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Bahçacı U, Atasavun Uysal S, Erdogan İyigün Z, Ordu Ç, Soybir GR, Ozmen V. Progressive relaxation training in patients with breast cancer receiving aromatase inhibitor therapy-randomized controlled trial. PLoS One 2024; 19:e0301020. [PMID: 38635763 PMCID: PMC11025930 DOI: 10.1371/journal.pone.0301020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/09/2023] [Accepted: 03/07/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Aromatase inhibitors have positive impacts on the disease-free life of patients with breast cancer. However, their side effects, especially arthralgia, may be experienced by many patients. This study sought to assess the efficacy of Progressive Relaxation Exercises on the prevalent side effects of Aromatase Inhibitors in patients with breast cancer. MATERIALS AND METHODS This clinical trial was conducted with single-blind randomization at a physiotherapy department in a local hospital. Patients who received Aromatase Inhibitor were assigned at random to either the study or control group. The study group (n = 22) performed a Progressive Relaxation Exercises program four days a week for six weeks, while the control group (n = 22) received advice on relaxation for daily life. Data was collected before the intervention and after six weeks. The study's primary endpoint was the Brief Pain Inventory, which was used to measure pain severity. Secondary endpoints included assessments of quality of life and emotional status, which were measured using the Functional Assessment of Chronic Illness Therapy and Hospital Anxiety and Depression scales, respectively. RESULTS The study group exhibited a significant reduction in Pain Severity (p = 0.001) and Pain Interference (p = 0.012) sub-scores. Reduction in Pain Severity (p<0.001) and Patient Pain Experience (p = 0.003) sub-scores was also noted between the groups. Quality of Life and Emotional Status showed no significant variation both within and between the groups (p>0.05). CONCLUSION The study demonstrated that Progressive Relaxation Exercises caused a significant reduction in pain scores among Breast Cancer patients receiving Aromatase Inhibitors. While a decrease in pain during the 6-week period is valuable data, it is necessary to monitor the long-term effects of relaxation techniques.
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Affiliation(s)
- Umut Bahçacı
- Graduate School of Health Sciences, Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | | | | | - Çetin Ordu
- Department of Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Gürsel Remzi Soybir
- Department of General Surgery, Memorial Etiler Health Center, Istanbul, Turkey
| | - Vahit Ozmen
- Breast Health Center, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Seker ME, Koyluoglu YO, Ozaydin AN, Gurdal SO, Ozcinar B, Cabioglu N, Ozmen V, Aribal E. Diagnostic capabilities of artificial intelligence as an additional reader in a breast cancer screening program. Eur Radiol 2024:10.1007/s00330-024-10661-3. [PMID: 38388718 DOI: 10.1007/s00330-024-10661-3] [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: 11/20/2023] [Revised: 01/18/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES We aimed to evaluate the early-detection capabilities of AI in a screening program over its duration, with a specific focus on the detection of interval cancers, the early detection of cancers with the assistance of AI from prior visits, and its impact on workload for various reading scenarios. MATERIALS AND METHODS The study included 22,621 mammograms of 8825 women within a 10-year biennial two-reader screening program. The statistical analysis focused on 5136 mammograms from 4282 women due to data retrieval issues, among whom 105 were diagnosed with breast cancer. The AI software assigned scores from 1 to 100. Histopathology results determined the ground truth, and Youden's index was used to establish a threshold. Tumor characteristics were analyzed with ANOVA and chi-squared test, and different workflow scenarios were evaluated using bootstrapping. RESULTS The AI software achieved an AUC of 89.6% (86.1-93.2%, 95% CI). The optimal threshold was 30.44, yielding 72.38% sensitivity and 92.86% specificity. Initially, AI identified 57 screening-detected cancers (83.82%), 15 interval cancers (51.72%), and 4 missed cancers (50%). AI as a second reader could have led to earlier diagnosis in 24 patients (average 29.92 ± 19.67 months earlier). No significant differences were found in cancer-characteristics groups. A hybrid triage workflow scenario showed a potential 69.5% reduction in workload and a 30.5% increase in accuracy. CONCLUSION This AI system exhibits high sensitivity and specificity in screening mammograms, effectively identifying interval and missed cancers and identifying 23% of cancers earlier in prior mammograms. Adopting AI as a triage mechanism has the potential to reduce workload by nearly 70%. CLINICAL RELEVANCE STATEMENT The study proposes a more efficient method for screening programs, both in terms of workload and accuracy. KEY POINTS • Incorporating AI as a triage tool in screening workflow improves sensitivity (72.38%) and specificity (92.86%), enhancing detection rates for interval and missed cancers. • AI-assisted triaging is effective in differentiating low and high-risk cases, reduces radiologist workload, and potentially enables broader screening coverage. • AI has the potential to facilitate early diagnosis compared to human reading.
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Affiliation(s)
- Mustafa Ege Seker
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Yilmaz Onat Koyluoglu
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | | | | | - Beyza Ozcinar
- Istanbul University, School of Medicine, Istanbul, Turkey
| | | | - Vahit Ozmen
- Istanbul University, School of Medicine, Istanbul, Turkey
| | - Erkin Aribal
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
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Dogan I, Aydin E, Khanmammadov N, Paksoy N, Ferhatoğlu F, Ak N, Emiroglu S, Ibis K, Onder S, Tukenmez M, Cabioglu N, Kucucuk S, Muslumanoğlu M, Ozmen V, Saip P, Igci A, Aydiner A. Long-term outcomes and predictors of recurrence in node-negative early stage breast cancer patients. J Cancer Res Clin Oncol 2023; 149:14833-14841. [PMID: 37594533 DOI: 10.1007/s00432-023-05276-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND We evaluated the outcomes, and risk factors for recurrence in patients with early stage node-negative breast cancer in this study. METHOD Retrospective data analysis was done on patient treatment records from 1988 to 2018. The patient's demographic, clinical, pathological, and therapeutic characteristics were noted. To evaluate survival analysis and predictors of recurrence, we employed Kaplan-Meier analysis with the log-rank test. RESULTS A total of 357 patients in all were enrolled in the research. At the time of diagnosis, the median age was 50 (with a range of 18-81). A total of 85.5% of patients had undergone a lumpectomy, while 14.5% had a mastectomy. 78.7% of patients had sentinel lymph node biopsy, and 21.3% had axillary lymph node dissection. In addition, the patients received adjuvant radiotherapy (88.7%), adjuvant endocrine therapy (82.1%), and adjuvant chemotherapy (48.5%). Recurrence of the tumor occurred in 31 (8.7%) patients (local recurrence 45.2% and metastatic disease 54.8%). Ten- and twenty-year recurrence-free survival rates were 92% and 77%. 19 (5.3%) patients had also developed contralateral breast cancer. Ten-year survival rates were 91.6%, and 20-year survival rates were 76.6%, respectively. Aged over 65 years (p = 0.004), necrosis (p = 0.002), mitosis (p = 0.003), and nuclear pleomorphism (p = 0.049) were found as statistically significant factors for recurrence in univariate analysis. In the ROC analysis, the largest size of the tumor (over 1.45 cm, p = 0.07) remained outside the statistical significance limit in terms of recurrence. CONCLUSIONS Thirty-year outcomes in individuals with early stage, node-negative breast cancer were shown in this study. We found that the recurrence ratios between 10 and 20 years were more frequent than the first 10 years during the follow-up. Despite the small number of patients who experienced a recurrence, we demonstrated that, in univariate analysis, being older than 65 and having some pathological characteristics (nuclear pleomorphism, mitosis, and necrosis) were statistically significant factors for disease recurrence.
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Affiliation(s)
- Izzet Dogan
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey.
| | - Esra Aydin
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Nijat Khanmammadov
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Ferhat Ferhatoğlu
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Naziye Ak
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Selman Emiroglu
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Kamuran Ibis
- Istanbul University Institute of Oncology, Radiation Oncology, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Tukenmez
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Seden Kucucuk
- Istanbul University Institute of Oncology, Radiation Oncology, Istanbul, Turkey
| | - Mahmut Muslumanoğlu
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Vahit Ozmen
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Abdullah Igci
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
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Agiannitopoulos K, Pepe G, Tsaousis GN, Potska K, Bouzarelou D, Katseli A, Ntogka C, Meintani A, Tsoulos N, Giassas S, Venizelos V, Markopoulos C, Iosifidou R, Karageorgopoulou S, Christodoulou C, Natsiopoulos I, Papazisis K, Vasilaki-Antonatou M, Kabletsas E, Psyrri A, Ziogas D, Lalla E, Koumarianou A, Anastasakou K, Papadimitriou C, Ozmen V, Tansan S, Kaban K, Ozatli T, Eniu DT, Chiorean A, Blidaru A, Rinsma M, Papadopoulou E, Nasioulas G. Copy Number Variations (CNVs) Account for 10.8% of Pathogenic Variants in Patients Referred for Hereditary Cancer Testing. Cancer Genomics Proteomics 2023; 20:448-455. [PMID: 37643779 PMCID: PMC10464942 DOI: 10.21873/cgp.20396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/29/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND/AIM Germline copy number variation (CNV) is a type of genetic variant that predisposes significantly to inherited cancers. Today, next-generation sequencing (NGS) technologies have contributed to multi gene panel analysis in clinical practice. MATERIALS AND METHODS A total of 2,163 patients were screened for cancer susceptibility, using a solution-based capture method. A panel of 52 genes was used for targeted NGS. The capture-based approach enables computational analysis of CNVs from NGS data. We studied the performance of the CNV module of the commercial software suite SeqPilot (JSI Medical Systems) and of the non-commercial tool panelcn.MOPS. Additionally, we tested the performance of digital multiplex ligation-dependent probe amplification (digitalMLPA). RESULTS Pathogenic/likely pathogenic variants (P/LP) were identified in 464 samples (21.5%). CNV accounts for 10.8% (50/464) of pathogenic variants, referring to deletion/duplication of one or more exons of a gene. In patients with breast and ovarian cancer, CNVs accounted for 10.2% and 6.8% of pathogenic variants, respectively. In colorectal cancer patients, CNV accounted for 28.6% of pathogenic/likely pathogenic variants. CONCLUSION In silico CNV detection tools provide a viable and cost-effective method to identify CNVs from NGS experiments. CNVs constitute a substantial percentage of P/LP variants, since they represent up to one of every ten P/LP findings identified by NGS multigene analysis; therefore, their evaluation is highly recommended to improve the diagnostic yield of hereditary cancer analysis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vahit Ozmen
- Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | | | | | - Dan Tudor Eniu
- Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania
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Cabioglu N, Bayram A, Emiroglu S, Onder S, Karatay H, Oner G, Tukenmez M, Muslumanoglu M, Igci A, Aydiner A, Saip P, Yavuz E, Ozmen V. Diverging prognostic effects of CD155 and CD73 expressions in locally advanced triple-negative breast cancer. Front Oncol 2023; 13:1165257. [PMID: 37519808 PMCID: PMC10374450 DOI: 10.3389/fonc.2023.1165257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/13/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Background Immune checkpoint inhibition, combined with novel biomarkers, may provide alternative pathways for treating chemotherapy-resistant triple-negative breast cancer (TNBC). This study investigates the expression of new immune checkpoint receptors, including CD155 and CD73, which play a role in T and natural killer (NK) cell activities, in patients with residual TNBC after neoadjuvant chemotherapy (NAC). Methods The expression of biomarkers was immunohistochemically examined by staining archival tissue from surgical specimens (n = 53) using specific monoclonal antibodies for PD-L1, CD155, and CD73. Results Of those, 59.2% (29/49) were found to be positive (>1%) for PD-L1 on the tumour and tumour-infiltrating lymphocytes (TILs), while CD155 (30/53, 56.6%) and CD73 (24/53, 45.3%) were detected on tumours. Tumour expressions of CD155 and CD73 significantly correlated with PD-L1 expression on the tumour (p = 0.004 for CD155, p = 0.001 for CD73). Patients with CD155 positivity ≥10% were more likely to have a poor chemotherapy response, as evidenced by higher MDACC Residual Cancer Burden Index scores and Class II/III than those without CD155 expression (100% vs 82.6%, p = 0.03). At a median follow-up time of 80 months (range, 24-239), patients with high CD73 expression showed improved 10-year disease-free survival (DFS) and disease-specific survival (DSS) rates compared to those with low CD73 expression. In contrast, patients with CD155 (≥10%) expression exhibited a decreasing trend in 10-year DFS and DSS compared to cases with lower expression, although statistical significance was not reached. However, patients with coexpression of CD155 (≥10%) and low CD73 were significantly more likely to have decreased 10-year DFS and DSS rates compared to others (p = 0.005). Conclusion These results demonstrate high expression of CD73 and CD155 in patients with residual tumours following NAC. CD155 expression was associated with a poor response to NAC and poor prognosis in this chemotherapy-resistant TNBC cohort, supporting the use of additional immune checkpoint receptor inhibitor therapy. Interestingly, the interaction between CD155 and CD73 at lower levels resulted in a worse outcome than either marker alone, which calls for further investigation in future studies.
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Affiliation(s)
- Neslihan Cabioglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Aysel Bayram
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Selman Emiroglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Huseyin Karatay
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Department of Pathology, Basaksehir Cam Sakura Hospital, Istanbul, Türkiye
| | - Gizem Oner
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Edegem, Belgium
- Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - Mustafa Tukenmez
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Mahmut Muslumanoglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Abdullah Igci
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Department of General Surgery, American Hospital, Istanbul, Türkiye
| | - Adnan Aydiner
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Türkiye
| | - Pinar Saip
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Türkiye
| | - Ekrem Yavuz
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Vahit Ozmen
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
- Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Türkiye
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Cabioglu N, Trabulus DC, Emiroglu S, Ozkurt E, Yalcin N, Dinc N, Tukenmez M, Muslumanoglu M, Igci A, Ozmen V, Dinccag AS, Guven YI. Ozone therapy as a novel complementary therapeutic approach in refractory idiopathic granulomatous mastitis. Front Med (Lausanne) 2023; 10:1174372. [PMID: 37484853 PMCID: PMC10357005 DOI: 10.3389/fmed.2023.1174372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/03/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Background Autoimmunity may play a major role in the pathogenesis of idiopathic granulomatous mastitis (IGM). The therapeutic potential of ozone therapy has recently been shown in rheumatological diseases, and this study aimed to assess the clinical efficacy of ozone therapy (OT) in refractory IGM. Methods Patients with biopsy-verified IGM and incomplete response after steroid therapy (n = 47) between 2018 and 2021 were enrolled. Of these, 23 cases in cohort A had standard treatment with further steroid therapy (ST), and 24 were treated with systemic OT via autohemotherapy (AHT) in addition to steroid therapy (cohort B). Results The median age was 33 years (range, 24-45). Patients in cohort B had a higher complete response rate after completion of a four-month ozone therapy than those in the ST-group (OT-group, 37.5% vs. ST-group, 0%; p = 0.002). At a median follow-up of 12 months (range, 12-35), the patients treated with OT had a lower one-year recurrence in the affected breast than cases in cohort A treated with ST (OT-group, 21% vs. ST-group, 70%; p = 0.001). No significant side effects were observed in patients in cohort B related to AHT. Furthermore, OT significantly decreased the total steroid treatment duration (median week of steroid use; 26 weeks in cohort A vs. 12 weeks in cohort B; p = 0.001). Conclusion Systemic OT increases the complete response rate and decreases the duration of steroid treatment in patients with refractory IGM. Therefore, ozone therapy is an effective, well-tolerated, and safe novel complementary therapeutic modality.
