute of Health & Medical Research (INSERM), Besançon, France
| | - Trevor Cole
- West Midlands Regional Genetics Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Sofia Douzgou
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.,Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Katrina Tatton-Brown
- South West Thames Regional Genetics Service, St George's University NHS Foundation Trust, London, UK.,St George's University of London, London, UK
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Toss M, Miligy I, Gorringe K, Mittal K, Aneja R, Ellis I, Green A, Rakha E. Prognostic significance of cathepsin V (CTSV/CTSL2) in breast ductal carcinoma in situ. J Clin Pathol 2019; 73:76-82. [PMID: 31444238 DOI: 10.1136/jclinpath-2019-205939] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/29/2019] [Accepted: 08/10/2019] [Indexed: 12/14/2022]
Abstract
AIMS Cathepsin V (CTSV/CTSL2) is a lysosomal cysteine proteinase and plays a role in extracellular matrix degradation. It is associated with poor prognosis in invasive breast cancer (IBC), but its role in breast ductal carcinoma in situ (DCIS) remains unclear. In this study, we aimed to evaluate the prognostic significance of CTSV in DCIS. METHODS CTSV protein expression was immunohistochemically assessed in a well-characterised and annotated cohort of DCIS comprising pure DCIS (n=776) and DCIS coexisting with IBC (n=239). CTSV expression was analysed in tumour cells and surrounding stroma, including its association with clinicopathological parameters and outcome. RESULTS In pure DCIS, high CTSV expression was observed in 29% of epithelial tumour cells and 20% of surrounding stroma. High expression in both components was associated with features of poor prognosis including higher nuclear grade, hormone receptor negativity and HER2 positivity. In addition, stromal CTSV expression was associated with larger DCIS size, comedo-type necrosis and high proliferation index. DCIS associated with IBC showed higher CTSV expression than pure DCIS either within the epithelial tumour cells or surrounding stroma (p<0.0001 and p=0.001, respectively). In DCIS/IBC, CTSV expression was higher in the invasive component than DCIS component either in tumour cells or surrounding stroma (both p<0.0001). CTSV stromal expression was associated with invasive recurrence independent of other prognostic factors in patients treated with breast conserving surgery (HR=3.0, p=0.005). CONCLUSION High expression of CTSV is associated with poor outcome in DCIS and is a potential marker to predict DCIS progression to invasive disease.
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Affiliation(s)
- Michael Toss
- Histopathology, University of Nottingham School of Medicine, Nottingham, UK
| | - Islam Miligy
- Histopathology, University of Nottingham School of Medicine, Nottingham, UK
| | | | | | | | - Ian Ellis
- Histopathology, University of Nottingham School of Medicine, Nottingham, UK
| | - Andrew Green
- Histopathology, University of Nottingham School of Medicine, Nottingham, UK
| | - Emad Rakha
- Histopathology, University of Nottingham School of Medicine, Nottingham, UK
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Gorman KM, Meyer E, Grozeva D, Spinelli E, McTague A, Sanchis-Juan A, Carss KJ, Bryant E, Reich A, Schneider AL, Pressler RM, Simpson MA, Debelle GD, Wassmer E, Morton J, Sieciechowicz D, Jan-Kamsteeg E, Paciorkowski AR, King MD, Cross JH, Poduri A, Mefford HC, Scheffer IE, Haack TB, McCullagh G, Millichap JJ, Carvill GL, Clayton-Smith J, Maher ER, Raymond FL, Kurian MA, McRae JF, Clayton S, Fitzgerald TW, Kaplanis J, Prigmore E, Rajan D, Sifrim A, Aitken S, Akawi N, Alvi M, Ambridge K, Barrett DM, Bayzetinova T, Jones P, Jones WD, King D, Krishnappa N, Mason LE, Singh T, Tivey AR, Ahmed M, Anjum U, Archer H, Armstrong R, Awada J, Balasubramanian M, Banka S, Baralle D, Barnicoat A, Batstone P, Baty D, Bennett C, Berg J, Bernhard B, Bevan AP, Bitner-Glindzicz M, Blair E, Blyth M, Bohanna D, Bourdon L, Bourn D, Bradley L, Brady A, Brent S, Brewer C, Brunstrom K, Bunyan DJ, Burn J, Canham N, Castle B, Chandler K, Chatzimichali E, Cilliers D, Clarke A, Clasper S, Clayton-Smith J, Clowes V, Coates A, Cole T, Colgiu I, Collins A, Collinson MN, Connell F, Cooper N, Cox H, Cresswell L, Cross G, Crow Y, D’Alessandro M, Dabir T, Davidson R, Davies S, de Vries D, Dean J, Deshpande C, Devlin G, Dixit A, Dobbie A, Donaldson A, Donnai D, Donnelly D, Donnelly C, Douglas A, Douzgou S, Duncan A, Eason J, Ellard S, Ellis I, Elmslie F, Evans K, Everest S, Fendick T, Fisher R, Flinter F, Foulds N, Fry A, Fryer A, Gardiner C, Gaunt L, Ghali N, Gibbons R, Gill H, Goodship J, Goudie D, Gray E, Green A, Greene P, Greenhalgh L, Gribble S, Harrison R, Harrison L, Harrison V, Hawkins R, He L, Hellens S, Henderson A, Hewitt S, Hildyard L, Hobson E, Holden S, Holder M, Holder S, Hollingsworth G, Homfray T, Humphreys M, Hurst J, Hutton B, Ingram S, Irving M, Islam L, Jackson A, Jarvis J, Jenkins L, Johnson D, Jones E, Josifova D, Joss S, Kaemba B, Kazembe S, Kelsell R, Kerr B, Kingston H, Kini U, Kinning E, Kirby G, Kirk C, Kivuva E, Kraus A, Kumar D, Kumar VKA, Lachlan K, Lam W, Lampe A, Langman C, Lees M, Lim D, Longman C, Lowther G, Lynch SA, Magee A, Maher E, Male A, Mansour S, Marks K, Martin K, Maye U, McCann E, McConnell V, McEntagart M, McGowan R, McKay K, McKee S, McMullan DJ, McNerlan S, McWilliam C, Mehta S, Metcalfe K, Middleton A, Miedzybrodzka Z, Miles E, Mohammed S, Montgomery T, Moore D, Morgan S, Morton J, Mugalaasi H, Murday V, Murphy H, Naik S, Nemeth A, Nevitt L, Newbury-Ecob R, Norman A, O’Shea R, Ogilvie C, Ong KR, Park SM, Parker MJ, Patel C, Paterson J, Payne S, Perrett D, Phipps J, Pilz DT, Pollard M, Pottinger C, Poulton J, Pratt N, Prescott K, Price S, Pridham A, Procter A, Purnell H, Quarrell O, Ragge N, Rahbari R, Randall J, Rankin J, Raymond L, Rice D, Robert L, Roberts E, Roberts J, Roberts P, Roberts G, Ross A, Rosser E, Saggar A, Samant S, Sampson J, Sandford R, Sarkar