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Affiliation(s)
- Neslihan Cabioglu
- Istanbul Faculty of Medicine, Department of Surgery, Istanbul University, Istanbul, Türkiye
| | | | - Selman Emiroglu
- Istanbul Faculty of Medicine, Department of Surgery, Istanbul University, Istanbul, Türkiye
| | - Enver Ozkurt
- Department of Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Türkiye
| | - Nesli Yalcin
- Istanbul Faculty of Medicine, Department of Surgery, Istanbul University, Istanbul, Türkiye
| | - Nagehan Dinc
- Istanbul Faculty of Medicine, Department of Surgery, Istanbul University, Istanbul, Türkiye
| | - Mustafa Tukenmez
- Istanbul Faculty of Medicine, Department of Surgery, Istanbul University, Istanbul, Türkiye
| | - Mahmut Muslumanoglu
- Istanbul Faculty of Medicine, Department of Surgery, Istanbul University, Istanbul, Türkiye
| | - Abdullah Igci
- Department of Surgery, American Hospital, Istanbul, Türkiye
| | - Vahit Ozmen
- Department of Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Türkiye
| | - Ahmet Sait Dinccag
- Istanbul Faculty of Medicine, Department of Surgery, Istanbul University, Istanbul, Türkiye
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Ozmen T, Ozmen V. Treatment Changes in Breast Cancer Management and De-Escalation of Breast Surgery. Eur J Breast Health 2023; 19:186-190. [PMID: 37415650 PMCID: PMC10320639 DOI: 10.4274/ejbh.galenos.2023.2023-6-2] [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: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
A better understanding of tumor biology and new drugs have led to significant changes in the management of breast cancer (BC). Radical mastectomy, which had been the treatment for BC for more than a century, was based on the hypothesis that BC is a local-regional disease. In the 1970s, Fisher's studies showed that cancer cells could reach the systemic circulation without passage through the regional lymphatic system. Multidisciplinary treatment of BC, which was now considered a systemic disease, was started and radical mastectomy was replaced by breast-conserving surgery (BCS)+, axillary dissection (AD), systemic chemotherapy, hormonotherapy, and radiotherapy in early-stage BC. Modified radical mastectomy, chemotherapy, and radiotherapy were applied as a treatment for locally advanced BC. However, later clinical studies demonstrated that the breast can be preserved in those who respond well to neo-adjuvant chemotherapy (NAC). In the early 1990s, sentinel lymph node biopsy (SLNB) in early-stage BC (cN0) was performed using blue dye and radioisotope markers. It was shown that AD may be avoided in SLN-negative patients, and SLNB has been a standard intervention in cN0 patients. In this way, the very serious complications of AD, especially lymphedema, were avoided. BC has been shown to be a heterogeneous disease and the tumor may be divided into four different molecular subtypes. Thus, optimal treatment differed from patient to patient (one size fits all was inappropriate), individualized treatments have emerged and over-treatment was avoided. The prolongation of life expectancy and the decrease in recurrence led to an increase in the rate of BCS, an acceptable cosmetic result with oncoplastic surgery, and a better quality of life. The increase in the rate of complete response to NAC with new and targeted agents and especially in human epidermal growth factor receptor-2+ and triple-negative patients with a poor prognosis has led to the use of NAC regardless of cN0. The complete disappearance of the tumor after NAC has been reported by some studies, suggesting that breast surgery may not be needed. However, other studies have shown that vacuum biopsies performed on the tumor bed have a high rate of false negativity. Therefore, it is difficult to suggest that there is no need for lumpectomy, which is cheaper and safer today. The false negativity rate of SLNB is high in patients with cN1 at the time of diagnosis and cN0 after NAC (approximately 13%). In order to reduce this rate to ≤5%, clinical studies have recommended the use of the dual method, marking the positive lymph node before chemotherapy and removing 3-4 nodules with SLN. In summary, a better understanding of tumor biology and new drugs have changed the management of BC and de-escalate the role of surgical treatment.
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Affiliation(s)
- Tolga Ozmen
- Massachusetts General Hospital, Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Massachusetts, USA
| | - Vahit Ozmen
- Breast Surgery Unit, Department of General Surgery, Grup Florence Nightingale Hospital, Istanbul, Turkey
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Ünal Ç, Özmen T, Ordu Ç, Pilanci KN, İlgün AS, Gökmen E, Almuradova E, Özdoğan M, Güler N, Uras C, Kara H, Demircan O, Işık S, Alço G, Saip P, Aydın E, Duymaz T, Çelebi F, Yararbaş K, Soybir G, Ozmen V. Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey. Front Oncol 2023; 13:1151733. [PMID: 37448522 PMCID: PMC10338087 DOI: 10.3389/fonc.2023.1151733] [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: 01/26/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background The Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions. Patients and methods Estrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS. Results A total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18. Conclusion This first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS.
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Affiliation(s)
- Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye
| | - Tolga Özmen
- Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Boston, MA, United States
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, İstanbul, Türkiye
| | - Kezban Nur Pilanci
- Division of Medical Oncology, Department of Internal Medicine, Memorial Bahçelievler Hospital, İstanbul, Türkiye
| | | | - Erhan Gökmen
- Division of Medical Oncology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Türkiye
| | - Elvina Almuradova
- Division of Medical Oncology, Department of Internal Medicine, Tınaztepe Galen Bayraklı Hospital, Izmir, Türkiye
| | - Mustafa Özdoğan
- Division of Medical Oncology, Department of Internal Medicine, Akdeniz University, Antalya, Türkiye
| | - Nilüfer Güler
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Institute of Oncology, Ankara, Türkiye
| | - Cihan Uras
- Department of General Surgery, Acıbadem University, İstanbul, Türkiye
| | - Halil Kara
- Department of General Surgery, Acıbadem University, İstanbul, Türkiye
| | - Orhan Demircan
- Department of General Surgery, Çukurova University School of Medicine, Adana, Türkiye
| | - Selver Işık
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Türkiye
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Türkiye
| | - Pınar Saip
- Division of Medical Oncology, Department of Internal Medicine, İstanbul University Institute of Oncology, İstanbul, Türkiye
| | - Esra Aydın
- Division of Medical Oncology, Department of Internal Medicine, İstanbul University Institute of Oncology, İstanbul, Türkiye
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İstanbul Bilgi University, İstanbul, Türkiye
| | - Filiz Çelebi
- Department of Radiology, Yeditepe University Hospital, İstanbul, Türkiye
| | - Kanay Yararbaş
- Department of Medical Genetics, Demiroglu Bilim University, İstanbul, Türkiye
| | - Gursel Soybir
- Department of General Surgery, Memorial Şişli Hospital, Istanbul, Türkiye
| | - Vahit Ozmen
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Türkiye
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9
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Turkyilmaz Z, Sarisik E, Ozkurt E, Tukenmez M, Emiroglu S, Emiroglu B, Onder S, Yilmaz R, Muslumanoglu M, Igci A, Ozmen V, Cabioglu N. Evaluation of Benign Breast Diseases With or Without Atypical Epithelial Hyperplasia Accompanying Radial Scars. Eur J Breast Health 2023; 19:166-171. [PMID: 37025577 PMCID: PMC10071881 DOI: 10.4274/ejbh.galenos.2023.2022-10-4] [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: 10/19/2022] [Accepted: 02/28/2023] [Indexed: 04/05/2023]
Abstract
Objective: A radial scar (RS) is a benign breast lesion (BBL) that has an obscure etiology. RS is easily confused with breast carcinoma and therefore correct identification radiologically and pathologically is important. The aim of this study was to determine the incidence of atypical lesions by evaluating RS detected with BBL and to investigate whether atypia and RS are related to their characteristics. Materials and Methods: A total of 1.370 patients with a diagnosis of BBL postoperatively in a single department were analyzed retrospectively. Forty-six confirmed RS/complex sclerosing lesion (CSL) cases were selected. The demographic and clinical characteristics of the patients and the relationship between RS and other BBL were evaluated. In addition, the relationship between RS/CSL and the presence of atypia was interpreted. Results: The mean age was 45.17±8.72 years. Spiculated lesion (34.8%) on mammography and microcalcification (37%) on histopathological examination were the most common features. The most common BBL accompanying RS/CSL was adenosis. Atypical epithelial hyperplasia (AEH) was presented in 15 (32.6%) of those diagnosed with RS. Although all patients were benign, the frequency of AEH accompanying RS was found to be significantly higher. The mean size of RS was 10.8±8.4 mm (2-30 mm). The size of RS/CSL was not significantly associated with atypia. Conclusion: RS/CSLs usually present as suspicious lesions that must be distinguished radiologically from malignancy. However RS, which can be present with malign breast lesions, can be also seen with all BBL. Therefore, core biopsy and/or excisional biopsy continue to be important for definitive histopathological diagnosis.
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Affiliation(s)
- Zeliha Turkyilmaz
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
- * Address for Correspondence: E-mail:
| | - Elif Sarisik
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Enver Ozkurt
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Tukenmez
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selman Emiroglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baris Emiroglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ravza Yilmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abdullah Igci
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vahit Ozmen
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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10
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Emiroglu S, Abuaisha AM, Tukenmez M, Cabioglu N, Bayram A, Ozmen V, Muslumanoglu M. Pure Tubular Breast Carcinoma: Clinicopathological Characteristics and Clinical Outcomes. Eur J Breast Health 2023; 19:115-120. [PMID: 37025580 PMCID: PMC10071886 DOI: 10.4274/ejbh.galenos.2023.2022-12-9] [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: 01/04/2023] [Accepted: 02/09/2023] [Indexed: 04/05/2023]
Abstract
Objective: Tubular breast carcinoma (TBC) is a rare subtype of breast carcinoma (BC) with a good prognosis. In this study, we aimed to assess the clinicopathological characteristics of pure TBC (PTBC), analyze factors that may influence long-term prognosis, examine the frequency of axillary lymph node metastasis (ALNM), and discuss the need for axillary surgery in PTBC. Materials and Methods: Fifty-four Patients diagnosed with PTBC between January 2003 and December 2020 at Istanbul Faculty of Medicine were included. Clinicopathological, surgical, treatment, and overall survival (OS) data were analyzed. Results: A total of 54 patients with a mean age of 52.2 years were assessed. The mean size of the tumor was 10.6 mm. Four (7.4%) patients had not undergone axillary surgery, while thirty-eight (70.4%) had undergone sentinel lymph node biopsy and twelve (22.2%) had undergone axillary lymph node dissection (ALND). Significantly, four (33.3%) of those who had undergone ALND had tumor grade 2 (p = 0.020) and eight of them (66.7%) had ALNM. Fifty percent (50%) of patients who were treated with chemotherapy had grade 2 and multifocal tumors and ALNM. Moreover, the frequency of ALNM was higher in patients with tumor diameters greater than 10 mm. Median follow-up time was 80 months (12–220). None of the patients had locoregional recurrence, but one patient had systemic metastasis. Furthermore, five-year OS was 97.9%, while ten-year OS was 93.6%. Conclusion: PTBC is associated with favorable prognosis, good clinical outcomes and high survival rate, with rare recurrences and metastases.
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Affiliation(s)
- Selman Emiroglu
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- * Address for Correspondence: E-mail:
| | - Asmaa Mahmoud Abuaisha
- Department of Genetics, Institute of Health Sciences, Istanbul University, Istanbul, Turkey
| | - Mustafa Tukenmez
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysel Bayram
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vahit Ozmen
- Breast Surgery Unit, Department of General Surgery, Grup Florence Nightingale Hospital, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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11
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Cabıoğlu N, Karanlik H, Gulcelik MA, İgci A, Muslumanoglu M, Kocer HB, Uras C, Akgul GG, Tukenmez M, Ilgun S, Trabulus DC, Cakmak GK, Dağ A, Yıldirim N, Zengel B, Oran ES, Senol K, Kara H, Emiroglu S, Ugurlu MU, Citgez B, Ersoy YE, Celik A, Dilege E, Bolukbaşı Y, Karaman N, Basaran G, Soyder A, Polat AK, Sakman G, Ozbas S, Altınok A, Zer L, Akcan A, Ozemir IA, Yeniay L, Utkan NZ, Dogan L, Dogan M, Velidedeoglu M, Ozcinar B, Erozgen F, Kebudi A, Atahan K, Valiyeva V, Yormaz S, Sevinc A, Arici C, Soran A, Ozmen V. Abstract PD15-01: PD15-01 AXILLARY NODAL RECURRENCE IS RARE IN PATIENTS WITH NODE-POSITIVE BREAST CANCER UNDERGOING SLNB FOLLOWING NEOADJUVANT CHEMOTHERAPY : EARLY RESULTS OF THE NEOSENTITURK-TRIAL/MF-18-03. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd15-01] [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: 03/06/2023]
Abstract
Abstract
Background: Whether axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB) could be spared in patients with initially clinically positive axilla after neoadjuvant chemotherapy (NAC) is still controversial even though recent studies indicate that axillary recurrence seems to be a rare event. Our aim is to find out whether omitting ALND could be oncologically safe in patients undergoing SLNB after NAC.
Material and Methods: Of patients presented with c T1-4N1-3M0 disease, those undergoing SLNB after NAC were included in the prospective multicentre registry trial " MF18-03/BHWG" (ClinicalTrials.gov/NCT04250129). Cases with inflammatory breast cancer, distant metastases, pregnancy, bilateral breast cancer, or other cancers and those without adjuvant nodal radiotherapy were excluded from the study. The end points of the present report are the axillary nodal recurrence (AR) and locoregional recurrence (LRR) rates at a median follow-up more than 2 years, and determine factors associated with AR and LRR . The locoregional recurrences included ipsilateral, and contralateral axillary recurrences, infra-and supraclavicular recurrences, and recurrences in the mammaria interna region.
Results: Between January 2018 to January 2021, 2358 patients with cN(+) disease, who became cN0 after NAC, and underwent SLNB, were analyzed. Median age was 47 (range, 21-86). Of those, the majority of patients had cT1-2 (80.5%) and N1 (80.3%) disease. Following NAC, half of the patients (50%) had breast conserving surgery, whereas the remaining half had mastectomy (50%). Of 2358 patients, 908 (38.5%) had ALND following SLN (ypN+, 85%) and 1450 (61.5%) underwent SLNB alone (ypN0, 72%). SLNB was performed by using the blue dye technique-alone in 66.6% of patients and by targeted axillary dissection in 659 patients (27.9%). Of those, 819 (34.8%) were HER2(+) and 373 (15.8%) were triple negative. The pCR rates for the axilla, breast and both for the axilla and breast were 50%, 35% and 28%, respectively. At a median follow-up time of 28 months (range, 12-62), the LRR, AR and isolated AR rates were 0.6% (n=14), 0.25% (n=6) and 0.13% (n=3), respectively. Furthermore, no significant difference could be found in LRR- and AR- rates between SLNB-alone and ALND groups regardless of the definitive nodal pathology (Table 1). Nodal recurrences were seen at a median of 12 months after the surgery. Of 6 cases with AR, 3 had synchronous local recurrences in breast, and 2 of them also had lung metastases in addition to local recurrence. All patients with AR were interestingly found to have HER2(+) or triple negative breast cancer at the initial diagnosis, and had residual invasive cancer in the breast surgical specimen. Logistic regression analyses revealed that patients with AR were significantly more likely to be younger than 45 (RR=7.81 ; 95% CI, 0.91-66.91) and have a cN2-3 (RR=4.1; 95% CI, 0.83-20.38), and non-luminal breast cancer (RR=12.47; 95% CI, 1.45-106.9) at the initial diagnosis (Table 2). Similarly, patients with LRR were more likely to present with cN2-3 disease (RR=3.09; 95% CI, 1.07-8.94) and non-luminal pathology (RR=6.27; 95%CI, 1.96-20.06) .
Conclusion: This large prospective registry data also suggest that nodal recurrences can be detected at very low rates within 3 years after surgery in patients with clinically node-positive disease following NAC regardless of the extent of axillary surgery or nodal pathology as long as regional nodal radiation is provided. Since patients with early nodal recurrences have an agressive tumor biology with a potential of systemic recurrences, effective adjuvant systemic therapies should be considered in those with HER2(+) or triple negative residual breast cancer after surgery following adjuvant nodal radiation.
Table 1. Local locoregoinal and systemic recurrences in cT1-4N1-3 patients with ypN0/ypN(+) diseases (n =2358)
Table 2. Factors associated with axillary and locoregoinal recurrences (AR = axillary recurrences, LRR = locoregoinal recurrences, pCR = pathologic complete response)
Citation Format: Neslihan Cabıoğlu, Hasan Karanlik, Mehmet Ali Gulcelik, Abdullah İgci, Mahmut Muslumanoglu, Havva Belma Kocer, Cihan Uras, Gokhan Giray Akgul, Mustafa Tukenmez, Serkan Ilgun, Didem Can Trabulus, Guldeniz Karadeniz Cakmak, Ahmet Dağ, Nilufer Yıldirim, Baha Zengel, Ebru Sen Oran, Kazim Senol, Halil Kara, Selman Emiroglu, M. Umit Ugurlu, Bulent Citgez, Yeliz Emine Ersoy, Atilla Celik, Ece Dilege, Yasemin Bolukbaşı, Niyazi Karaman, Gul Basaran, Aykut Soyder, Ayfer Kamali Polat, Gurhan Sakman, Serdar Ozbas, Ayse Altınok, Leyla Zer, Alper Akcan, Ibrahim Ali Ozemir, Levent Yeniay, N. Zafer Utkan, Lutfi Dogan, Mutlu Dogan, Mehmet Velidedeoglu, Beyza Ozcinar, Fazilet Erozgen, Abut Kebudi, Kemal Atahan, Vafa Valiyeva, Serdar Yormaz, Ali Sevinc, Cumhur Arici, Atilla Soran, Vahit Ozmen. PD15-01 AXILLARY NODAL RECURRENCE IS RARE IN PATIENTS WITH NODE-POSITIVE BREAST CANCER UNDERGOING SLNB FOLLOWING NEOADJUVANT CHEMOTHERAPY : EARLY RESULTS OF THE NEOSENTITURK-TRIAL/MF-18-03 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD15-01.
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Affiliation(s)
- Neslihan Cabıoğlu
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Bakırköy, Turkey
| | - Hasan Karanlik
- 2Istanbul University Institute of Oncology, Department of Surgical Oncology, Istanbul, Turkey, Istanbul, Turkey
| | - Mehmet Ali Gulcelik
- 3University of Health Sciences, Gulhane Hospital, Department of Surgery, Turkey
| | - Abdullah İgci
- 4American Hospital,Department of Surgery, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- 5Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Turkey
| | | | - Cihan Uras
- 7Acibadem University, School of Medicine, Department of Surgery
| | - Gokhan Giray Akgul
- 8University of Health Sciences, Gulhane Hospital, Department of Surgery, Turkey
| | - Mustafa Tukenmez
- 9Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Turkey
| | - Serkan Ilgun
- 10Florence Nightingale Hospital, Department of Surgery, Turkey
| | | | | | - Ahmet Dağ
- 13Mersin University, Faculty of Medicine, Department of Surgery, Turkey
| | | | - Baha Zengel
- 15University of Health Sciences, İzmir Bozyaka Hospital, Department of Surgery
| | - Ebru Sen Oran
- 16Basaksehir State Hospital, Department of Surgery, Istanbul, Turkey
| | - Kazim Senol
- 17Uludag University, Faculty of Medicine, Department of Surgery, Turkey
| | - Halil Kara
- 18Acibadem University, Faculty of Medicine, Department of Surgery
| | - Selman Emiroglu
- 19Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Turkey
| | - M. Umit Ugurlu
- 20Marmara University School of Medicine, Department of Surgery, Istanbul, Turkey, Istanbul, Turkey
| | | | | | - Atilla Celik
- 23Bagcilar State Hospital, Department of Surgery, Turkey
| | - Ece Dilege
- 24Koç University, Faculty of Medicine, Department of Surgery, Turkey
| | - Yasemin Bolukbaşı
- 25Koç University, Faculty of Medicine, Department of Radiation Oncology, Turkey
| | - Niyazi Karaman
- 26Ankara Oncology Hospital, Department of Surgery, Turkey
| | - Gul Basaran
- 27Acibadem University School of Medicine, Altunizade Hospital Breast Health Center, Turkey
| | - Aykut Soyder
- 28Acibadem University, Faculty of Medicine, Department of Surgery, Turkey
| | - Ayfer Kamali Polat
- 29Ondokuz Mayis University, Faculty of Medicine, Department of Surgery, Samsun, Turkey
| | - Gurhan Sakman
- 30Çukurova University, Faculty of Medicine, Adana, Turkey
| | | | - Ayse Altınok
- 32Bahcesehir University, Facult of Medicine, Department of Radiation Oncology, Turkey
| | - Leyla Zer
- 33Florence Nightingale Atasehir Hospital, Turkey
| | - Alper Akcan
- 34Erciyes University, Faculty of Medicine, Department of Surgery, Turkey
| | - Ibrahim Ali Ozemir
- 35Istanbul Medeniyet University, Goztepe Hospital, Department of Surgery, Turkey
| | - Levent Yeniay
- 36Ege University, Faculty of Medicine, Department of Surgery, İzmir, Turkey
| | - N. Zafer Utkan
- 37Kocaeli University, Faculty of Medicine, Department of Surgery, Turkey
| | | | - Mutlu Dogan
- 39Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital
| | - Mehmet Velidedeoglu
- 40Istanbul University Cerrahpasa Faculty of Medicine, Department of Surgery, Turkey
| | - Beyza Ozcinar
- 41Istanbul University Istanbul Medical Faculty, Turkey
| | - Fazilet Erozgen
- 42Health Sciences University, Haseki Hospital, Department of Surgery, Turkey
| | - Abut Kebudi
- 43Okan University, Faculty of Medicine, Department of Surgery, Turkey
| | - Kemal Atahan
- 44İzmir Katip Celebi Universitesi, Department of Surgery, Turkey
| | - Vafa Valiyeva
- 45Azerbaijan Medical University, Oncologic Clinic, Department of Breast Surgery
| | - Serdar Yormaz
- 46Selcuk University, Faculty of Medicine, Department of Surgery
| | - Ali Sevinc
- 47Dokuz Eylul Hospital, Faculty of Medicine, Department of Surgeryİzmir, Turkey
| | - Cumhur Arici
- 48Akdeniz University, Faculty of Medicine, Department of Surgery
| | - Atilla Soran
- 49UPMC Department of Surgery, Breast Health Working Group International
| | - Vahit Ozmen
- 50Florence Nightingale Sisli Hospital, Department of Surgery, Istanbul, Turkey
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12
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Emiroglu S, Özkurt E, Cabıoglu N, Igci A, Saip P, Yazici H, Ozmen T, Ozmen V, Muslumanoglu M, Tukenmez M. Is Breast Conserving Surgery Efficacious in Breast Cancer Patients with BRCA1 or BRCA2 Germline Mutation? Breast Cancer (Dove Med Press) 2023; 15:163-173. [PMID: 36852260 PMCID: PMC9960707 DOI: 10.2147/bctt.s395054] [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] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
Background The optimal surgical therapy for newly diagnosed breast cancer with germline mutations in susceptibility genes is still uncertain for many physicians. In this study, we aimed to determine the efficacy of breast conserving surgery (BCS) in breast cancer patients with BRCA1 or BRCA2 mutation by assessing its outcomes and locoregional recurrence (LR) rates. Materials and Methods Seventy-five patients operated with BCS or mastectomy for breast cancer between 2006 and 2017 and had BRCA1 or BRCA2 mutation were included in the study. Effects of the performed breast surgery and clinicopathological characteristics on surgical outcomes, LR rates and survival were analyzed with showing the distribution of BRCA1 and BRCA2 germline mutations. Results The median age of the patients was 42 years (20-77). BRCA1 mutations were found in 46 (61.3%) patients and BRCA2 mutations in 29 (38.7%) patients. Compared to BRCA2 carriers, BRCA1 carriers were more likely to have higher tumor grade (84.8% vs 44.8%; p = 0.001) and non-luminal subtype tumors (67.4% vs 13.8%; p = 0.001). A total of 44 (58.7%) patients underwent unilateral mastectomy and 31 (41.3%) patients underwent BCS. At a median follow-up time of 60 (12-240) months, LR was observed in 6 patients equally divided in both BCS and mastectomy groups. LR rates were slightly higher after BCS versus mastectomy (9.7% and 6.8%, respectively). Additionally, there were no statistically significant differences in disease-free survival (DFS) and disease-specific survival (DSS) rates after 10 years in the BCS group versus the mastectomy group (p = 0.117 and 0.109, respectively), but in fact, the rates were better in the BCS group. Conclusion Our findings indicate that BCS may serve as an efficacious alternative to mastectomy for breast cancer patients with BRCA1 or BRCA2 mutation. Additionally, tumor size, lymph node positivity, and TNM stage should be taken into consideration for a better surgical decision-making.
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Affiliation(s)
- Selman Emiroglu
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,Correspondence: Selman Emiroglu, Breast Surgery Service, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, 34390, Turkey, Email
| | - Enver Özkurt
- Department of Surgery, Ozel Basari Hospital, Istanbul, Turkey
| | - Neslihan Cabıoglu
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abdullah Igci
- Department of Surgery, American Hospital, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Hulya Yazici
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Tolga Ozmen
- Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Vahit Ozmen
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Tukenmez
- Breast Surgery Unit, Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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13
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Cabioglu N, Cetin Aktas E, Emiroglu S, Tukenmez M, Ozkurt E, Muslumanoglu M, Igci A, Ozmen V, Deniz G, Dinccag AS, Guven YI. Ozone therapy restores immune dysfunction in refractory idiopathic granulomatous mastitis as a novel potential therapeutic approach. Cell Biol Int 2023; 47:228-237. [PMID: 36378588 DOI: 10.1002/cbin.11953] [Citation(s) in RCA: 3] [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: 08/14/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
Immunological dysfunction has been suggested to play a major role in the pathogenesis of idiopathic granulomatous mastitis (IGM). We recently showed that ozone therapy was effective in patients with steroid-resistant IGM. This study assessed alterations in intracellular cytokine expression patterns in different T-lymphocyte subsets after ozone therapy in refractory IGM. Peripheral blood T lymphocyte subsets (CD8+ , CD4+ , CD4+ CD25+ CD127- ) were analyzed via flow-cytometry for intracellular cytokine expressions IFN-γ, TNF-α, IL-10, and TGF-β before and after completion of 4-month systemic ozone therapy. Ozone therapy significantly increased the CD4+ IFN-γ+ (p = 0.032), CD4+ TNF-α+ (p = 0.028), and the CD8+ TNF-α+ (p = 0.012) T cells. In contrast, significant decreases in CD4+ IL-10+ (p = 0.047) and CD8+ IL-10+ T cells (p = 0.022) and CD4+ CD25+ CD127-//low Treg cells secreting TGF-β (p = 0.005) were found after ozone therapy. When patients were analyzed according to the response to ozone therapy, patients with a complete remission were more likely to have increased CD3- CD16+ CD56+ natural killer cells (p = 0.0027) and decreased CD19+ B lymphocytes (p = 0.046) following ozone therapy. Our results suggest that ozone therapy stimulated a T-helper-1 response associated with IFN-γ production and downregulation of TGF-β expression in CD4+ CD25+ CD127- Treg cells. These alterations in the immune system following ozone therapy can improve wound healing and restore immune dysfunction in patients with refractory IGM.
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Affiliation(s)
- Neslihan Cabioglu
- Breast Surgery Service, Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esin Cetin Aktas
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Selman Emiroglu
- Breast Surgery Service, Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Tukenmez
- Breast Surgery Service, Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Enver Ozkurt
- Department of Surgery, Ozel Basari Hospital, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Breast Surgery Service, Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abdullah Igci
- Breast Surgery Service, Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Surgery, American Hospital, Istanbul, Turkey
| | - Vahit Ozmen
- Breast Surgery Service, Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Surgery, Florence Nightingale Hospital, Istanbul, Turkey
| | - Gunnur Deniz
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet S Dinccag
- Breast Surgery Service, Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yusuf I Guven
- Continuing Medical Education, Medipol University, Istanbul, Turkey
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14
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Mollavelioglu B, Cetin Aktas E, Cabioglu N, Abbasov A, Onder S, Emiroglu S, Tükenmez M, Muslumanoglu M, Igci A, Deniz G, Ozmen V. High co-expression of immune checkpoint receptors PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT on tumor-infiltrating lymphocytes in early-stage breast cancer. World J Surg Oncol 2022; 20:349. [PMID: 36271406 DOI: 10.1186/s12957-022-02810-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/08/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
High expression of immune checkpoint receptors (ICRs) in the tumor microenvironment regulates the anti-tumor response. In this study, the differential expressions of ICRs on tumor-infiltrating lymphocytes (TILs) in patients with early-stage breast cancer were investigated.The study included 32 patients who underwent surgery with a diagnosis of early-stage breast cancer between September 2018 and March 2020. TIL isolation was performed using a MACS tumor separation device and tumor separation kit. PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT expression of cytotoxic T and natural killer (NK) cells on TILs and peripheral blood lymphocytes (PBLs) were determined by flow cytometry.Patients with a high Ki-67 index, high TIL density, and HER-2 positivity were more likely to have increased CD16+CD56dim NK cells on TILs. Patients with T2 tumors were more likely to have increased expression of PD-1, LAG-3, and TIGIT on tumor-infiltrating CD8+ cytotoxic T cells than those with T1 tumors. PD-1, CTLA-4, TIGIT, LAG-3, and TIM-3 expression of CD8+ T and CD16-CD56bright NK cells in TILs showed significant positive correlations with each other. PD1+CD8+, TIGIT+CD16+, and CTLA-4+CD56+ cells in PBLs and TILs were found to be negatively correlated, whereas only TIM-3+ expression of CD8+ T and CD16+CD56dim cells in PBLs and TILs showed positive correlations.Our results suggest that CD16+CD56dim NK cells on TILs may play a major role in the immune response against HER2-positive or highly proliferating breast tumors in patients with early-stage breast cancer. Furthermore, various ICRs were found to be highly co-expressed with each other on TILs, including PD-1, CTLA-4, LAG-3, TIM-3, and TIGIT. These receptors may synergistically suppress the response to the tumor, which may trigger immune escape mechanisms in the early stage of carcinogenesis. However, ICR expressions other than TIM3 on PBLs were not found to accompany their counterparts on TILs.
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Affiliation(s)
- Baran Mollavelioglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Esin Cetin Aktas
- Department of Immunology, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Neslihan Cabioglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Aykhan Abbasov
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selman Emiroglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Mustafa Tükenmez
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Abdullah Igci
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey
| | - Gunnur Deniz
- Department of Immunology, Istanbul University, Aziz Sancar Institute of Experimental Medicine, Istanbul, Turkey
| | - Vahit Ozmen
- Istanbul Faculty of Medicine, Department of General Surgery, Istanbul University, Istanbul, Turkey.