A, Schweiger S, Scott R, Scurr I, Selby A, Seller A, Sequeira C, Shannon N, Sharif S, Shaw-Smith C, Shearing E, Shears D, Sheridan E, Simonic I, Singzon R, Skitt Z, Smith A, Smith K, Smithson S, Sneddon L, Splitt M, Squires M, Stewart F, Stewart H, Straub V, Suri M, Sutton V, Swaminathan GJ, Sweeney E, Tatton-Brown K, Taylor C, Taylor R, Tein M, Temple IK, Thomson J, Tischkowitz M, Tomkins S, Torokwa A, Treacy B, Turner C, Turnpenny P, Tysoe C, Vandersteen A, Varghese V, Vasudevan P, Vijayarangakannan P, Vogt J, Wakeling E, Wallwark S, Waters J, Weber A, Wellesley D, Whiteford M, Widaa S, Wilcox S, Wilkinson E, Williams D, Williams N, Wilson L, Woods G, Wragg C, Wright M, Yates L, Yau M, Nellåker C, Parker M, Firth HV, Wright CF, FitzPatrick DR, Barrett JC, Hurles ME, Al Turki S, Anderson C, Anney R, Antony D, Artigas MS, Ayub M, Balasubramaniam S, Barrett JC, Barroso I, Beales P, Bentham J, Bhattacharya S, Birney E, Blackwood D, Bobrow M, Bochukova E, Bolton P, Bounds R, Boustred C, Breen G, Calissano M, Carss K, Chatterjee K, Chen L, Ciampi A, Cirak S, Clapham P, Clement G, Coates G, Collier D, Cosgrove C, Cox T, Craddock N, Crooks L, Curran S, Curtis D, Daly A, Day-Williams A, Day IN, Down T, Du Y, Dunham I, Edkins S, Ellis P, Evans D, Faroogi S, Fatemifar G, Fitzpatrick DR, Flicek P, Flyod J, Foley AR, Franklin CS, Futema M, Gallagher L, Geihs M, Geschwind D, Griffin H, Grozeva D, Guo X, Guo X, Gurling H, Hart D, Hendricks A, Holmans P, Howie B, Huang L, Hubbard T, Humphries SE, Hurles ME, Hysi P, Jackson DK, Jamshidi Y, Jing T, Joyce C, Kaye J, Keane T, Keogh J, Kemp J, Kennedy K, Kolb-Kokocinski A, Lachance G, Langford C, Lawson D, Lee I, Lek M, Liang J, Lin H, Li R, Li Y, Liu R, Lönnqvist J, Lopes M, Iotchkova V, MacArthur D, Marchini J, Maslen J, Massimo M, Mathieson I, Marenne G, McGuffin P, McIntosh A, McKechanie AG, McQuillin A, Metrustry S, Mitchison H, Moayyeri A, Morris J, Muntoni F, Northstone K, O'Donnovan M, Onoufriadis A, O'Rahilly S, Oualkacha K, Owen MJ, Palotie A, Panoutsopoulou K, Parker V, Parr JR, Paternoster L, Paunio T, Payne F, Pietilainen O, Plagnol V, Quaye L, Quail MA, Raymond L, Rehnström K, Ring S, Ritchie GR, Roberts N, Savage DB, Scambler P, Schiffels S, Schmidts M, Schoenmakers N, Semple RK, Serra E, Sharp SI, Shin SY, Skuse D, Small K, Southam L, Spasic-Boskovic O, St Clair D, Stalker J, Stevens E, St Pourcian B, Sun J, Suvisaari J, Tachmazidou I, Tobin MD, Valdes A, Van Kogelenberg M, Vijayarangakannan P, Visscher PM, Wain LV, Walters JT, Wang G, Wang J, Wang Y, Ward K, Wheeler E, Whyte T, Williams H, Williamson KA, Wilson C, Wong K, Xu C, Yang J, Zhang F, Zhang P, Aitman T, Alachkar H, Ali S, Allen L, Allsup D, Ambegaonkar G, Anderson J, Antrobus R, Armstrong R, Arno G, Arumugakani G, Ashford S, Astle W, Attwood A, Austin S, Bacchelli C, Bakchoul T, Bariana TK, Baxendale H, Bennett D, Bethune C, Bibi S, Bitner-Glindzicz M, Bleda M, Boggard H, Bolton-Maggs P, Booth C, Bradley JR, Brady A, Brown M, Browning M, Bryson C, Burns S, Calleja P, Canham N, Carmichael J, Carss K, Caulfield M, Chalmers E, Chandra A, Chinnery P, Chitre M, Church C, Clement E, Clements-Brod N, Clowes V, Coghlan G, Collins P, Cooper N, Creaser-Myers A, DaCosta R, Daugherty L, Davies S, Davis J, De Vries M, Deegan P, Deevi SV, Deshpande C, Devlin L, Dewhurst E, Doffinger R, Dormand N, Drewe E, Edgar D, Egner W, Erber WN, Erwood M, Everington T, Favier R, Firth H, Fletcher D, Flinter F, Fox JC, Frary A, Freson K, Furie B, Furnell A, Gale D, Gardham A, Gattens M, Ghali N, Ghataorhe PK, Ghurye R, Gibbs S, Gilmour K, Gissen P, Goddard S, Gomez K, Gordins P, Gräf S, Greene D, Greenhalgh A, Greinacher A, Grigoriadou S, Grozeva D, Hackett S, Hadinnapola C, Hague R, Haimel M, Halmagyi C, Hammerton T, Hart D, Hayman G, Heemskerk JW, Henderson R, Hensiek A, Henskens Y, Herwadkar A, Holden S, Holder M, Holder S, Hu F, Huissoon A, Humbert M, Hurst J, James R, Jolles S, Josifova D, Kazmi R, Keeling D, Kelleher P, Kelly AM, Kennedy F, Kiely D, Kingston N, Koziell A, Krishnakumar D, Kuijpers TW, Kumararatne D, Kurian M, Laffan MA, Lambert MP, Allen HL, Lawrie A, Lear S, Lees M, Lentaigne C, Liesner R, Linger R, Longhurst H, Lorenzo L, Machado R, Mackenzie R, MacLaren R, Maher E, Maimaris J, Mangles S, Manson A, Mapeta R, Markus HS, Martin J, Masati L, Mathias M, Matser V, Maw A, McDermott E, McJannet C, Meacham S, Meehan S, Megy K, Mehta S, Michaelides M, Millar CM, Moledina S, Moore A, Morrell N, Mumford A, Murng S, Murphy E, Nejentsev S, Noorani S, Nurden P, Oksenhendler E, Ouwehand WH, Papadia S, Park SM, Parker A, Pasi J, Patch C, Paterson J, Payne J, Peacock A, Peerlinck K, Penkett CJ, Pepke-Zaba J, Perry DJ, Pollock V, Polwarth G, Ponsford M, Qasim W, Quinti I, Rankin S, Rankin J, Raymond FL, Rehnstrom K, Reid E, Rhodes CJ, Richards M, Richardson S, Richter A, Roberts I, Rondina M, Rosser E, Roughley C, Rue-Albrecht K, Samarghitean C, Sanchis-Juan A, Sandford R, Santra S, Sargur R, Savic S, Schulman S, Schulze H, Scott R, Scully M, Seneviratne S, Sewell C, Shamardina O, Shipley D, Simeoni I, Sivapalaratnam S, Smith K, Sohal A, Southgate L, Staines S, Staples E, Stauss H, Stein P, Stephens J, Stirrups K, Stock S, Suntharalingam J, Tait RC, Talks K, Tan Y, Thachil J, Thaventhiran J, Thomas E, Thomas M, Thompson D, Thrasher A, Tischkowitz M, Titterton C, Toh CH, Toshner M, Treacy C, Trembath R, Tuna S, Turek W, Turro E, Van Geet C, Veltman M, Vogt J, von Ziegenweldt J, Vonk Noordegraaf A, Wakeling E, Wanjiku I, Warner TQ, Wassmer E, Watkins H, Webster A, Welch S, Westbury S, Wharton J, Whitehorn D, Wilkins M, Willcocks L, Williamson C, Woods G, Wort J, Yeatman N, Yong P, Young T, Yu P. Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia. Am J Hum Genet 2019; 104:948-956. [PMID: 30982612 DOI: 10.1016/j.ajhg.2019.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Cav2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca2+ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Cav2.2 in normal human neurodevelopment.
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Curtis C, Rueda OM, Sammut SJ, Chin SF, Caswell-Jin JL, Seoane JA, Callari M, Batra R, Pereira B, Bruna A, Ali HR, Provenzano E, Liu B, Parisien M, Gillett C, McKinney S, Green A, Murphy L, Purushotham A, Ellis I, Pharoah P, Rueda C, Aparicio S, Caldas C. Abstract GS3-06: Dynamics of breast cancer relapse reveal molecularly defined late recurring ER-positive subgroups: Results from the METABRIC study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs3-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent studies have demonstrated that women with early stage ER-positive (ER+) and HER2-negative (HER2-) breast cancer have a persistent risk of recurrence and cancer related death up to 20 years post diagnosis, highlighting the chronic nature of ER+ breast cancer and critical need to identify tumor characteristics that are more predictive of risk of recurrence than standard clinical covariates. However, progress in delineating the dynamics of breast cancer relapse and biomarkers of late recurrence has been hindered by the lack of large cohorts with long-term clinical follow-up and molecular information.
Methods: We report the results of a cohort of 3,240 breast cancer patients from the United Kingdom and Canada with 20 years of follow-up (median 9.75 years), including 1,980 with accompanying molecular data from the primary breast tumor. Information for each patient on loco-regional recurrence (LR), distant recurrence (DR), and site(s) of metastases was collected. We developed a non-homogenous Markov chain model that accounted for different clinical endpoints and timescales, as well as competing risks of mortality and the distinct baseline hazards that characterize different molecular subgroups. This approach enabled robust analysis of the spatio-temporal dynamics of breast cancer recurrence across the clinical subgroups, PAM50 subgroups and the integrative clusters, while also enabling individual risk of relapse predictions.
Results: We employed our multistate model to compute the probability of experiencing a LR or DR, as well as the baseline transition probabilities from surgery, LR or DR at various time intervals for average individuals in each of the clinical/molecular subgroups. These analyses reveal four late-recurring ER+ (predominantly HER2-) subgroups, together accounting for 26% of all ER+ tumors, with high (median 42-55%) risk of recurrence up to 20 years post-diagnosis. Each of these four subgroups maps to one of the Integrative Clusters, defined based on genomic copy number alterations and gene expression, and is enriched for a characteristic copy number amplification events: 11q13 (CCND1, RSF1), 8p12 (FGFR1, ZNF703), 17q23 (RPS6KB1) and 8q24 (MYC). These four molecular subgroups are superior in predicting late DR than standard clinical variables.
Conclusions: A detailed understanding of the rates and routes of metastasis and their variability across the distinct molecular subtypes is essential for devising personalized approaches to breast cancer care. We describe a molecularly characterized breast cancer cohort with long-term clinical follow-up and a statistical modeling framework, enabling delineation of the dynamics of breast cancer recurrence at unprecedented resolution. These analyses reveal four late recurring ER+ subgroups and accompanying biomarkers that collectively define the quarter of ER+ cases at highest risk of recurrence. Our findings highlight opportunities for improved patient stratification and biomarker-driven clinical trials directed at the subset of breast cancer patients with persistent risk of recurrence.
Citation Format: Curtis C, Rueda OM, Sammut S-J, Chin S-F, Caswell-Jin JL, Seoane JA, Callari M, Batra R, Pereira B, Bruna A, Ali HR, Provenzano E, Liu B, Parisien M, Gillett C, McKinney S, Green A, Murphy L, Purushotham A, Ellis I, Pharoah P, Rueda C, Aparicio S, Caldas C. Dynamics of breast cancer relapse reveal molecularly defined late recurring ER-positive subgroups: Results from the METABRIC study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS3-06.
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Affiliation(s)
- C Curtis
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - OM Rueda
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - S-J Sammut
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - S-F Chin
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - JL Caswell-Jin
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - JA Seoane
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - M Callari
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - R Batra
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - B Pereira
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - A Bruna
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - HR Ali
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - E Provenzano
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - B Liu
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - M Parisien
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - C Gillett
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - S McKinney
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - A Green
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - L Murphy
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - A Purushotham
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - I Ellis
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - P Pharoah
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - C Rueda
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - S Aparicio
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
| | - C Caldas
- Stanford University School of Medicine, Stanford, CA; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Research Institute in Oncology and Hematology, Winnipeg, MB, Canada; Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom; British Columbia Cancer Research Centre, Vancouver, BC, Canada; University of Nottingham and Nottingham University Hospital NHS Trust, Nottingham, United Kingdom; University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom; Universidad de Valladolid Facultad de Ciencias, Valladolid, Spain
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Ebili HO, Iyawe VO, Adeleke KR, Salami BA, Banjo AA, Nolan C, Rakha E, Ellis I, Green A, Agboola AOJ. Checkpoint Kinase 1 Expression Predicts Poor Prognosis in Nigerian Breast Cancer Patients. Mol Diagn Ther 2018; 22:79-90. [PMID: 29075961 DOI: 10.1007/s40291-017-0302-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Checkpoint kinase 1 (CHEK1), a DNA damage sensor and cell death pathway stimulator, is regarded as an oncogene in tumours, where its activities are considered essential for tumourigenesis and the survival of cancer cells treated with chemotherapy and radiotherapy. In breast cancer, CHEK1 expression has been associated with an aggressive tumour phenotype, the triple-negative breast cancer subtype, an aberrant response to tamoxifen, and poor prognosis. However, the relevance of CHEK1 expression has, hitherto, not been investigated in an indigenous African population. We therefore aimed to investigate the clinicopathological, biological, and prognostic significance of CHEK1 expression in a cohort of Nigerian breast cancer cases. MATERIAL AND METHODS Tissue microarrays of 207 Nigerian breast cancer cases were tested for CHEK1 expression using immunohistochemistry. The clinicopathological, molecular, and prognostic characteristics of CHEK1-positive tumours were determined using the Chi-squared test and Kaplan-Meier and Cox regression analyses in SPSS Version 16. RESULTS Nuclear expression of CHEK1 was present in 61% of breast tumours and was associated with tumour size, triple-negative cancer, basal-like phenotype, the epithelial-mesenchymal transition, p53 over-expression, DNA homologous repair pathway dysfunction, and poor prognosis. CONCLUSIONS The rate expression of CHEK1 is high in Nigerian breast cancer cases and is associated with an aggressive phenotype and poor prognosis.