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15
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Emiroglu S, Tukenmez M, Karakus S, Karanlik H, Onder S, Ozmen V, Cabioglu N, Ozkurt E, Yilmaz R, Muslumanoglu M. Pure Mucinous Breast Carcinoma With a Favorable Tumor Biology and Clinical Outcomes. Eur J Breast Health 2022; 18:353-359. [DOI: 10.4274/ejbh.galenos.2022.2022-8-1] [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] [Received: 08/27/2022] [Accepted: 09/09/2022] [Indexed: 12/01/2022]
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16
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Ilgun AS, Aktepe F, Gonullu O, Kapucuoglu N, Yararbas K, Alco G, Ozturk A, Elbuken Celebi F, Erdogan Z, Ordu C, Unal C, Duymaz T, Soybir G, Yavuz E, Tuzlali S, Ozmen V. The effect of neoadjuvant chemotherapy on tumor-infiltrating lymphocytes in patients with breast cancer. Future Oncol 2022; 18:3289-3298. [PMID: 36017739 DOI: 10.2217/fon-2022-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/21/2022] Open
Abstract
Aim: This study investigated the effect of neoadjuvant chemotherapy (NAC) on stromal tumor-infiltrating lymphocytes (sTILs) and their treatment response. Materials & methods: One hundred fifteen patients with pre-NAC core biopsies and post-NAC surgical resection specimens were reviewed. Results: There was no significant change between pre- and post-treatment sTILs. Both pre- and post-NAC sTILs were significantly lower in patients with luminal A subtype. An increase in sTILs was observed in 21 (25.9%) patients after NAC, a decrease in 29 (35.8%) and no change in 31 (38.3%; p = 0.07). Pretreatment sTIL density was independent predictor of pathological complete response in multivariate analyses (odds ratio: 1.025, 95% CI: 1.003-1.047; p = 0.023). Conclusion: High sTIL density in core biopsies was independently related to pathological complete response. In addition, ER appears to be the most crucial factor determining the rate of sTIL.
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Affiliation(s)
- Ahmet Serkan Ilgun
- Department of Surgery, Demiroglu Bilim University, Abide-i Hürriyet Cd No:164, Şişli/Istanbul, 34387, Turkey
| | - Fatma Aktepe
- Department of Pathology, Sisli Memorial Hospital, Istanbul, 34384, Turkey
| | - Onur Gonullu
- Department of Pathology, Sisli Etfal Training & Research Hospital, Istanbul, 34371, Turkey
| | - Nilgun Kapucuoglu
- Department of Pathology, Koc University Medical School, Istanbul, 34010, Turkey
| | - Kanay Yararbas
- Department of Medical Genetics, Demiroglu Bilim University, Istanbul, 34349, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Demiroglu Bilim University, Istanbul, 34349, Turkey
| | - Alper Ozturk
- Department of Surgery, Biruni University Medical School, Istanbul, 34295, Turkey
| | - Filiz Elbuken Celebi
- Department of Radiology, Yeditepe University Medical School, Istanbul, 34718, Turkey
| | - Zeynep Erdogan
- Physical Therapy & Rehabilitation Center, Medical Park Hospital, Istanbul, 34732, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Demiroglu Bilim University, Istanbul, 34349, Turkey
| | - Caglar Unal
- Department of Medical Oncology, Kartal Lutfi Kirdar Training & Research Hospital, Istanbul, 34865, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy & Rehabilitation, Bilgi University, Istanbul, 34060, Turkey
| | - Gursel Soybir
- Department of Surgery, Sisli Memorial Hospital, Istanbul, 34060, Turkey
| | - Ekrem Yavuz
- Tuzlali Pathology Laboratory, Istanbul, 34394, Turkey
| | - Sitki Tuzlali
- Tuzlali Pathology Laboratory, Istanbul, 34394, Turkey
| | - Vahit Ozmen
- Department of Surgery, Istanbul Florence Nightingale Hospital, Istanbul, 34387, Turkey
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17
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Ward SV, Burton A, Tamimi RM, Pereira A, Garmendia ML, Pollan M, Boyd N, Dos-Santos-Silva I, Maskarinec G, Perez-Gomez B, Vachon C, Miao H, Lajous M, López-Ridaura R, Bertrand K, Kwong A, Ursin G, Lee E, Ma H, Vinnicombe S, Moss S, Allen S, Ndumia R, Vinayak S, Teo SH, Mariapun S, Peplonska B, Bukowska-Damska A, Nagata C, Hopper J, Giles G, Ozmen V, Aribal ME, Schüz J, Van Gils CH, Wanders JOP, Sirous R, Sirous M, Hipwell J, Kim J, Lee JW, Dickens C, Hartman M, Chia KS, Scott C, Chiarelli AM, Linton L, Flugelman AA, Salem D, Kamal R, McCormack V, Stone J. The association of age at menarche and adult height with mammographic density in the International Consortium of Mammographic Density. Breast Cancer Res 2022; 24:49. [PMID: 35836268 PMCID: PMC9284807 DOI: 10.1186/s13058-022-01545-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/07/2022] [Accepted: 06/29/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk. METHODS Participants were 10,681 breast-cancer-free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemiologic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi-level linear regression models estimated changes in square-root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult height in pooled analyses and population-specific meta-analyses. Models were adjusted for age at mammogram, body mass index, menopausal status, hormone therapy use, mammography view and type, mammographic density assessor, parity and height/age at menarche. RESULTS In pooled analyses, later age at menarche was associated with higher per cent density (β√PD = 0.023 SE = 0.008, P = 0.003) and larger dense area (β√DA = 0.032 SE = 0.010, P = 0.002). Taller women had larger dense area (β√DA = 0.069 SE = 0.028, P = 0.012) and higher per cent density (β√PD = 0.044, SE = 0.023, P = 0.054), although the observed effect on per cent density depended upon the adjustment used for body size. Similar overall effect estimates were observed in meta-analyses across population groups. CONCLUSIONS In one of the largest international studies to date, later age at menarche was positively associated with mammographic density. This is in contrast to its association with breast cancer risk, providing little evidence of mediation. Increased height was also positively associated with mammographic density, particularly dense area. These results suggest a complex relationship between growth and development, mammographic density and breast cancer risk. Future studies should evaluate the potential mediation of the breast cancer effects of taller stature through absolute breast density.
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Affiliation(s)
- Sarah V Ward
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Anya Burton
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
- Translation Health Sciences, University of Bristol, Bristol, UK
| | - Rulla M Tamimi
- Population Health Sciences, Weill Cornell Medical College, Cornell University, New York, USA
| | - Ana Pereira
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | | | - Marina Pollan
- Cancer and Environmental Epidemiology Unit, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Norman Boyd
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Beatriz Perez-Gomez
- Cancer and Environmental Epidemiology Unit, Instituto de Salud Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hui Miao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Martín Lajous
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | - Ava Kwong
- Division of Breast Surgery, Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong, China
- Department of Surgery and Cancer Genetics Center, Hong Kong Sanatorium and Hospital, Pok Fu Lam, Hong Kong, China
- Hong Kong Hereditary Breast Cancer Family Registry, Pok Fu Lam, Hong Kong, China
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eunjung Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Huiyan Ma
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Sarah Vinnicombe
- Division of Cancer Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK
| | - Sue Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Steve Allen
- Department of Imaging, Royal Marsden NHS Foundation Trust, London, UK
| | - Rose Ndumia
- Aga Khan University Hospital, Nairobi, Kenya
| | | | - Soo-Hwang Teo
- Breast Cancer Research Group, University Malaya Medical Centre, University Malaya, Kuala Lumpur, Malaysia
- Cancer Research Malaysia, Subang Jaya, Malaysia
| | | | - Beata Peplonska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Łódź, Poland
| | - Agnieszka Bukowska-Damska
- Department of Physiology, Pathophysiology and Clinical Immunology,, Medical University of Lodz., Łódź, Poland
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - John Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Graham Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Vahit Ozmen
- Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Erkin Aribal
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Joachim Schüz
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Carla H Van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna O P Wanders
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Reza Sirous
- Radiology Department, George Washington University Hospital, Washington, DC, USA
| | - Mehri Sirous
- Radiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - John Hipwell
- Centre for Medical Image Computing, University College London, London, UK
| | - Jisun Kim
- Asan Medical Center, Seoul, Republic of Korea
| | | | - Caroline Dickens
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Kee-Seng Chia
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Christopher Scott
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Anna M Chiarelli
- Ontario Breast Screening Program, Cancer Care Ontario, Toronto, ON, Canada
| | - Linda Linton
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anath Arzee Flugelman
- National Cancer Control Center, Lady Davis Carmel Medical Center, Faculty of Medicine, Technion-Israel Institute Technology, Haifa, Israel
| | - Dorria Salem
- Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo, Egypt
| | - Rasha Kamal
- Woman Imaging Unit, Radiodiagnosis Department, Kasr El Aini, Cairo University Hospitals, Cairo, Egypt
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
| | - Jennifer Stone
- School of Population and Global Health, The University of Western Australia, Perth, Australia
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18
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Tsoulos N, Agiannitopoulos K, Pepe G, Papadopoulou E, Tsaousis GN, Apostolopoulou D, Meintani A, Venizelos V, Markopoulos C, Iosifidou R, Karageorgopoulou S, Christodoulou C, Natsiopoulos I, Papazisis K, Vasilaki-Antonatou M, Kabletsas E, Psyrri A, Giassas S, Ziogas D, Lalla E, Koumarianou A, Papadimitriou C, Ozmen V, Tansan S, Kaban K, Ozatlı T, Eniu DT, Chiorean A, Blidaru A, Nasioulas G. Abstract P2-09-10: Different CNVs account for 10.4% of pathogenic variants in 1418 patients referred for hereditary breast cancer testing. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-09-10] [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: Breast cancer is the most frequently diagnosed cancer in women and about 10% of breast cancer cases are hereditary. BRCA1 and BRCA2 are the genes most frequently associated with Hereditary Breast Cancer, although there are numerous other genes, such as PALB2, CHEK2 and ATM, that require to be considered as well. Germline Copy Number Variation (CNV) is one mutation type that is an important contributor to hereditary breast cancer. Nowadays, next-generation sequencing (NGS) technologies has contributed to multi-gene panel analysis used in clinical practice. Methods: In total, 1418 individuals were tested for breast cancer predisposition, using a solution-based capture approach. Targeted NGS was performed with a panel of 36 genes. The capture-based approach allowed for computational analysis of CNVs from NGS data. Results: We investigate the performance of the CNV module of the commercial software suite SeqPilot (JSI Medical Systems) and the non-commercial tool panelcn.MOPS. Both algorithms are specifically developed for CNV analysis of sequencing data reporting 99-100% sensitivity and up to 100% specificity for the prediction of CNVs up to the level of a single gene exon. All CNVs detected with these algorithms were then verified experimentally using the MLPA technique as an orthogonal assay. At least one pathogenic/likely pathogenic variant was identified in 289 samples (20.4%). CNVs accounted for 10.4% (30/289), referring to the deletion of one or more exons of a gene. Interestingly, 50% of deletions were single exon and approximately 36% of CNVs were detected in genes other than BRCA1/2. In specific, of the 30 CNVs detected, 60% occurred in BRCA1, 3.3% in BRCA2, 20% in CHEK2, 6.7% in FANCA, 6.7% in PMS2, and 3.3% in ATM. The majority of CNVs in BRCA1 were deletions of exons 19, 22, and 22-23 whereas deletions of exons 9-10 were the most common deletions in CHEK2. Detailed information of all CNVs detected is provided in Table 1.
Conclusions: Our results suggest that CNV analysis should not be restricted to BRCA1/2 due to the significant proportion of CNVs (36%) in additional breast cancer predisposition genes. Furthermore, in silico CNV detection tools provide a cost-effective and feasible methodology for the identification of CNVs from NGS experiments. This outlines the clinical utility of comprehensive genetic testing that includes full sequencing and CNV analysis in hereditary breast cancer facilitating personalized management decisions for patients.
Table 1.Pathogenic Copy Number Variations (CNVs) identified in this studyGeneHGVS nomenclatureOther nomenclature# detectedATMNM_000051:c.(-30+1_-29-1)_(331+1_332-1)deldeletion of exons 2-41BRCA1NM_007294:c.(5467+1_5468-1)-(*1_?)deldeletion of exon 237BRCA1NM_007294:c.(5406+1_5407-1)_(*1_?)deldeletion of exons 23-245BRCA1NM_007294:c.(5193+1_5194-1)-(5277+1_5278-1)deldeletion of exon 196BRCA2NM_000059:c.(6841+1_6842-1)_(7007+1_7008-1)deldeletion of exons 12-131CHEK2NM_007194:c.(908+1_909-1)_(1095+1_1096-1)deldeletion of exons 9-104CHEK2NM_007194:c.(792+1_793-1)_(846+1_847-1)deletion of exon 72FANCANM_000135:c.(1626+1_1627-1)_ (2852+1_2853-1)deldeletion of exons 18-291FANCANM_000135:c.(893+1_894-1)_(1359+1_1360-1)deldeletion of exons 11-141PMS2NM_000535: c.(903+1_904-1)_(988+1_989-1)deldeletion of exon 91PMS2NM_000535:c.(705+1_706-1)_(2006+1_2007-1)deldeletion of exons 7-111
Citation Format: Nikolaos Tsoulos, Konstantinos Agiannitopoulos, Georgia Pepe, Eirini Papadopoulou, Georgios N Tsaousis, Despina Apostolopoulou, Angeliki Meintani, Vassileios Venizelos, Christos Markopoulos, Rodoniki Iosifidou, Sofia Karageorgopoulou, Christos Christodoulou, Ioannis Natsiopoulos, Konstantinos Papazisis, Maria Vasilaki-Antonatou, Eleftherios Kabletsas, Amanta Psyrri, Stylianos Giassas, Dimitrios Ziogas, Efthalia Lalla, Anna Koumarianou, Christos Papadimitriou, Vahit Ozmen, Sualp Tansan, Kerim Kaban, Tahsin Ozatlı, Dan Tudor Eniu, Angelica Chiorean, Alexandru Blidaru, George Nasioulas. Different CNVs account for 10.4% of pathogenic variants in 1418 patients referred for hereditary breast cancer testing [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-09-10.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vahit Ozmen
- Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | | | | | - Dan Tudor Eniu
- Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania
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19
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Cabioglu N, Karanlık H, Igci A, Muslumanoglu M, Tukenmez M, Emiroglu S, Ozkurt E, Onder S, Saip P, Eralp Y, Aydiner A, Yavuz E, Ozmen V. Abstract P1-01-07: Factors predicting a lower likelihood of residual nodal disease in clinically-node positive patients undergoing sentinel node surgery after neoadjuvant chemotherapy for breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-01-07] [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: Residual nodal disease at the completion axillary lymph node dissection (ALND) has been reported in over 60% in patients with a positive sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC). This study aimed to explore whether any clinical or histopathological characteristics of patients may be associated with a lower likelihood of having non-SLN metastasis at ALND. Methods: Between January 2004 to January 2021, 459 patients with cT1-4/N1-3 underwent ALND due to a positive SLNB after NAC. Demographic, clinical and histopathological characteristics of patients were analyzed to predict the non-SLN metastasis at ALND. Sentinel lymph node ratio was defined as the ratio of the number of positive SLN to the total excised SLNs. Results: Median age was 47 (21-84). Of those, the majority of the patients had cT1-2 (67.8%) and cN1 disease (78.1%), whereas 76.5% of tumors were invasive ductal carcinoma. The frequency of non-SLN metastases according to the tumor subtypes were 59.5% in luminal A, 73.8% in HER2(-) luminal B, 60.3% in HER2(+) luminal B, 66.7% in non-luminal HER2(+), and 66.7% in triple negative breast carcinoma. Of those with removal more than 2 SLNs, having 1 positive SLN, or breast pathologic complete response, or cT1-2 disease , or a SLN ratio <50% or low volume metastatic disease including isolated tumor cell (ITC)/micrometastasis were statistically less likely found to have a non-SLN metastasis (p<0.05). Factors associated with a non-SLN involvement less than 40% were a SLN ratio <50% (39.2%) and low volume metastatic disease (36.4%). Multivariate logistic regression analysis revealed a decreased likelihood for non-SLN metastasis at ALND for patients with cT1-2 (OR= 0.45; 95% CI: 0.25-0.82; p=0.009), ITC and micrometastasis (OR=0.24; 95% CI: 0.09-0.65; p=0.006), and a SLN-ratio <50% ((OR=0.15; 95% CI: 0.08-0.26; p<0.001). A subgroup of patients with cT1-2/N1 having a SLN ratio <50% or ITC/micrometastasis were found to have 25.9% and 28.6% non-SLN positivity at ALND, respectively. Conclusions: In patients with a positive SLN after NAC, the likelihood of having residual disease at ALND was high across all tumor subtypes and clinical patient and tumor characteristics. However, the residual nodal disease rate was found to be lower than 30% in carefully selected patient subgroups with cT1-2/N1 along with ITC/micrometastasis or a SLN ratio <50% (Table 1) . These results suggest omission of ALND could be considered in meticulously selected patients with cT1-2 and low volume metastatic disease as long as axillary radiation and effective systemic treatment provided Table 1. Factors associated with non-SLN metastasis at ALND
FactorsOR(95%CI)p-valuecT0.009*1&20.45(0.25-0.82)3&4Reference (1)SLN Status0.006*ITC and micrometastasis0.24(0.09-0.65)MacrometastasisReference (1)SLN-Ratio (%)<0.001*<50%Reference(1)≥50%0.15(0.08-0.26)*:p<0.05, Logistic regression(enter method), OR:Odds Ratio; Dependent variable:Non-SLN positivity
Citation Format: Neslihan Cabioglu, Hasan Karanlık, Abdullah Igci, Mahmut Muslumanoglu, Mustafa Tukenmez, Selman Emiroglu, Enver Ozkurt, Semen Onder, Pinar Saip, Yesim Eralp, Adnan Aydiner, Ekrem Yavuz, Vahit Ozmen. Factors predicting a lower likelihood of residual nodal disease in clinically-node positive patients undergoing sentinel node surgery after neoadjuvant chemotherapy for breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-07.