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Affiliation(s)
- Henry Okuchukwu Ebili
- Department of Morbid Anatomy and Histopathology, Olabisi Onabanjo University, Sagamu Campus, Hospital Road, Sagamu, Ogun State, Nigeria.
| | - Victoria O Iyawe
- Department of Morbid Anatomy and Histopathology, Olabisi Onabanjo University, Sagamu Campus, Hospital Road, Sagamu, Ogun State, Nigeria
| | - Kikelomo Rachel Adeleke
- Department of Morbid Anatomy and Histopathology, Olabisi Onabanjo University, Sagamu Campus, Hospital Road, Sagamu, Ogun State, Nigeria
| | | | - Adekunbiola Aina Banjo
- Department of Morbid Anatomy and Histopathology, Olabisi Onabanjo University, Sagamu Campus, Hospital Road, Sagamu, Ogun State, Nigeria
| | - Chris Nolan
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emad Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ian Ellis
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew Green
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ayodeji Olayinka Johnson Agboola
- Department of Morbid Anatomy and Histopathology, Olabisi Onabanjo University, Sagamu Campus, Hospital Road, Sagamu, Ogun State, Nigeria
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Fewings E, Larionov A, Redman J, Goldgraben MA, Scarth J, Richardson S, Brewer C, Davidson R, Ellis I, Evans DG, Halliday D, Izatt L, Marks P, McConnell V, Verbist L, Mayes R, Clark GR, Hadfield J, Chin SF, Teixeira MR, Giger OT, Hardwick R, di Pietro M, O'Donovan M, Pharoah P, Caldas C, Fitzgerald RC, Tischkowitz M. Germline pathogenic variants in PALB2 and other cancer-predisposing genes in families with hereditary diffuse gastric cancer without CDH1 mutation: a whole-exome sequencing study. Lancet Gastroenterol Hepatol 2018; 3:489-498. [PMID: 29706558 PMCID: PMC5992580 DOI: 10.1016/s2468-1253(18)30079-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Germline pathogenic variants in the E-cadherin gene (CDH1) are strongly associated with the development of hereditary diffuse gastric cancer. There is a paucity of data to guide risk assessment and management of families with hereditary diffuse gastric cancer that do not carry a CDH1 pathogenic variant, making it difficult to make informed decisions about surveillance and risk-reducing surgery. We aimed to identify new candidate genes associated with predisposition to hereditary diffuse gastric cancer in affected families without pathogenic CDH1 variants. METHODS We did whole-exome sequencing on DNA extracted from the blood of 39 individuals (28 individuals diagnosed with hereditary diffuse gastric cancer and 11 unaffected first-degree relatives) in 22 families without pathogenic CDH1 variants. Genes with loss-of-function variants were prioritised using gene-interaction analysis to identify clusters of genes that could be involved in predisposition to hereditary diffuse gastric cancer. FINDINGS Protein-affecting germline variants were identified in probands from six families with hereditary diffuse gastric cancer; variants were found in genes known to predispose to cancer and in lesser-studied DNA repair genes. A frameshift deletion in PALB2 was found in one member of a family with a history of gastric and breast cancer. Two different MSH2 variants were identified in two unrelated affected individuals, including one frameshift insertion and one previously described start-codon loss. One family had a unique combination of variants in the DNA repair genes ATR and NBN. Two variants in the DNA repair gene RECQL5 were identified in two unrelated families: one missense variant and a splice-acceptor variant. INTERPRETATION The results of this study suggest a role for the known cancer predisposition gene PALB2 in families with hereditary diffuse gastric cancer and no detected pathogenic CDH1 variants. We also identified new candidate genes associated with disease risk in these families. FUNDING UK Medical Research Council (Sackler programme), European Research Council under the European Union's Seventh Framework Programme (2007-13), National Institute for Health Research Cambridge Biomedical Research Centre, Experimental Cancer Medicine Centres, and Cancer Research UK.
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Affiliation(s)
- Eleanor Fewings
- Academic Laboratory of Medical Genetics, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Alexey Larionov
- Academic Laboratory of Medical Genetics, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - James Redman
- Academic Laboratory of Medical Genetics, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mae A Goldgraben
- Academic Laboratory of Medical Genetics, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - James Scarth
- Academic Laboratory of Medical Genetics, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Susan Richardson
- Familial Gastric Cancer Study, Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Ian Ellis
- Cheshire and Merseyside Regional Genetic Service, Liverpool, UK
| | | | - Dorothy Halliday
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louise Izatt
- Clinical Genetics Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter Marks
- West Midlands Regional Genetics Service, Birmingham, UK
| | - Vivienne McConnell
- Northern Ireland Regional Genetics Centre, Belfast City Hospital, Belfast, UK
| | - Louis Verbist
- Department of Gastroenterology, ZNA Jan Palfijn, Antwerp, Belgium
| | - Rebecca Mayes
- Centre for Cancer Genetic Epidemiology, Strangeway's Research Laboratory, University of Cambridge, Cambridge, UK
| | - Graeme R Clark
- Academic Laboratory of Medical Genetics, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - James Hadfield
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK; Precision Medicine and Genomics, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Cambridge, UK
| | - Suet-Feung Chin
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Manuel R Teixeira
- Department of Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal; Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Olivier T Giger
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Richard Hardwick
- Department of Oesophago-Gastric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Massimiliano di Pietro
- Medical Research Council (MRC) Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Maria O'Donovan
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul Pharoah
- Centre for Cancer Genetic Epidemiology, Strangeway's Research Laboratory, University of Cambridge, Cambridge, UK
| | - Carlos Caldas
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Rebecca C Fitzgerald
- Medical Research Council (MRC) Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK
| | - Marc Tischkowitz
- Academic Laboratory of Medical Genetics, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK.
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Islam M, Mane S, Hyder E, Jones S, Ellis I. The motogenic effect of EGF and TGF-α on the migration of tumor cells from the oral region. Translational Research in Oral Oncology 2017. [DOI: 10.1177/2057178x17698481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mohammad Islam
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, Scotland, UK
| | - Shraddha Mane
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, Scotland, UK
| | - Erum Hyder
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, Scotland, UK
| | - Sarah Jones
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, Scotland, UK
| | - Ian Ellis
- Unit of Cell and Molecular Biology, Dundee Dental School, University of Dundee, Dundee, Scotland, UK
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Klimov S, Wei G, Green A, Aleskandarany M, Rakha E, Ellis I, Cantuaria G, Agboola AO, Reid M, Xiaoxian L, Padmashree RCG, Osan R, Aneja R. Abstract B08: Identifying high-risk triple negative breast cancer patients using a novel cycling kinetics metric. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-b08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Ki67 Index (KI) and Mitotic Index (MI) are proliferation markers with established prognostic value in breast cancer. These indices are evaluated individually and on disparate measurement scales; they thereforefail to capture information about cell cycling kinetics of proliferating cells. Within the triple negative (TNBC) subtype , we rationally integrate the two markers to identify high-risk patients whose proliferative cells exhibit fast cycling kinetics.
Methods
Pathology reports of breast cancer patients (n=10,504 from Northside Hospital, Atlanta and n=1560 from Nottingham Hospital, UK) were retrospectively analyzed for mitotic scores, KI and clinical outcomes. Mitotic counts in 267 H&E-stained breast carcinoma samples were evaluated by two pathologists to transform mitotic scores into %MI based on cellularity. %MI: %KI ratio was defined as the Ki67-Adjusted Mitotic Score (KAMS), which reflects cycling kinetics of proliferative cells. Ability of KAMS to stratify triplenegative breast cancers (TNBCs) was tested in three cohorts who received only adjuvant chemotherapy (n=478 from Northside Hospital, USA; n=322 from Nottingham Hospital, UK, and n=108 from OlabisiOnabanjo University, Nigeria). Stratification of KAMS, KI and MI were performed onthe thresholdsthat produced the lowest AIC (best model fit).Slow-cycling and fast-cycling TNBC subgroups from Nottingham Hospital were analyzed for biomarker expression.
Results
Kaplan-Meier survival analyses, AIC andc2 values showed that KAMS-based stratification of TNBCs into two subgroups was superior to that by either KI or MI, regardless of hospital, and KAMS retained its significance in multivariate analyses, controlling for stage and age. Fast-cycling TNBCs have poorer prognosis than slow-cycling TNBCs, perhaps due to higher intratumoral heterogeneity in fast cycling tumors. Fast-cycling TNBCs showed high expression of proteins implicated in DNA damage response, sumoylation, EGFR signaling and metastasis. By contrast, slow-cycling TNBCs showed extensive chromatin modification.
Conclusion
KAMS quantifies cell cycling kinetics, stratifies TNBCs and yields new risk-predictive information that is not revealed by either KI or MI. KAMS reveals the underlying heterogeneity in cycling kinetics among TNBCs and helps identify TNBCs who might benefit from treatments that target the cell cycle machinery.
Citation Format: Sergey Klimov, Guanhao Wei, Andrew Green, Mohammed Aleskandarany, Emad Rakha, Ian Ellis, Guilherme Cantuaria, Ayodeji O. Agboola, Michelle Reid, Li Xiaoxian, Rida C. G. Padmashree, Remus Osan, Ritu Aneja. Identifying high-risk triple negative breast cancer patients using a novel cycling kinetics metric. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B08.
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Affiliation(s)
| | | | - Andrew Green
- 2University of Nottingham, Nottingham, United Kingdom,
| | | | - Emad Rakha
- 2University of Nottingham, Nottingham, United Kingdom,
| | - Ian Ellis
- 2University of Nottingham, Nottingham, United Kingdom,
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Klimov S, Green A, Aleskandarany M, Rakha E, Ellis I, Reid M, Padmashree RCG, Aneja R. Abstract B09: Multivariable Models for Predicting Likely Metastatic Sites for Triple Negative Breast Cancers. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-b09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Unique organ microenvironment may preferentially support growth of specific tumor clones because of which different breast cancer subtypes show distinct tropisms for sites of metastasis. While a few gene expressionbased signatures are known to predict sitespecific metastasis of breast cancer, little work has focused on identification of clinically facile immunohistochemical predictors of metastasis to specific sites, especially for triple negative breast cancers (TNBCs).
Methods: Primary tumor samples from 322 TNBC patients were stained for 133 biomarkers and assessed by immunohistochemistry. Differences in average levels of these biomarkers were compared between patients with or without metastasis to specific sites (brain, bone, lungs, liver, lymph nodes). Significantly different biomarkers were then analyzed within a Cox regression model to evaluate their prognostic value when patients with metastasis to the site of interest were compared to patients with no metastasis. Ideal thresholds, based on maximizing model fit, stratified cohorts that show high and low expression of each biomarker. A combination of a biomarker found high for each site, low for each site, and the Nottingham Prognostic Index (NPI) was used to stratify patients.
Results: Our analysis uncovered several biomarkers whose expression levels in primary tumors can predict the site of future metastasis in TNBCs. Our models for brain (PARP1 & BRCA2), bone (MTA1 &Tumor-Adjacent CD8), liver (TFF1 & N-Cadherin), and lung (ROR) were able to identify patients who had at least a 500% risk of site specific distant metastasis.
Conclusion: Relatively simple and inexpensive immunohistochemical analyses of biomarkers, combined with logical model building, in primary tumors of TNBCs may allow prediction of the site of future metastasis. Highrisk patients may benefit from increased surveillance of such sites.
Citation Format: Sergey Klimov, Andrew Green, Mohammed Aleskandarany, Emad Rakha, Ian Ellis, Michelle Reid, Rida C. G. Padmashree, Ritu Aneja. Multivariable Models for Predicting Likely Metastatic Sites for Triple Negative Breast Cancers. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B09.