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Affiliation(s)
- Neslihan Cabioglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Hasan Karanlık
- Istanbul University, Institute of Oncology, Surgical Oncology Division, Istanbul, Turkey
| | - Abdullah Igci
- American Hospital, Department of Surgery, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Mustafa Tukenmez
- Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Selman Emiroglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Enver Ozkurt
- Ozel Basari Hospital, Department of Surgery, Istanbul, Turkey
| | - Semen Onder
- Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Pinar Saip
- Istanbul University, Institute of Oncology, Department of Medical Oncology, Istanbul, Turkey
| | - Yesim Eralp
- Acibadem Maslak Hospital, Acibadem Health Group, Istanbul, Turkey
| | - Adnan Aydiner
- Istanbul University, Institute of Oncology, Department of Medical Oncology, Istanbul, Turkey
| | - Ekrem Yavuz
- Tuzlali Pathology Laboratory, Istanbul, Turkey
| | - Vahit Ozmen
- Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
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Ozmen V, Caglayan A, Yararbas K, Ordu C, Aktepe F, Ozmen T, Ilgun A, Soybir G, Alco G, Tsaousis G, Papadopoulou E, Agiannitopoulos K, Pepe G, Kampouri S, Nasioulas G, Sezgin E, Soran A. Importance of multigene panel test in patients with consanguineous marriage and family history of breast cancer. Oncol Lett 2022; 23:118. [PMID: 35261632 PMCID: PMC8855161 DOI: 10.3892/ol.2022.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/06/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vahit Ozmen
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey
| | - Ahmet Caglayan
- Department of Medical Genetics, Dokuz Eylul University, Izmir 35330, Turkey
| | - Kanay Yararbas
- Department of Medical Genetics, Demiroglu Bilim University, Istanbul 34403, Turkey
| | - Cetin Ordu
- Medical Oncology, Demiroglu Bilim University, Istanbul 34403, Turkey
| | - Fatma Aktepe
- Department of Pathology, Memorial Hospital, Istanbul 34385, Turkey
| | - Tolga Ozmen
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33127, USA
| | - Ahmet Ilgun
- Department of Surgery, Demiroglu Bilim University, Istanbul 34403, Turkey
| | - Gursel Soybir
- Department of Surgery, Memorial Hospital, Istanbul 34385, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Demiroglu Bilim University, Istanbul 34403, Turkey
| | | | | | | | | | | | | | - Efe Sezgin
- Department of Food Engineering, Faculty of Engineering, Izmir Institute of Technology, Izmir 35430, Turkey
| | - Atilla Soran
- Department of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA 15260, USA
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21
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Kizildag Yirgin I, Koyluoglu YO, Seker ME, Ozkan Gurdal S, Ozaydin AN, Ozcinar B, Cabioğlu N, Ozmen V, Aribal E. Diagnostic Performance of AI for Cancers Registered in A Mammography Screening Program: A Retrospective Analysis. Technol Cancer Res Treat 2022; 21:15330338221075172. [PMID: 35060413 PMCID: PMC8796113 DOI: 10.1177/15330338221075172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate the performance of an artificial intelligence (AI) algorithm in a simulated screening setting and its effectiveness in detecting missed and interval cancers. Methods: Digital mammograms were collected from Bahcesehir Mammographic Screening Program which is the first organized, population-based, 10-year (2009-2019) screening program in Turkey. In total, 211 mammograms were extracted from the archive of the screening program in this retrospective study. One hundred ten of them were diagnosed as breast cancer (74 screen-detected, 27 interval, 9 missed), 101 of them were negative mammograms with a follow-up for at least 24 months. Cancer detection rates of radiologists in the screening program were compared with an AI system. Three different mammography assessment methods were used: (1) 2 radiologists’ assessment at screening center, (2) AI assessment based on the established risk score threshold, (3) a hypothetical radiologist and AI team-up in which AI was considered to be the third reader. Results: Area under curve was 0.853 (95% CI = 0.801-0.905) and the cut-off value for risk score was 34.5% with a sensitivity of 72.8% and a specificity of 88.3% for AI cancer detection in ROC analysis. Cancer detection rates were 67.3% for radiologists, 72.7% for AI, and 83.6% for radiologist and AI team-up. AI detected 72.7% of all cancers on its own, of which 77.5% were screen-detected, 15% were interval cancers, and 7.5% were missed cancers. Conclusion: AI may potentially enhance the capacity of breast cancer screening programs by increasing cancer detection rates and decreasing false-negative evaluations.
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Affiliation(s)
| | | | | | | | | | - Beyza Ozcinar
- Istanbul University, School of Medicine, Istanbul, Turkey
| | | | - Vahit Ozmen
- Istanbul University, School of Medicine, Istanbul, Turkey
| | - Erkin Aribal
- Acibadem M.A.A University School of Medicine, Istanbul, Turkey
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22
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Ilgun AS, Sarsenov D, Alco G, Ozturk A, Agacayak F, Elbuken F, Erdogan Z, Pilanci KN, Ordu C, Aktepe F, Soybir G, Ozmen V. Long-Term Survival Effects of Preoperative Breast MRI in Patients with Breast-Conserving Surgery. Acta Clin Croat 2022; 61:30-37. [PMID: 36398075 PMCID: PMC9616035 DOI: 10.20471/acc.2022.61.01.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
The benefit of breast magnetic resonance imaging (MRI) in breast-conserving surgery (BCS) is unclear. Our study compared breast cancer patients with and without preoperative breast MRI and their long-term oncologic outcomes are reported. A total of 1378 BCS cases with early breast cancer between 1996 and 2017 were reviewed. Patients with carcinoma in situ or neoadjuvant treatment or having breast MRI after tumor excision were excluded. Of 1378 patients, 270 (19.5%) had preoperative MRI. There were no significant differences regarding T and N stage and molecular subtypes between the groups. Surgical margins were significantly wider in the breast MRI group. Five-year overall survival (OS) was 96.9% in the MRI group and 94.3% in the control group, and this difference was not significant (p=0.11). Five-year local-regional recurrence-free survival (LRFS) was not significantly different either (98.8% and 96.5%, respectively, p=0.41). When analyses were repeated only for patients with hormone receptor-negative or triple-negative breast cancer, there was still no significant difference in OS, LRFS, or disease-free survival. In conclusion, MRI does not seem necessary in all patients undergoing BCS. New prospective randomized controlled trials are needed to determine appropriate use of preoperative MRI and its effects on oncologic outcomes in early breast cancer patients.
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Affiliation(s)
| | | | - Gul Alco
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Alper Ozturk
- Department of Surgery, Biruni University Medical School, Istanbul, Turkey
| | - Filiz Agacayak
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Elbuken
- Department of Radiology, Yeditepe University Medical School, Istanbul, Turkey
| | - Zeynep Erdogan
- Physical Therapy and Rehabilitation Center, Biruni University Medical School, Istanbul, Turkey
| | - Kezban Nur Pilanci
- Department of Medical Oncology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Sisli Memorial Hospital, Istanbul, Turkey
| | - Gursel Soybir
- Department of Surgery, Sisli Memorial Hospital, Istanbul, Turkey
| | - Vahit Ozmen
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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23
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Tsaousis GN, Papadopoulou E, Agiannitopoulos K, Pepe G, Tsoulos N, Boukovinas I, Floros T, Iosifidou R, Katopodi O, Koumarianou A, Markopoulos C, Papazisis K, Venizelos V, Kapsimalis A, Xepapadakis G, Psyrri A, Banu E, Eniu DT, Blidaru A, Stanculeanu DL, Ungureanu A, Ozmen V, Tansan S, Tekinel M, Yalcin S, Nasioulas G. Revisiting the Implications of Positive Germline Testing Results Using Multi-gene Panels in Breast Cancer Patients. Cancer Genomics Proteomics 2021; 19:60-78. [PMID: 34949660 DOI: 10.21873/cgp.20304] [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: 07/12/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/AIM The use of multi-gene panels for germline testing in breast cancer enables the estimation of cancer risk and guides risk-reducing management options. The aim of this study was to present data that demonstrate the different levels of actionability for multi-gene panels used in genetic testing of breast cancer patients and their family members. MATERIALS AND METHODS We performed an analysis in our clinical database to identify breast cancer patients undergoing genetic testing. We reviewed positive results in respect of risk estimation and management, cascade family testing, secondary findings and information for treatment decision-making. RESULTS A total of 415 positive test reports were identified with 57.1%, 18.1%, 10.8% and 13.5% of individuals having pathogenic/likely pathogenic variants in high, moderate, low and with insufficient evidence for breast cancer risk genes, respectively. Six point seven percent of individuals were double heterozygotes. CONCLUSION Germline findings in 92% of individuals are linked to evidence-based treatment information and risk estimates for predisposition to breast and/or other cancer types. The use of germline findings for treatment decision making expands the indication of genetic testing to include individuals that could benefit from targeted treatments.
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Affiliation(s)
| | | | | | | | | | | | - Theofanis Floros
- Oncology Department, Athens Naval and Veterans Hospital, Athens, Greece
| | | | | | - Anna Koumarianou
- Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | | | | | | | - Amanda Psyrri
- Department of Internal Medicine, Section of Medical Oncology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Eugeniu Banu
- Spitalul Sfantul Constantin Brasov, Brasov, Romania
| | - Dan Tudor Eniu
- Department of Surgery II, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alexandru Blidaru
- Department of Surgical Oncology, Oncological Institute "Al. Trestioneanu" of Bucharest, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Dana Lucia Stanculeanu
- Department of Oncology, Faculty of General Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Vahit Ozmen
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | | | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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24
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Ozmen V, Ordu C, Ilgun AS, Unal C, Soybir G, Erdogan Z, Kayan Tapan T, Aktepe F, Alco G, Duymaz T, Ozmen T. The effects of vitamin D replacement on pathological complete response (pCR) in breast cancer patients receiving neoadjuvant systemic chemotherapy (NAC). Breast J 2021; 27:902-905. [PMID: 34806247 DOI: 10.1111/tbj.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Vahit Ozmen
- Department of General Surgery, Istanbul University Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Ahmet Serkan Ilgun
- Department of General Surgery, Demiroglu Bilim University, Istanbul, Turkey
| | - Caglar Unal
- Department of Medical Oncology, Demiroglu Bilim University, Istanbul, Turkey
| | - Gursel Soybir
- Department of General Surgery, Sisli Memorial Hospital, Istanbul, Turkey
| | - Zeynep Erdogan
- Department of Physical Therapy Rehabilitation, Biruni University, Istanbul, Turkey
| | - Tuba Kayan Tapan
- Department of Nutrition and Dietetic, Demiroglu Bilim University, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Sisli Memorial Hospital, Istanbul, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Tolga Ozmen
- Department of General Surgery, University of Miami, Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA
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Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk NZ, Utkan Z, Evrensel T, Sezgin E. Primary Surgery with Systemic Therapy in Patients with de Novo Stage IV Breast Cancer: 10-year Follow-up; Protocol MF07-01 Randomized Clinical Trial. J Am Coll Surg 2021; 233:742-751.e5. [PMID: 34530124 DOI: 10.1016/j.jamcollsurg.2021.08.686] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this randomized clinical trial was to evaluate the overall survival (OS) data of patients diagnosed with de novo stage IV breast cancer (BC) who received locoregional treatment (LRT) over a 10-year follow-up. STUDY DESIGN The MF07-01 is a 1:1 multicenter, randomized clinical trial comparing the LRT with systemic therapy (ST), where ST was given to all patients either immediately after randomization or after surgical resection of the intact primary tumor. RESULTS A total of 278 patients were randomized and 265 patients were in the final analysis. At 10-year follow-up, survivals were 19% (95% CI 13%-28%) and 5% (95% CI 2%-12%) in the LRT group and ST group, respectively. Median survival was 46 months for the LRT group and 35 months for the ST group, and hazard of death was 29% lower in the LRT group compared with the ST group (hazard ratio [HR] 0.71; 95% CI 0.59-0.86; p = 0.0003). CONCLUSIONS Patients with a diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 14% higher chance of OS by the end of the 10-year follow-up compared with the patients who received only ST. The longer study follow-up revealed that LRT should be presented to patients when discussing treatment options.
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Affiliation(s)
- Atilla Soran
- Department of Surgery, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA.
| | - Vahit Ozmen
- Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Hasan Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Capa, Istanbul, Turkey
| | | | - Abdullah Igci
- Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Zafer Utkan
- Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Turkkan Evrensel
- Department of Medical Oncology, Uludag University School of Medicine, Bursa, Turkey
| | - Efe Sezgin
- Department of Food Engineering, Laboratory of Nutrigenomics and Epidemiology, Izmir Institute of Technology, Izmir, Turkey
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26
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Çakmak GK, Emiroğlu S, Sezer A, Canturk NZ, Yeniay L, Kuru B, Karanlık H, Soyder A, Gökgöz Ş, Sakman G, Ucuncu M, Akcay MN, Girgin S, Gurdal SO, Emiroglu M, Ozbas S, Öz AB, Arici C, Toktas O, Demircan O, Çalık A, Polat AK, Maralcan G, Demirer S, Ozmen V. Surgical Trends in Breast Cancer in Turkey: An Increase in Breast-Conserving Surgery. JCO Glob Oncol 2021; 6:285-292. [PMID: 32109157 PMCID: PMC7051798 DOI: 10.1200/jgo.19.00275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients’ choices, surgical approaches, and academic institutions. RESULTS All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia (P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery. CONCLUSION Increasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.