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Affiliation(s)
| | - Andrew Green
- 2University of Nottingham, Nottingham, United Kingdom,
| | | | - Emad Rakha
- 2University of Nottingham, Nottingham, United Kingdom,
| | - Ian Ellis
- 2University of Nottingham, Nottingham, United Kingdom,
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Ellis I. Learning and influencing in a digital age – is physiotherapy making (mega) byte-sized progress? Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones L, Ellis I, Cuzick J. Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. Lancet 2016; 387:866-73. [PMID: 26686313 PMCID: PMC4769326 DOI: 10.1016/s0140-6736(15)01129-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Third-generation aromatase inhibitors are more effective than tamoxifen for preventing recurrence in postmenopausal women with hormone-receptor-positive invasive breast cancer. However, it is not known whether anastrozole is more effective than tamoxifen for women with hormone-receptor-positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole with that of tamoxifen in postmenopausal women with hormone-receptor-positive DCIS. METHODS In a double-blind, multicentre, randomised placebo-controlled trial, we recruited women who had been diagnosed with locally excised, hormone-receptor-positive DCIS. Eligible women were randomly assigned in a 1:1 ratio by central computer allocation to receive 1 mg oral anastrozole or 20 mg oral tamoxifen every day for 5 years. Randomisation was stratified by major centre or hub and was done in blocks (six, eight, or ten). All trial personnel, participants, and clinicians were masked to treatment allocation and only the trial statistician had access to treatment allocation. The primary endpoint was all recurrence, including recurrent DCIS and new contralateral tumours. All analyses were done on a modified intention-to-treat basis (in all women who were randomised and did not revoke consent for their data to be included) and proportional hazard models were used to compute hazard ratios and corresponding confidence intervals. This trial is registered at the ISRCTN registry, number ISRCTN37546358. RESULTS Between March 3, 2003, and Feb 8, 2012, we enrolled 2980 postmenopausal women from 236 centres in 14 countries and randomly assigned them to receive anastrozole (1449 analysed) or tamoxifen (1489 analysed). Median follow-up was 7·2 years (IQR 5·6-8·9), and 144 breast cancer recurrences were recorded. We noted no statistically significant difference in overall recurrence (67 recurrences for anastrozole vs 77 for tamoxifen; HR 0·89 [95% CI 0·64-1·23]). The non-inferiority of anastrozole was established (upper 95% CI <1·25), but its superiority to tamoxifen was not (p=0·49). A total of 69 deaths were recorded (33 for anastrozole vs 36 for tamoxifen; HR 0·93 [95% CI 0·58-1·50], p=0·78), and no specific cause was more common in one group than the other. The number of women reporting any adverse event was similar between anastrozole (1323 women, 91%) and tamoxifen (1379 women, 93%); the side-effect profiles of the two drugs differed, with more fractures, musculoskeletal events, hypercholesterolaemia, and strokes with anastrozole and more muscle spasm, gynaecological cancers and symptoms, vasomotor symptoms, and deep vein thromboses with tamoxifen. CONCLUSIONS No clear efficacy differences were seen between the two treatments. Anastrozole offers another treatment option for postmenopausal women with hormone-receptor-positive DCIS, which may be be more appropriate for some women with contraindications for tamoxifen. Longer follow-up will be necessary to fully evaluate treatment differences. FUNDING Cancer Research UK, National Health and Medical Research Council Australia, Breast Cancer Research Fund, AstraZeneca, Sanofi Aventis.
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Affiliation(s)
- John F Forbes
- Australia and New Zealand Breast Cancer Trials Group, University of Newcastle, Waratah, NSW, Australia
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Nigel Bundred
- South Manchester University Hospital, Manchester, UK
| | | | | | | | - Patrick Neven
- Department of Oncology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Michael Stierer
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool University Hospital, Liverpool, UK
| | - Robert E Coleman
- Department of Oncology and Metabolism, Weston Park Hospital, Sheffield, UK
| | - Louise Jones
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Ian Ellis
- Department of Histopathology University of Nottingham, Nottingham, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
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Cuzick J, Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones LJ, Ellis I. Abstract S6-03: Anastrozole versus tamoxifen for the prevention of loco-regional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in-situ (IBIS-II DCIS). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s6-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Third generation aromatase inhibitors are a more effective treatment option than tamoxifen for hormone receptor positive invasive breast cancer in postmenopausal women. However, it is not known whether anastrozole is more effective than tamoxifen in preventing the recurrence of breast cancer in women with hormone receptor (HR) positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole versus tamoxifen in postmenopausal women with HR positive DCIS.
Methods: A multi-centre randomised placebo-controlled trial of 1mg/day anastrozole (oral) vs. 20mg/day tamoxifen (oral) for five years was conducted in 2980 postmenopausal women with locally excised HR positive DCIS. The primary endpoint was to determine if anastrozole is at least as effective as tamoxifen in loco-regional control and prevention of contralateral disease. Secondary endpoints included breast cancer mortality, other cancers, cardiovascular disease, fractures, adverse events and non-breast cancer deaths. All analyses were done on an intention-to-treat basis and Cox proportional hazard were used to compute hazard ratios and corresponding confidence intervals for recurrence.
Results: Between 2003 and 2012, a total of 2980 postmenopausal women were recruited into the IBIS-II DCIS trial. 1471 women were randomly assigned to receive anastrozole and 1509 women tamoxifen. Median follow-up for this first analysis is 6.8 years and 131 breast cancer recurrences have been recorded. Median age was 60.3 years (56.1-64.6), median BMI was 26.7 (23.6-30.7), and 45.6% of women had used hormone replacement therapy (HRT) before joining the trial. Of the 131 women with recurrent disease, 77 had a loco-regional recurrence and 51 reported contralateral disease. A total of 61 deaths were recorded. We will present a comprehensive analysis of the efficacy of anastrozole and tamoxifen for preventing loco-regional/contralateral breast cancer and major adverse events by intention to treat (ITT).
Conclusions: To follow.
Citation Format: Cuzick J, Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones LJ, Ellis I. Anastrozole versus tamoxifen for the prevention of loco-regional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in-situ (IBIS-II DCIS). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S6-03.
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Affiliation(s)
- J Cuzick
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - JF Forbes
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - I Sestak
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - A Howell
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - B Bonanni
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - N Bundred
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - C Levy
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - G von Minckwitz
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - W Eiermann
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - P Neven
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - M Stierer
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - C Holcombe
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - RE Coleman
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - LJ Jones
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - I Ellis
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
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Giri D, Hart R, Jones C, Ellis I, Ramakrishnan R. An unusual case of hereditary nephrogenic diabetes insipidus (HNDI) affecting mother and daughter. J Pediatr Endocrinol Metab 2016; 29:93-6. [PMID: 26244674 DOI: 10.1515/jpem-2015-0174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 05/04/2015] [Indexed: 11/15/2022]
Abstract
Hereditary nephrogenic diabetes iInsipidus (HNDI) is an uncommon disorder due to a resistance to anti-diuretic hormone leading to a reduced urinary concentrating ability. The X-linked form is fully expressed in hemizygous male patients, but diabetes insipidus may also present in heterozygous females where it must be distinguished from autosomal and other secondary causes. We report a mother and daughter in the same family with HNDI due to a heterozygous deletion in exon 1 of the AVPR2 gene, not previously described in the literature. A 5-year-old girl was referred for investigation of polyuria and polydipsia. The patient had a water deprivation test elsewhere at the age of 3 that was inconclusive. A degree of water restriction was imposed leading to headaches. The thyroid, cortisol, renal, and calcium profiles were normal. Her mother showed similar symptoms that had not been previously investigated. AQP2 (Aquaporin) and initial AVPR2 gene sequencing had not identified a mutation, but subsequent quantitative polymerase chain reaction analysis revealed a heterozygous large exon 1 deletion of the AVPR2 gene. The same deletion was also found in the child's mother. The patient's symptoms have significantly improved on appropriate treatment. Further analysis revealed skewed X inactivation in mother and daughter.
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Lim S, O'Reilly S, Behrens H, Skinner T, Ellis I, Dunbar JA. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis. Obes Rev 2015; 16:972-87. [PMID: 26313354 DOI: 10.1111/obr.12312] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/14/2015] [Accepted: 07/17/2015] [Indexed: 12/31/2022]
Abstract
Post-partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post-partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post-partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self-monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home- or centre-based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta-analysis (1,892 women, age 24-36 years). Studies with self-monitoring had significantly greater weight lost than those without (-4.61 kg [-7.08, -2.15] vs. -1.34 kg [-1.66, -1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (-3.24 kg [-4.59, -1.90] vs. -1.63 kg [-2.16, -1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self-monitoring and take a combined diet-and-exercise approach have significantly greater weight loss in post-partum women.
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Affiliation(s)
- S Lim
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Hamilton, Vic., Australia
| | - S O'Reilly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Vic., Australia
| | - H Behrens
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - T Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, NT, Australia
| | - I Ellis
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - J A Dunbar
- Deakin Population Health Strategic Research Centre, Deakin University, Warrnambool, Victoria, Australia
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Albanghali M, Green A, Rakha E, Aleskandarany M, Nolan C, Ellis I, Cheung KL. Construction of tissue microarrays from core needle biopsies - a systematic literature review. Histopathology 2015; 68:323-32. [PMID: 26266325 DOI: 10.1111/his.12802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In some clinical circumstances, core needle biopsy (CNB) may be the only source of material from cancer tissue for diagnostic use. The volume of tissue available in a CNB is low, and opportunities for research use can therefore be limited. The tissue microarray (TMA) principle, if applied to the use of CNBs, could facilitate research studies in circumstances where CNB specimens are available. However, various challenges are expected in applying such a technique in CNBs, which has limited their use in research. We therefore conducted a systematic review of the literature on this subject. A systematic search was carried out with CINAHL, EMBASE, the Cochrane library, and MEDLINE, to identify studies that have primarily developed methods for constructing TMAs from CNBs. Eight studies were found to meet the inclusion criteria; six of these employed the vertical rearrangement technique, and two used multiple layers of biopsy tissue. Representation of the CNB was significantly influenced by the quantity of tumour cells present in the original biopsy and the degree of heterogeneity of biomarker expression. This review shows that technologies have been developed to enable construction of TMAs from CNBs. However, challenges remain to improve amplification and representation.
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Affiliation(s)
- Mohammad Albanghali
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Andrew Green
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emad Rakha
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals City Hospital Campus, Nottingham, UK
| | - Mohamed Aleskandarany
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Nolan
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ian Ellis
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histopathology, Nottingham University Hospitals City Hospital Campus, Nottingham, UK
| | - Kwok-Leung Cheung
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
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Benjamin C, Houghton C, Foo C, Edgar C, Mannion G, Birch J, Ellis I, Weber A. A prospective cohort study assessing clinical referral management & workforce allocation within a UK regional medical genetics service. Eur J Hum Genet 2015; 23:996-1003. [PMID: 25758997 PMCID: PMC4795118 DOI: 10.1038/ejhg.2015.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/02/2015] [Accepted: 01/20/2015] [Indexed: 11/09/2022] Open
Abstract
Ensuring patient access to genomic information in the face of increasing demand requires clinicians to develop innovative ways of working. This paper presents the first empirical prospective observational cohort study of UK multi-disciplinary genetic service delivery. It describes and explores collaborative working practices including the utilisation and role of clinical geneticists and non-medical genetic counsellors. Six hundred and fifty new patients referred to a regional genetics service were tracked through 850 clinical contacts until discharge. Referral decisions regarding allocation of lead health professional assigned to the case were monitored, including the use of initial clinical contact guidelines. Significant differences were found in the cases led by genetic counsellors and those led by clinical geneticists. Around a sixth, 16.8% (109/650) of referrals were dealt with by a letter back to the referrer or re-directed to another service provider and 14.8% (80/541) of the remaining patients chose not to schedule an appointment. Of the remaining 461 patients, genetic counsellors were allocated as lead health professional for 46.2% (213/461). A further 61 patients did not attend. Of those who did, 86.3% (345/400) were discharged after one or two appointments. Genetic counsellors contributed to 95% (784/825) of total patient contacts. They provided 93.7% (395/432) of initial contacts and 26.8% (106/395) of patients were discharged at that point. The information from this study informed a planned service re-design. More research is needed to assess the effectiveness and efficiency of different models of collaborative multi-disciplinary working within genetics services.
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Affiliation(s)
- Caroline Benjamin
- Health Research Methodology and Implementation Hub (HeRMI), School of Health, University of Central Lancashire (UCLan), Preston, UK
- Merseyside and Cheshire Clinical Genetics Service, Liverpool Women's (NHS) Foundation Hospital Trust, Liverpool, UK
| | - Catherine Houghton
- Merseyside and Cheshire Clinical Genetics Service, Liverpool Women's (NHS) Foundation Hospital Trust, Liverpool, UK
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals (NHS) Foundation Trust, Manchester, UK
| | - Claire Foo
- Merseyside and Cheshire Clinical Genetics Service, Liverpool Women's (NHS) Foundation Hospital Trust, Liverpool, UK
| | - Chris Edgar
- Merseyside and Cheshire Clinical Genetics Service, Liverpool Women's (NHS) Foundation Hospital Trust, Liverpool, UK
| | - Gail Mannion
- Merseyside and Cheshire Clinical Genetics Service, Liverpool Women's (NHS) Foundation Hospital Trust, Liverpool, UK
| | - Jan Birch
- Merseyside and Cheshire Clinical Genetics Service, Liverpool Women's (NHS) Foundation Hospital Trust, Liverpool, UK
| | - Ian Ellis
- Merseyside and Cheshire Clinical Genetics Service, Liverpool Women's (NHS) Foundation Hospital Trust, Liverpool, UK
| | - Astrid Weber
- Merseyside and Cheshire Clinical Genetics Service, Liverpool Women's (NHS) Foundation Hospital Trust, Liverpool, UK
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Hiscox S, Smith C, Nicholson RI, Gee J, Harris A, Bliss J, Kalaizak E, Sestak I, Dowsett M, Cuzick J, Ellis I, Barrett-Lee P. Abstract P3-06-01: Nuclear β-catenin negativity predicts for late relapse in ER+, tamoxifen-treated breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p3-06-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The annual recurrence rates of post-menopausal ER-positive breast cancers persist beyond the first 5 years of diagnosis and treatment and the mortality rates in this period are higher versus ER-negative cancers. Extended endocrine therapy past 5 years has been shown to be of benefit but is associated with increased toxicity and cost thus the ability to predict patients who are at highest risk of late relapse would be of significant benefit in clinical decision making in this context. β-catenin is an intracellular protein that undergoes Wnt-mediated nuclear translocation where it transactivates genes implicated in tumour development and progression. We have also previously reported that β-catenin can play a role in aggressive resistance that accompanies prolonged endocrine treatment in vitro. In this study, we thus investigated whether β-catenin expression in ER+ breast cancer was predictive of recurrence beyond 5 years in an analysis of three separate endocrine-treated cohorts.