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Affiliation(s)
- Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Selman Emiroğlu
- Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Atakan Sezer
- Department of Surgery, The School of Medicine, Trakya University, Edirne, Turkey
| | - Nuh Zafer Canturk
- Department of Surgery, The School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Levent Yeniay
- Department of Surgery, The School of Medicine, Ege University, Izmir, Turkey
| | - Bekir Kuru
- Department of Surgery, The School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Hasan Karanlık
- Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Aykut Soyder
- Department of Surgery, The School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Şehsuvar Gökgöz
- Department of Surgery, The School of Medicine, Uludag University, Bursa, Turkey
| | - Gürhan Sakman
- Department of Surgery, The School of Medicine, Cukurova University, Adana, Turkey
| | | | - Mufide Nuran Akcay
- Department of Surgery, The School of Medicine, Ataturk University, Erzurum, Turkey
| | - Sadullah Girgin
- Department of Surgery, The School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sibel Ozkan Gurdal
- Department of Surgery, The School of Medicine, Namık Kemal University, Tekirdag, Turkey
| | | | | | - Abdullah Bahadir Öz
- Department of Surgery, The School of Medicine, Erciyes University, Kayseri, Turkey
| | - Cumhur Arici
- Department of Surgery, The School of Medicine, Akdeniz University, Antalya, Turkey
| | - Osman Toktas
- Department of Surgery, The School of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | | | - Adnan Çalık
- Department of Surgery, The School of Medicine, Karadeniz Teknik University, Trabzon, Turkey
| | - Ayfer Kamali Polat
- Department of Surgery, The School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Gokturk Maralcan
- Department of Surgery, The School of Medicine, Sanko University, Gaziantep, Turkey
| | - Seher Demirer
- Department of Surgery, The School of Medicine, Ankara University, Ankara, Turkey
| | - Vahit Ozmen
- Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
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27
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Ozmen V, Ordu C, Ilgun AS, Unal C, Soybir G, Erdogan Z, Aktepe F, Tuzlali S, Ozturk A, Alco G, Duymaz T, Kayan Tapan T, Ozmen T. The effects of vitamin D (Vit D) replacement on pathological complete response (PCR) in breast cancer (BC) patients receiving neoadjuvant systemic chemotherapy (NAC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e12604] [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: 11/20/2022] Open
Abstract
e12604 Background: Studies show that Vit D increases apoptosis by inhibiting the proliferation of BC cells. The aims of this study were to prospectively investigate the effects of Vit D replacement on PCR rates in patients receiving NAC. Methods: Breast cancer patients qualified for NAC between June 2019 and September 2020 and consent for the study were given weekly oral 50,000 IU Vit D (study group). The Control group consisted of patients who were given NAC between 2015-2020 and who did not receive Vit D replacement. Tumor characteristics and PCR compared between the study and control groups. Results: A total of 117 patients included in the study (55% in the study group). Both groups had similar patient, tumor, and treatment characteristics. PCR (ypT0/is ypN0 and ypT0/is) rates were significantly higher in the study group (28.1% vs 11.3%, p=0.025 and 37.5% vs 13.2%, p=0.003, respectively). In multivariate logistic regression analysis, estrogen receptor (ER) and HER 2 positivity, and Vit D3 replacement were identified as independent variables affecting PCR. Conclusions: Adding Vit D to NAC in breast cancer patients significantly increases PCR. This effect is more prominent in ER negative and HER2 positive breast cancer patients. Clinical trial information: NCT03986268. [Table: see text]
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Affiliation(s)
- Vahit Ozmen
- Istanbul University Istanbul Faculty of Medicine Department of Surgery, Istanbul, Turkey
| | - Cetin Ordu
- Bilim University, Department of Medical Oncology, Istanbul, Turkey
| | | | - Caglar Unal
- Demiroglu Bilim University, Istanbul, Turkey
| | | | | | - Fatma Aktepe
- Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | | | - Alper Ozturk
- Istanbul Florence Nightingale Hospital, Abidei Hurriyet Cad. No:166, Istanbul, Turkey
| | - Gul Alco
- Gayrettepe Florence Nightingale Hospital, Cemil Aslan Guder Sok. N0:8 Gayrettepe, Istanbul, Turkey
| | | | | | - Tolga Ozmen
- University of Miami, Department of Surgical Oncology, Miami, FL
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28
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Agiannitopoulos K, Pepe G, Papadopoulou E, Tsaousis GN, Kampouri S, Maravelaki S, Fassas A, Christodoulou C, Iosifidou R, Karageorgopoulou S, Markopoulos C, Natsiopoulos I, Papazisis K, Vasilaki-Antonatou M, Venizelos V, Ozmen V, Tansan S, Kaban K, Eniu DT, Chiorean A, Nasioulas G. Clinical Utility of Functional RNA Analysis for the Reclassification of Splicing Gene Variants in Hereditary Cancer. Cancer Genomics Proteomics 2021; 18:285-294. [PMID: 33893081 DOI: 10.21873/cgp.20259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/11/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Classification of splicing variants (SVs) in genes associated with hereditary cancer is often challenging. The aim of this study was to investigate the occurrence of SVs in hereditary cancer genes and the clinical utility of RNA analysis. MATERIAL AND METHODS 1518 individuals were tested for cancer predisposition, using a Next Generation Sequencing (NGS) panel of 36 genes. Splicing variant analysis was performed using RT-PCR and Sanger Sequencing. RESULTS In total, 34 different SVs were identified, 53% of which were classified as pathogenic or likely pathogenic. The remaining 16 variants were initially classified as Variant of Uncertain Significance (VUS). RNA analysis was performed for 3 novel variants. CONCLUSION The RNA analysis assisted in the reclassification of 20% of splicing variants from VUS to pathogenic. RNA analysis is essential in the case of uncharacterized splicing variants, for proper classification and personalized management of these patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vahit Ozmen
- Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | | | - Dan Tudor Eniu
- Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania
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29
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Ozkan Gurdal S, Ozaydın AN, Aribal E, Ozcinar B, Cabioglu N, Sahin C, Ozmen V. Bahcesehir long-term population-based screening compared to National Breast Cancer Registry Data: effectiveness of screening in an emerging country. ACTA ACUST UNITED AC 2021; 27:157-163. [PMID: 33599208 DOI: 10.5152/dir.2021.20486] [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: 11/22/2022]
Abstract
PURPOSE We aimed to show the effects of long-term screening on clinical, pathologic, and survival outcomes in patients with screen-detected breast cancer and compare these findings with breast cancer patients registered in the National Breast Cancer Registry Data (NBCRD). METHODS Women aged 40-69 years, living in Bahcesehir county, Istanbul, Turkey, were screened every 2 years using bilateral mammography. The Bahcesehir National Breast Cancer Registry Data (BMSP) data were collected during a 10-year screening period (five rounds of screening). BMSP data were compared with the NBCRD regarding age, cancer stage, types of surgery, tumor size, lymph node status, molecular subtypes, and survival rates. RESULTS During the 10-year screening period, 8758 women were screened with 22621 mammograms. Breast cancer was detected in 130 patients; 51 (39.2%) were aged 40-49 years. The comparison of breast cancer patients in the two programs revealed that BMSP patients had earlier stages, higher breast-conserving surgery rates, smaller tumor size, more frequent negative axillary nodal status, lower histologic grade, and higher ductal carcinoma in situ rates than NBCRD patients (p = 0.001, for all). CONCLUSION These results indicate the feasibility of successful population-based screening in middle-income countries.
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Affiliation(s)
- Sibel Ozkan Gurdal
- Department of General Surgery, Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Ayse Nilufer Ozaydın
- Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
| | - Erkin Aribal
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar. University, School of Medicine, Istanbul, Turkey
| | - Beyza Ozcinar
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cennet Sahin
- Department of Radiology University of Health Sciences, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Vahit Ozmen
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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30
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Cabioglu N, Karanlık H, Muslumanoglu M, Karadeniz Çakmak G, Trablus DC, Tukenmez M, Ersoy YE, Uras C, Zengel B, Emiroğlu S, Polat AK, Yeniay L, Ozkurt E, Kara H, Ibis K, Aydiner A, Ozmen V, Igci A. Abstract PS1-26: Sentinel lymph node biopsy alone in locally advanced breast cancer after neoadjuvant chemotherapy: Turkish multicentric neosenti-turk MF-18-02-study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps1-26] [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: Omitting axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB) in patients with locally advanced breast cancer (LABC) after neoadjuvant chemotherapy (NAC) is still controversial. In this study, we evaluated factors affecting local recurrence and outcome in patients with LABC, who underwent SLNB alone after NAC. METHODS: Between 2004 to 2018, 320 patients with clinically node-positive LABC who received NAC and underwent SLNB alone after negative axillary staging were analyzed. All patients had breast and/or regional nodal irradiation. RESULTS: Median age was 46 (23-70). Of those, 228 patients had ypN0 disease (71.25%), whereas 92 patients had ypN(+) disease including 19 (20.6%) isolated tumor cells (ITC), 33 micrometastasis (35.9%) and 40 macrometastases (43.5%). At a median follow-up of 37 months (24-172), one patient (0.3%) with macrometastatic SLN having extracapsular extension was found to have locoregional recurrence at the 60th month. Five-year disease-free survival (DFS) and disease specific survival (DSS) rates were found as 87% and 95%, respectively. Patients with cT3&4 (HR=2.22, 95% CI; 1.07-4.62), non-luminal molecular pathology (HR=2.71, 95% CI, 1.23-5.97), and non-pCR in the breast (HR=2.21, 95% CI, 0.94-5.17) were found to have an increased HR compared to others in 5-year DFS. However, no significant differences could be found between patients ypN0, ypN-ITCµmetastasis and ypN-macrometastasis regarding 5-year DFS and DSS rates. CONCLUSIONS: ALND could be safely avoided in selected patients with LABC who underwent SLNB after NAC having cT1-2, luminal pathology, breast and/or nodal pCR or low volume nodal disease, as long as axillary radiotherapy is provided.
Citation Format: Neslihan Cabioglu, Hasan Karanlık, Mahmut Muslumanoglu, Guldeniz Karadeniz Çakmak, Didem Can Trablus, Mustafa Tukenmez, Yeliz E. Ersoy, Cihan Uras, Baha Zengel, Selman Emiroğlu, Ayfer Kamalı Polat, Levent Yeniay, Enver Ozkurt, Halil Kara, Kamuran Ibis, Adnan Aydiner, Vahit Ozmen, Abdullah Igci. Sentinel lymph node biopsy alone in locally advanced breast cancer after neoadjuvant chemotherapy: Turkish multicentric neosenti-turk MF-18-02-study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-26.
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Affiliation(s)
- Neslihan Cabioglu
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Hasan Karanlık
- 2Istanbul University, Institute of Oncology, Department of Surgical Oncology, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | | | - Didem Can Trablus
- 4İstanbul Samatya Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
| | - Mustafa Tukenmez
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Yeliz E. Ersoy
- 56Vakıf Guraba Bezmialem Valide Sultan University, Department of General Surgery, Istanbul, Turkey
| | - Cihan Uras
- 67Acıbadem University, Department of General Surgery, Istanbul, Turkey
| | - Baha Zengel
- 78 The University of Health Sciences, Izmir Bozyaka Education and Training Hospital, Department of General Surgery, İzmir, Turkey
| | - Selman Emiroğlu
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Ayfer Kamalı Polat
- 8Samsun 19 Mayıs University, Faculty of Medicine, Department of General Surgery, Samsun, Turkey
| | - Levent Yeniay
- 9Ege University, Faculty of Medicine, Department of General Surgery, Izmir, Turkey
| | - Enver Ozkurt
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Halil Kara
- 10Acıbadem University, Department of General Surgery, Istanbul, Turkey
| | - Kamuran Ibis
- 11Istanbul University, Institute of Oncology, Department of Radiaiton Oncology, Istanbul, Turkey
| | - Adnan Aydiner
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Vahit Ozmen
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Abdullah Igci
- 1Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
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Cabioglu N, Onder S, Oner G, Karatay H, Tukenmez M, Muslumanoglu M, Igci A, Eralp Y, Aydiner A, Saip P, Yavuz E, Ozmen V. Abstract PS4-32: Tim3 expression on tumor infiltrating lymphocytes is associated with poor response to neoadjuvan chemotherapy in patients with locally advanced triple negative breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps4-32] [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: Expression of immune checkpoint receptors (ICR) on tumor infiltrating lymphocytes (TILSs) is associated with better response to immunotherapies via immune checkpoint inhibitors. Therefore, we investigated various ICR expressions on TILs in patients with locally advanced triple negative breast cancer (TNBC) after neoadjuvant chemotherapy (NAC). Methods: Expressions of ICRs were examined immunohistochemically by staining surgical specimen (n=61) using specific monoclonal antibodies for PDL-1, PD-1, TIM-3, LAG-3, CTLA-4. Positivity was defined staining >1% on TILs. Results: Median age was 49 (24-76) years. The majority patients were clinically T3-4 (n=31, 50.8%), and clinically N1-3 (n=58, 95.1%) before NAC. Of those, 82% were found to have CTLA-4 positivity, whereas TILs associated positivites for PD1, PDL-1, LAG3 and TIM-3 were 62.3%, 50.9%, 26.2%, 68.9%. High expression of CTLA-4 was found to be associated with a better chemotherapy response (OR=7.94, 95%CI: 0.9-70.12, p=0.06), whereas TIM-3 positivity was contrarly associated with a worse chemotherapy response (OR=0.253, 95%CI: 0.066-0.974, p=0.047) as measured by MDACC Residual Cancer Burden Index. At a 47-month follow-up, patients with ypN0 disease (DFS; HR=0.31, 95% CI: 0.12-0.83, p=0.02 and DSS; HR=0.21, 95% CI:0.07-0.62, p=0.005) and CTLA-4 high expression on TILs (DFS; HR=0.38, 95% CI=0.17-0.85, p=0.019 and DSS; HR=0.34, 95% CI:0.15-0.78, p=0.01) were found to have improved survival. Conclusions: These findings demonstrate that CTLA-4, PD-1, PDL-1 and TIM-3 were highly expressed in TNBC after NAC. Our results more favor an immuncheckpoint inhibitor therapy via CTLA-4 alone or in combination with other immune check point inhibitors against PDL-1 and/or TIM-3 in addition to NAC in advanced TNBC.
Citation Format: Neslihan Cabioglu, Semen Onder, Gizem Oner, Hüseyin Karatay, Mustafa Tukenmez, Mahmut Muslumanoglu, Abdullah Igci, Yesim Eralp, Adnan Aydiner, Pinar Saip, Ekrem Yavuz, Vahit Ozmen. Tim3 expression on tumor infiltrating lymphocytes is associated with poor response to neoadjuvan chemotherapy in patients with locally advanced triple negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-32.