Methods: Associations between β-catenin gene expression and relapse free survival (RFS) were performed using the online KMplotter tool. Immunostaining for total β-catenin was performed on tissue samples from 3 ER+ primary breast cancer series with long-term follow-up data: Nottingham 2000 (n=384, tamoxifen-only); ABC (n=570; tamoxifen only); transATAC (n=743; tamoxifen or ansatrozole). The association between subcellular (nuclear or cytoplasmic) β-catenin expression and RFS was determined in (i) the entire cohort, (ii) the first 5 years of tamoxifen treatment versus post-5 years.
Results: KMplotter analysis of β-catenin in ER+, tamoxifen-treated patient samples (n=665) revealed a significant relationship with improved RFS in the post-five year cohort [HR: 0.48 (0.34-0.68); p=0.000019) versus the first 5 years [HR: 0.91 (0.61-1.36; p=0.64)]. No significant association was observed in untreated ER+ patients. In the Nottingham series, nuclear β-catenin positivity was significantly associated with improved survival in the 20-year follow-up for tamoxifen-treated patients (p=0.047) but not in the first five years (p=0.239). Cytoplasmic β-catenin did not associate with survival. Further analysis in the ABC series revealed an association between nuclear β-catenin positivity and improved survival for tamoxifen-treated patients in the entire cohort (HR: 0.52 (0.18, 0.55); p=0.00005). However, nuclear β-catenin was more strongly associated with improved outcome in the post 5-year treatment group (HR: 0.30 (0.14, 0.66); p=0.01) versus the first five years of treatment (HR: 0.33 (0.15,0.73); p=0.06). No significant associations were seen with cytoplasmic β-catenin. The transATAC trial material again revealed an association between presence of nuclear β-catenin and reduced distant recurrence in the post 5-years endocrine-treated cohort (HR: 0.54 (0.33, 0.91): x2=5.52, p=0.018) versus years 1-5 (HR: 1.16 (0.67, 2.01); x2=0.29, p=0.59).
Conclusions: This is the first study to demonstrate that nuclear β-catenin may represent a predictive biomarker for late relapse following tamoxifen treatment in ER+ breast cancer where, contrary to traditional hypotheses and pre-clinical data, its nuclear expression is strongly associated with good outcome post-five years of treatment.
Citation Format: Stephen Hiscox, Chris Smith, Robert I Nicholson, Julia Gee, Adrian Harris, Judith Bliss, Eleftheria Kalaizak, Ivana Sestak, Mitch Dowsett, Jack Cuzick, Ian Ellis, Peter Barrett-Lee. Nuclear β-catenin negativity predicts for late relapse in ER+, tamoxifen-treated breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-06-01.
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Affiliation(s)
- Stephen Hiscox
- 1Breast Cancer Molecular Pharmacology Group, Cardiff University
| | - Chris Smith
- 1Breast Cancer Molecular Pharmacology Group, Cardiff University
| | | | - Julia Gee
- 1Breast Cancer Molecular Pharmacology Group, Cardiff University
| | - Adrian Harris
- 3Weatherall Institute of Molecular Medicine, University of Oxford
| | - Judith Bliss
- 4Institute of Cancer Research, Division of Clinical Studies
| | | | - Ivana Sestak
- 6Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry
| | - Mitch Dowsett
- 5Institute of Cancer Research, Division of Breast Cancer Research
| | - Jack Cuzick
- 6Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry
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Jasani B, Campbell F, Jones P, Gilbert J, Dowd J, Miller K, Ibrahim M, Ellis I, Hurley E, Falzon M, Peter BL, Starczynski J. Abstract P5-10-03: Audit of the accuracy of immunohistochemical (IHC) testing of HER2 negative status of breast cancer in the United Kingdom. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The analysis of the level and distribution of HER2 protein expressed by cancer cells (HER2 status) is of great clinical value in the management of breast cancer patients both for the determination of the prognosis of disease and for identification of those patients who are eligible for anti-HER2 therapy. Accurate assessment of the HER2 status is essential for identifying patients which will benefit from HER2 targeted therapy. HER2 status in the UK is established using a two tier strategy with IHC as the initial test and subsequent reflex of equivocal results to in situ hybridization (ISH). IHC staining of the HER2 protein is graded as 0, 1+, 2+ or 3+ dependent upon the intensity of staining, cellular localisation and the percentage
of cells positive in accordance with CAP/ASCO and UK guidelines. HER2 3+ cases are considered as positive, with HER2 2+ cases (equivocal) retested by ISH to ascertain the gene amplification status. Cases that are scored as 0 and 1+ by IHC have no additional testing and are classed as negative. The literature indicates that a subset of these IHC negative cases show HER2 gene amplification by FISH (range 1.1-11.5%). The aim of this audit is to evaluate the discordance rate of HER2 IHC negative,
FISH positive breast cancer in the UK, with a secondary objective to resolve if this is related to the choice of antibody and assay platform used.
Materials and methods: This audit selected a total of 600 sequential cases reported as HER2 negative on IHC, from three UK reference centres receiving cases from 29 different hospitals. The cases were given a unique identifying number and annonymised. Each of the three centres used a different IHC method for frontline HER2 testing with centre one using HercepTestTM (DAKO), centre two Pathway 4B5 (Roche), and centre three, Oracle (Leica Microsystems). HER2 gene amplification status was determined using dual colour FISH analysis, PathVysion (ABBOTT) fluorescence ISH (FISH)
in a single centre to provide standardised methodology and assessment. HER2 was classed as amplified when the HER2/CEP 17 ratio was two or greater in accordance with UK guidelines. All cases which showed discordance between IHC and FISH were re-tested with each of the HER2 IHC platforms to discover whether these are truly discordant results or if the discrepancy is a consequence of the choice of antibody.
Results: 16/600 (2.8%) unequivocal HER2 gene amplification (mean ratio >2.0) whilst 8/600 (1.2%) had borderline amplification status(mean ratio = or <2.0). The overall assay specific discordance rates were 3.0% (HercepTest), 2.5% (4B5) and 3.0% (Oracle), respectively.
Conclusion: The observed level of discordance is well within the range of discordance rates reported by previous studies. The discrepancies could be due to inadequate quality fixation and/or inadequate sensitivity of the assay platforms used, or under scoring. A detailed analysis of possible assay related source of discrepancy is currently underway by repeating the analyses of the 24 discordant cases using like for like three assay platforms at an independent expert centre.
Citation Format: Bharat Jasani, Fiona Campbell, Phillapa Jones, Jane Gilbert, James Dowd, Keith Miller, Merdol Ibrahim, Ian Ellis, Emma Hurley, Mary Falzon, Barrett-Lee Peter, Jane Starczynski. Audit of the accuracy of immunohistochemical (IHC) testing of HER2 negative status of breast cancer in the United Kingdom [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-10-03.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mary Falzon
- 8University College London Hospitals NHS Foundation Trust
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Foxler BE, Ziff OJ, Ellis I, Bodansky DM. Effective provision of a genetic screening program delivered to University students with limited resources. Am J Med Genet A 2015; 167A:922-4. [DOI: 10.1002/ajmg.a.36964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/24/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Becky E. Foxler
- College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - Oliver J. Ziff
- College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
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