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Affiliation(s)
- Neslihan Cabioglu
- 1Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Semen Onder
- 2Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Gizem Oner
- 3Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Edegem, Belgium, and Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium
| | - Hüseyin Karatay
- 1Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Tukenmez
- 1Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | | | - Abdullah Igci
- 1Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yesim Eralp
- 4Istanbul University, Institute of Oncology, Department of Medical Oncology, Istanbul, Turkey
| | - Adnan Aydiner
- 5Istanbul University, Institute of Oncology, Department of Medical Oncology, Istanbul, Turkey
| | - Pinar Saip
- 5Istanbul University, Institute of Oncology, Department of Medical Oncology, Istanbul, Turkey
| | - Ekrem Yavuz
- 2Istanbul University, Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Vahit Ozmen
- 6Istanbul University, Istanbul Faculty of Medicine, Department of Surgery, Istanbul, Turkey
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Ozturk A, Ilgun S, Ucuncu M, Gachayev F, Ordu C, Alco G, Elbuken F, Erdogan Z, Duymaz T, Aktepe F, Soybir G, Ozmen V. The effect of multifocal and multicentric tumours on local recurrence and survival outcomes in breast cancer. J BUON 2021; 26:196-203. [PMID: 33721452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to compare the multifocal (MF)/multicentric (MC) breast cancers with unifocal (UF) breast cancers in terms of tumour characteristics, treatment methods, loco-regional recurrence and survival rates. METHODS Patients who were treated with a diagnosis of early-stage breast cancer (stage I,II) and had regular follow-up were included in the study. MF tumours were defined as having more than one tumour focus in the same quadrant, whereas MC tumours refered to the presence of more than one tumour focus in different quadrants. RESULTS In total, 1865 patients with invasive breast cancer were evaluated, 1493 (80.1%) of whom had UF cancer, 330 (17.7%) had MF cancer, and 42 (2.3%) had MC cancer. After comparing the groups with each other, it was seen that MF and MC breast cancers occurred more often at early ages and that lymph node invasion (LNI) was greater. No differences were seen between the 3 groups in terms of local recurrence-free survival (RFS) and overall survival (OS) rates . In multivariate analysis, it was found that MF and MC tumours had no impact on local recurrence and OS. In multivariate analysis, it was understood that HER2 positivity and triple-negative breast cancer (TNBC) had an impact on local recurrence, and age, lymphovascular invasion (LVI), T3 tumour, lymph node positivity and TNBC subtype had an impact on OS. CONCLUSION Although MC and MF tumours show aggressive features such as high lymph node positivity and LVI, they have similar loco-regional recurrence and survival rates to UF tumours.
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Affiliation(s)
- Alper Ozturk
- Biruni University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey. 2Gaziosmanpasa Taksim Training and Research Hospital, Department of General Surgery, Istanbul, Turkey
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Abstract
Objective: To determine the relationship between the dietary characteristics of breast cancer patients. Methods: Patients with breast cancer whose treatments have finished and are in remission formed the study group and healthy people formed the control group. Demographic, anthropometric characteristics, food consumption frequency form and exercise status were recorded with all groups. Data analysis was done by SPSS 22. Results: In the study group, mean carbohydrate percentage was lower, while fat, fat percentage, monosaccharide, glucose, fructose, omega3(n3), saturated fatty acids(SFA), monounsaturated fatty acids (MUFA), vitamin A, C, E, B6, biotin and copper values were significantly higher (p<0.05). Recurrence was observed in seven patients (7.1%) during the follow-up period, hormone receptor levels (ER) and vitamin B2 intake (accuracy 93.9%) were inversely related to the recurrence of the disease (p=0.02). Conclusions: While the percentage of carbohydrate taken was lower in study group; total fat, n3, SFA, MUFA, monosaccharide, glucose, fructose, water-soluble fiber, B6, biotin and copper values were higher. Further studies are needed for vitamin B2 deficiency in patients with recurrence
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Affiliation(s)
- Tuba Kayan Tapan
- Dr. Tuba Kayan Tapan Nutrition and Dietetic, Faculty of Health Science, Demiroglu Bilim University, Istanbul, Turkey
| | - Zeynep Erdogan Iyigun
- Dr. Zeynep Erdogan Iyigun Physical therapy and rehabilitation, Faculty of Health Science, Demiroglu Bilim University, Istanbul, Turkey
| | - Serkan Ilgun
- Dr. Serkan Ilgun General Surgery Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Vahit Ozmen
- Dr. Vahit Ozmen General Surgery Faculty of Medicine Istanbul University, Istanbul, Turkey
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Kizildag Yirgin I, Has D, Arslan G, Aydin EC, Sari M, Onder S, Yasemin S, Cabioglu N, Karanlik H, Tukenmez M, Dursun M, Muslumanoglu M, Ozmen V. Comparison between body composition parameters and response to neoadjuvant chemotherapy by using pre-treatment PET CT in locally advanced breast cancer. Eur J Radiol Open 2020; 7:100286. [PMID: 33294497 PMCID: PMC7689395 DOI: 10.1016/j.ejro.2020.100286] [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: 10/02/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
Weight and the BMI are inadequate proxies for adiposity that do not distinguish between muscle and adipose tissue or different specific deposits of adipose tissue (visceral and subcutaneous), which have different physiological effects. Patients with the same BMI are likely to have different anatomical distribution of adipose and muscle tissue. To our knowledge, only few studies have investigated the association between fat and muscle tissue distribution of the body, and response to neoadjuvant chemotherapy.
Purpose To compare the adipose and muscle tissue areas in patients who responded differently to neoadjuvant chemotherapy. Methods One hundred and eighty six patients diagnosed with breast cancer who underwent neoadjuvant chemotherapy between January 2015- October 2019 and were operated after the treatment were retrospectively included in the study. Pathological results were divided into five groups using the Miller-Payne grading systems. Grade 1 indicating no significant reduction in malignant cells; Grade 2: a minor loss of malignant cells (≤ 30 %); Grade 3: reduction in malignant cells between 30 % and 90 %; Grade 4: disappearance of malignant cells >90 %; Grade 5: no malignant cells identifiable. Pre-treatment PET CT scans were evaluated, and calculation of body composition parameters were performed on a single axial section passing through the L3 vertebrae. Spearman’s correlation test was used to analyze the correlation between SAT, VAT, MT parameters and pathological responses. Results There was no strong correlation between the 5 groups separated according to neoadjuvant chemotherapy treatment response and tissue distributions. However, that there was a very low correlation found between superficial adipose tissue and pathological response (r=, 156). Conclusion In conclusion, our results have provided a very low correlation between SAT and more than 30 % response. More research is required to evaluate the role of the body fat and muscle parameters in response to neoadjuvant chemotherapy in larger patient populations.
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Key Words
- ASP, Acylation-stimulating protein
- Adipose tissue
- BMI, Body mass index
- Body composition parameter
- Breast cancer
- CT, Computed tomography
- Computed tomography
- DCIS, Ductal carcinoma in situ
- ER, Estrogen receptor
- HER-2, Human epidermal growth factor receptor-2
- IHC, Immunohistochemistry
- MP, Miller -Payne
- MT, Muscle tissue
- NAC, Neoadjuvant chemotheraphy
- PAI-1, Plasminogen activator inhibitor-1
- PET, CT Positron-emission tomography-computed tomography
- PR, Progesterone receptor
- SAT, Subcutaneous adipose tissue
- VAT, Visceral adipose tissue
- ypCR, Pathological complete response
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Affiliation(s)
- Inci Kizildag Yirgin
- Department of Radiology, Oncology Institute, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Duygu Has
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Gozde Arslan
- Department of Radiology, Baskent University Hospital, Ankara, Turkey
| | - Esra Cureoglu Aydin
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Murat Sari
- Department of Medical Oncology, Istanbul Haydarpasa Education and Research Hospital, Istanbul, 34668, Uskudar, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Sanli Yasemin
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Neslihan Cabioglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Hasan Karanlik
- Department of General Surgery, Oncology Institute, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Mustafa Tukenmez
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Memduh Dursun
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Mahmut Muslumanoglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey
| | - Vahit Ozmen
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, 34390, Capa, Turkey
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Abbasov A, Çetin E, Cabioglu N, Mollavelioglu B, Onder S, Emiroglu S, Tukenmez M, Muslumanoglu M, Igci A, Deniz G, Ozmen V. Abstract 947: Differential expressions of immune check point receptors on tumor infiltrating lymphocytes after neo-adjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-947] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent advances in tumor biology and immune system have identified check points modulating the anti-tumoral immune response. This study aimed to determine immune check point expressions patients with locally advanced breast cancer to explore any associations between clinical and prognostic factors to show effectiveness of targeted therapies for these molecules.
Materials and Methods: This prospective study was carried out between September 2018 and November 2019 in the Department of General Surgery of Istanbul University Istanbul Faculty of Medicine Breast Unit. Twenty-four patients with LABC with a partial response to neoadjuvant chemotherapy (NAC) were included in the study. Tumor infiltrating lymphocytes (TILs) were isolated from the residual tumor burden separated from the surgical material with cell dissociation kit by using MACS tumor separation device. Expressions of immune checkpoints receptors including PD-1, LAG-3, TIM-3, TIGIT and CTLA-4 on CD8 T lymphocytes and Natural Killer (NK) cell subsets obtained from TIL were analyzed by using flow cytometry.
Results: TILs of patients <50 years were more likely to express CTLA-4 on CD8−T lymphocytes in compared to patients ≥ 50 years (p= 0.004). In addition, patients with an initially advanced clinical tumor stage pT3-T4 were more likely to have increased LAG 3 expression on CD56+ NK cells and PD-1, CTLA-4 expression on CD8+ T cells in regards to pT1-T2 (p = 0.014, p = 0.018, p = 0.042; respectively). Contrarly, PD-1 expression on cytokine secreting CD56bright NK cells were found to be lower in patients with pN+ than those patients with pN- (p= 0.022). Interestingly, increased TIGIT, LAG-3, PD-1 and CTLA-4 expressions in CD16+ NK cells were demonstrated in patients with extensive intra-ductal component (p=0,024, p=0,003, p=0,032, p=0,013; respectively). However, HER2+ patients were more likely to have increased TIM-3 expressions on cytotoxic CD8- T cells compared to others (p = 0.043). Furthermore, TIGIT expressions in CD8+ T and CD56bright NK cells were significantly higher in patients with higher response to NAC (p = 0.014, p = 0.030; respectively). Finally, there was a significant correlation between pathological regression scores and CTLA-4 expressions of cytotoxic NK cells in Pearson analyses (p = 0.03).
Conclusion: Our results suggest that patients with a younger age and advanced tumor burden are more likely to benefit from immunotherapeutical approaches using immune check point inhibitors. Furthermore, combination of systemic chemotherapy with immunotherapy may increase the pathologic response rate in breast cancer patients.
Citation Format: Ayxan Abbasov, Esin Çetin, Neslihan Cabioglu, Baran Mollavelioglu, Semen Onder, Selman Emiroglu, Mustafa Tukenmez, Mahmut Muslumanoglu, Abdullah Igci, Gunnur Deniz, Vahit Ozmen. Differential expressions of immune check point receptors on tumor infiltrating lymphocytes after neo-adjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 947.
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Affiliation(s)
- Ayxan Abbasov
- 1Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | | | | | | | - Semen Onder
- 1Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | | | | | | | - Abdullah Igci
- 1Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | | | - Vahit Ozmen
- 1Istanbul University, Faculty of Medicine, Istanbul, Turkey
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Ozmen V, Ilgun S, Celet Ozden B, Ozturk A, Aktepe F, Agacayak F, Elbuken F, Alco G, Ordu C, Erdogan Iyigun Z, Emre H, Pilancı K, Soybir G, Ozmen T. Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates. World J Surg Oncol 2020; 18:87. [PMID: 32370753 PMCID: PMC7201547 DOI: 10.1186/s12957-020-01858-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/20/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates. PATIENTS AND METHODS The data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively. RESULTS A total of 317 patients were included in the study, 242 (76.3%) of them in group 1 and 75 (23.6%) of them in group 2. Median follow-up time was 56 (14-116) months. There were no differences identified between the groups in terms of tumor histology, hormonal receptors and HER-2 positivity, surgical morbidity, and 5-year overall and disease-free survival. Group 2 patients were significantly younger than group 1 (p = 0.003). The multifocality/multicentricity rate was higher in group 2 (p ≤ 0.001), whereas tumor size (p = 0.009), body mass index (BMI, p = 0.006), histological grade (p ≤ 0.001), lymph node positivity (p = 0.002), axillary lymph node dissection (ALND) rate (p = 0.005), and presence of lympho-vascular invasion (LVI, p = 0.013) were significantly higher in group 1. When the quality of life was assessed by using the EORTC QLQ C30 and BR23 questionnaires, it was seen that the body image perception (p < 0.001) and nausea/vomiting score (p = 0.024) were significantly better in PM + MLDF group whereas physical function score was significantly better in M + I group (p = 0.012). When both groups were examined in terms of cosmesis with JBCS Cosmetic Evaluation Scale, good cosmetic evaluation score was significantly higher in patients in MLDF group (p = 0.01). DISCUSSION The results of this study indicate that in comparison to M + I procedure, the PM + MLDF procedure provides significantly superior results in terms of body image and cosmetic result with similar morbidity and oncologic outcomes. In selected patients with small breasts and a high tumor/breast ratio, PM + MLDF may be an alternative to subcutaneous mastectomy and implant.
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Affiliation(s)
- Vahit Ozmen
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Istanbul, Turkey
| | - Serkan Ilgun
- Department of General Surgery, School of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Burcu Celet Ozden
- Department of Plastic and Reconstructive Surgery, School of Medicine, Altinbas University, Istanbul, Turkey
| | - Alper Ozturk
- Department of General Surgery, School of Medicine, Biruni University, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Agacayak
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Elbuken
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Zeynep Erdogan Iyigun
- Department of Physical Therapy and Rehabilitation, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Hocaoglu Emre
- Department of Plastic & Reconstructive Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Kezban Pilancı
- Department of Medical Oncology, Bahcesehir Memorial Hospital, Istanbul, Turkey
| | - Gursel Soybir
- Department of General Surgery, Sisli Memorial Hospital, Istanbul, Turkey
| | - Tolga Ozmen
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Mollavelioglu B, Cetin EA, Cabioglu N, Abbasov A, Onder S, Emiroglu S, Tukenmez M, Muslumanoglu M, Igci A, Deniz G, Ozmen V. Abstract P5-04-24: Differential expression of novel immune checkpoint receptors expressed on tumor-infiltrating lymphocytes (TIL) in patients with early breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-04-24] [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
Introduction: High expression of immune checkpoint receptors in tumor microenvironment reduces antitumor immunity and cause immune evasion of tumor cells. In recent years, immunotherapy trials using PD-1 or PDL-1 inhibitors in advanced triple negative (TN) breast cancer evolved very rapidly. The differential expression of novel immune checkpoint receptors such as TIM-3, LAG-3 and TIGIT in addition to PD-1, and CTLA-4 on tumor infiltrating lymphocytes (TIL) in patients with early breast cancer was investigated.
Material and methods: TIL were isolated by using a Tumor Dissociation Kit from fresh tumoral tissue. Flow-cytometric analyses were performed by using CD8, CD16, CD56, PD-1, CTLA-4, TIM-3, LAG-3 and TIGIT specific monoclonal antibodies on isolated TIL. Correlations were estimated between biological and clinical characteristics of tumors and demographic features of patients and flow cytometric findings.
Results: Median age was 47 (range 28-68). There were 7 patients (35%) with HER2+ or triple negative tumors, whereas 13 patients (65%) had HER2 (-) luminal cancers. Our findings showed that patients younger than 45 years were more likely to express high levels of CTLA-4 (p=0.013) and TIGIT (p=0.007) on CD56+ natural killer (NK) cells and TIM-3 (p=0.043) on CD16+ lymphocytes (Table 1), whereas the other high expressions including LAG-3 (p=0,08) and TIM-3 (p=0.06) on CD56+ NK cells did not reach the statistical significance. Furthermore, patients with high Ki-67 proliferation index >35% were found to express higher CTLA-4 (p=0.011) on CD16+ lymphocytes. Patients with Stage II disease expressed higher levels of PD-1 (p=0.018) and LAG-3 (p=0.04) on CD8+ cytotoxic T lymphocytes than patients with Stage I disease. Similarly, patients with lymph node metastasis had higher TIGIT (p=0.04) and PD-1 (p=0.05) levels on CD16+ and CD56+ lymphocytes, respectively. No other significant associations could be found between immune check receptors and other parameters.
Conclusion: Our results suggest TIL in patients with more advanced stages and younger than 45 years old are more likely to express higher levels of immune checkpoint receptors such as LAG-3, TIM-3, CTLA-4, TIGIT and PD-1. Interestingly, no difference could be found in immune checkpoint receptor expressions in TIL between patients with luminal and TN or HER2+, that would justify immunotherapeutical approaches in selected luminal breast cancers in future trials.
Table 1. Significant correlations between immune check point receptor expression and demographic and tumor features CD8PD1CD8LAG3CD16CTLA4CD16TIGITCD16TIM3CD56CTLA4CD56TIGITCD56PD1meanpmeanpmeanpmeanpmeanpmeanpmeanpmeanpAge<45 (n:7)11.930.427120.40513.210.13212.290.3214.140.043150.01315.360.00710.290.905>45 (n:13)9.739.699.049.548.548.087.8810.62Ki-67 (cut off %35)<%35 (n:12)10.710.84711.710.26313.250.01110.920.69810.540.96911.920.18911.880.20312.040.153≥%35 (n:8)10.198.696.389.8810.448,388.448.19N stageN0 (n:13)10.120.69210.770.7819.810.4758.580.04710.270.8129,580.3419.960.5798.620.05N1 (n:7)11.211011.7914.0710.9312,2111.514StageStage 1 (n:5)5.10.0185.90.0447.40.17611.40.69311.20.7690.51312.50.3826.40.073Stage 2 (n:15)12.312.0311.5310.210.27119.8311.87
All statistical analyses were evaluated using the Mann Whitney U test.
Citation Format: Baran Mollavelioglu, Esin Aktas Cetin, Neslihan Cabioglu, Aykhan Abbasov, Semen Onder, Selman Emiroglu, Mustafa Tukenmez, Mahmut Muslumanoglu, Abdullah Igci, Gunnur Deniz, Vahit Ozmen. Differential expression of novel immune checkpoint receptors expressed on tumor-infiltrating lymphocytes (TIL) in patients with early breast cancer [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 P5-04-24.
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Affiliation(s)
- Baran Mollavelioglu
- 1Istanbul University Istanbul Faculty of Medicine, General Surgery Department, Istanbul, Turkey
| | - Esin Aktas Cetin
- 2Istanbul University, Institute of Experimental Medicine, Immunology Department, Istanbul, Turkey
| | - Neslihan Cabioglu
- 1Istanbul University Istanbul Faculty of Medicine, General Surgery Department, Istanbul, Turkey
| | - Aykhan Abbasov
- 1Istanbul University Istanbul Faculty of Medicine, General Surgery Department, Istanbul, Turkey
| | - Semen Onder
- 3Istanbul University Istanbul Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Selman Emiroglu
- 1Istanbul University Istanbul Faculty of Medicine, General Surgery Department, Istanbul, Turkey
| | - Mustafa Tukenmez
- 1Istanbul University Istanbul Faculty of Medicine, General Surgery Department, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- 1Istanbul University Istanbul Faculty of Medicine, General Surgery Department, Istanbul, Turkey
| | - Abdullah Igci
- 1Istanbul University Istanbul Faculty of Medicine, General Surgery Department, Istanbul, Turkey
| | - Gunnur Deniz
- 2Istanbul University, Institute of Experimental Medicine, Immunology Department, Istanbul, Turkey
| | - Vahit Ozmen
- 1Istanbul University Istanbul Faculty of Medicine, General Surgery Department, Istanbul, Turkey
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Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk Z, Utkan Z, Ozaslan C, Evrensel T, Uras C, Aksaz E, Soyder A, Ugurlu U, Col C, Cabioglu N, Erdem E, Gurleyik G, Sezgin E. Abstract P1-20-01: Primary surgery in patients with de novo stage IV BC; finalizing the protocol MF07-01 randomized clinical trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-20-01] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. The MF07-01 trial is a multicenter randomized study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone in de novo Stage IV breast cancer (BC) patients.
Aim: To evaluate and finalize the survival data of LRT in patients with the diagnosis of de novo Stage IV BC.
Methods. At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. Continuous and categorical variable differences between LRT and ST groups were analyzed using t-test and Chi-square test, respectively. Overall survival (OS) and 5-year survival rates were compared using Kaplan-Meier log-rank tests. Univariate and multivariate Cox models were used to estimate hazard ratios, and logistic regession model used to estimate odds ratio.
Results. During more than 10 years follow-up, 23% of patients in LRT group and 8% of patients in ST group were alive. Median survival was 46 months for LRT (n=134) and 35 months for ST (n=131) [HR:0.71, 95%CI;0.59-0.86, p=0.0004]. Solitary bone metastasis patients’ median survival was 14 months longer in LRT group comparing ST group [HR:0.55, 95%CI; 0.35-0.86, p=0.008]; 16% of solitary bone metastasis patients in the LRT group were alive, but all patients died in the ST group. Patients younger than 55 lived longer compared the patients older than 55 [HR:0.67, 95%CI; 0.52-0.87, p=0.002], and 26% of hormone receptor positive patients were still alive in the LRT group comparing 10% in the ST group [HR:0.71, 95%CI; 0.58-0.88, p=0.002]. Regarding the patients who lived at least 5 years since randomization, LRT (p=0.003), hormone receptor positivity (p=0.004), Triple negative status (p=0.02), hormonotherapy (p=0.0001), bisphosphonates usage (p=0.03), and 2 or more organ metastases (p=0.004) were associated with OS in univariant analyses. However, in the multivariate model with significant baseline and clinical characteristics only LRT [OR= 1.58, p=0.03] was found to be significantly related with over 5 years of survival.
Conclusion. In the current analysis, patients at the diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 58% higher chance to live at least 5 years compared to the patients who received only ST. Longer follow-up of the study discloses that LRT should be presented to patients when discussing treatment options.
ClinicalTrials.gov identifier number is NCT00557986
Citation Format: Atilla Soran, Vahit Ozmen, Serdar Ozbas, Hasan Karanlik, Mahmut Muslumanoglu, Abdullah Igci, Zafer Canturk, Zafer Utkan, Cihangir Ozaslan, Turkkan Evrensel, Cihan Uras, Erol Aksaz, Aykut Soyder, Umit Ugurlu, Cavit Col, Neslihan Cabioglu, Ergun Erdem, Gunay Gurleyik, Efe Sezgin. Primary surgery in patients with de novo stage IV BC; finalizing the protocol MF07-01 randomized clinical trial [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 P1-20-01.
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Ordu C, Gachayev F, Elbuken F, Baysal B, Pilanci K, Alco G, Ilgun A, Ucuncu M, Ozturk A, Erdogan Z, Agacayak F, Ozdem G, Kayan T, Uyar T, Hocaoğlu E, Soybir G, Aktepe F, Ozmen V. Anti-mullerian hormone (AMH) levels and antral follicle counts (AFC) may predict ovarian reserves before systemic chemotherapy (SC) in women with breast cancer (BC): A prospective clinical study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.078] [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: 11/13/2022] Open
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Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk Z, Utkan Z, Ozaslan C, Evrensel T, Uras C, Aksaz E, Soyder A, Ugurlu U, Col C, Cabioglu N, Bozkurt B, Uzunkoy A, Sezgin E, Gurleyik G, Soran A. The importance of primary surgery in patients with de novo stage IV BC surviving at least 5 years: Protocol MF07-01 randomized clinical trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.005] [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: 11/14/2022] Open
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Tsaousis GN, Papadopoulou E, Apessos A, Agiannitopoulos K, Pepe G, Kampouri S, Diamantopoulos N, Floros T, Iosifidou R, Katopodi O, Koumarianou A, Markopoulos C, Papazisis K, Venizelos V, Xanthakis I, Xepapadakis G, Banu E, Eniu DT, Negru S, Stanculeanu DL, Ungureanu A, Ozmen V, Tansan S, Tekinel M, Yalcin S, Nasioulas G. Analysis of hereditary cancer syndromes by using a panel of genes: novel and multiple pathogenic mutations. BMC Cancer 2019; 19:535. [PMID: 31159747 PMCID: PMC6547505 DOI: 10.1186/s12885-019-5756-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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: 09/03/2018] [Accepted: 05/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Hereditary cancer predisposition syndromes are responsible for approximately 5–10% of all diagnosed cancer cases. In the past, single-gene analysis of specific high risk genes was used for the determination of the genetic cause of cancer heritability in certain families. The application of Next Generation Sequencing (NGS) technology has facilitated multigene panel analysis and is widely used in clinical practice, for the identification of individuals with cancer predisposing gene variants. The purpose of this study was to investigate the extent and nature of variants in genes implicated in hereditary cancer predisposition in individuals referred for testing in our laboratory. Methods In total, 1197 individuals from Greece, Romania and Turkey were referred to our laboratory for genetic testing in the past 4 years. The majority of referrals included individuals with personal of family history of breast and/or ovarian cancer. The analysis of genes involved in hereditary cancer predisposition was performed using a NGS approach. Genomic DNA was enriched for targeted regions of 36 genes and sequencing was carried out using the Illumina NGS technology. The presence of large genomic rearrangements (LGRs) was investigated by computational analysis and Multiplex Ligation-dependent Probe Amplification (MLPA). Results A pathogenic variant was identified in 264 of 1197 individuals (22.1%) analyzed while a variant of uncertain significance (VUS) was identified in 34.8% of cases. Clinically significant variants were identified in 29 of the 36 genes analyzed. Concerning the mutation distribution among individuals with positive findings, 43.6% were located in the BRCA1/2 genes whereas 21.6, 19.9, and 15.0% in other high, moderate and low risk genes respectively. Notably, 25 of the 264 positive individuals (9.5%) carried clinically significant variants in two different genes and 6.1% had a LGR. Conclusions In our cohort, analysis of all the genes in the panel allowed the identification of 4.3 and 8.1% additional pathogenic variants in other high or moderate/low risk genes, respectively, enabling personalized management decisions for these individuals and supporting the clinical significance of multigene panel analysis in hereditary cancer predisposition. Electronic supplementary material The online version of this article (10.1186/s12885-019-5756-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Theofanis Floros
- Oncology Department, Athens Naval and Veterans Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | - Eugeniu Banu
- Spitalul Sfantul Constantin Brasov, Brasov, Romania
| | - Dan Tudor Eniu
- Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania
| | - Serban Negru
- University of Medicine and Pharmacy of Timisoara, Timisoara, Romania
| | | | | | - Vahit Ozmen
- Faculty of Medicine Istanbul University, Istanbul, Turkey
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Erdogan Iyigun Z, Agacayak F, Ilgun AS, Elbuken Celebi F, Ordu C, Alco G, Ozturk A, Duymaz T, Aktepe F, Ozmen V. The Role of Elastography in Diagnosis and Staging of Breast Cancer-Related Lymphedema. Lymphat Res Biol 2019; 17:334-339. [DOI: 10.1089/lrb.2018.0012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Zeynep Erdogan Iyigun
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey
| | - Filiz Agacayak
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Ahmet Serkan Ilgun
- Department of General Surgery, Gaziosmanpaşa Taksim Education and Research Hospital, Istanbul, Turkey
| | - Filiz Elbuken Celebi
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Cetin Ordu
- Department of Oncology and Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Alper Ozturk
- Department of General Surgery, Biruni University Hospital, Istanbul, Turkey
| | - Tomris Duymaz
- Physiotheraphy and Rehabilitation School, Istanbul Bilgi University, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Vahit Ozmen
- Department of Breast Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Tsoulos N, Tsaousis GN, Papadopoulou E, Agiannitopoulos K, Pepe G, Kambouri S, Apessos A, Diamantopoulos N, Floros T, Iosifidou R, Katopodi O, Koumarianou A, Markopoulos C, Papazisis K, Venizelos V, Xanthakis I, Xepapadakis G, Banu E, Eniu DT, Negru S, Stanculeanu DL, Ungureanu A, Ozmen V, Tansan S, Tekinel M, Yalcin S, Nasioulas G. Abstract P4-03-07: Analysis of hereditary cancer syndromes by using a panel of genes: Novel and multiple pathogenic mutations. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-03-07] [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
BACKGOUND: Hereditary cancer predisposition syndromes are believed to be responsible for approximately 5-10% of all diagnosed cancer cases. In the past, single genes analysis of certain high risk genes was used for the determination of the genetic cause of cancer heritability in certain families. The selection of genes was mainly based on the family history of the individuals analyzed and included only highly associated genes (e.g. the BRCA1 and BRCA2 genes for families with breast cancer history. Nowadays though, the application of Next Generation Sequencing (NGS) technology has facilitated multigene panel analysis and is widely used in clinical practice, for the identification of individuals with cancer predisposition gene mutations.
AIM: The aim of this study was to investigate the extent and nature of mutations in 36 genes implicated in hereditary cancer predisposition in individuals referred for testing in our lab.
MATERIALS & METHODS: In total, 1197 individuals were referred for testing in our lab in the past four years from Greece, Romania and Turkey. The analysis of genes involved in hereditary cancer predisposition was performed using two NGS approaches. The first 451 individuals were analyzed using an amplicon based sequencing method (26 gene panel), while the following 746 individuals were analyzed using a capture based method (33 gene panel). Genomic DNA was enriched for targeted regions of 36 genes involved in hereditary predisposition to cancer included in both versions of the panel (APC, BMPR1A, BRCA1, BRCA2, CDH1, CDK4, CDKN2A, EPCAM, MEN1, MLH1, MSH2, MSH6, MUTYH, PALB2, PMS2, PTEN, RET, SMAD4, STK11, TP53, VHL, ATM, BRIP1, CHEK2, NBN, RAD51C, RAD51D, BARD1, BLM, CHEK1, ABRAXAS1 (FAM175A), MRE11 (MRE11A), NF1, RAD50, RAD51B, XRCC2). Sequencing was carried out using the Illumina NGS technology. Reads were aligned to the reference sequence (GRCh37), and sequence changes were identified and interpreted in the context of a single clinically relevant transcript. The presence of large genomic rearrangements was investigated by computational analysis of NGS results and the use of MLPA for 13 genes. All clinically significant observations were confirmed by orthogonal technologies.
RESULTS: In total, a pathogenic mutation was identified in 259 of the 1197 individuals (21.6%) analyzed while a VUS was identified in 35.7% of the cases. Clinically significant mutations were identified in 29 of the genes analyzed. Concerning the mutation distribution among individuals with positive findings, 44.7% of them were located in BRCA1/2 genes whereas 20.9%, 19.9%, and 14.5% in high, moderate and low risk genes respectively. In addition to BRCA1 and BRCA2 genes other highly mutated genes were CHEK2 (10.6%), PALB2 (7.1%), MUTYH (7.1%) and ATM (4.3%). Of note is that 25 of the 259 positive individuals (9.7%) carried clinically significant mutations in two different genes and 5.8% had a large genomic rearrangement (LGR).
CONCLUSIONS: Our results support the clinical significance of analysis of a panel of genes involved in hereditary cancer predisposition. In our cohort, analysis of this panel allowed for the identification of 8.3% additional pathogenic variants in moderate/low risk genes, enabling personalized management of these individuals.
Citation Format: Tsoulos N, Tsaousis GN, Papadopoulou E, Agiannitopoulos K, Pepe G, Kambouri S, Apessos A, Diamantopoulos N, Floros T, Iosifidou R, Katopodi O, Koumarianou A, Markopoulos C, Papazisis K, Venizelos V, Xanthakis I, Xepapadakis G, Banu E, Eniu DT, Negru S, Stanculeanu DL, Ungureanu A, Ozmen V, Tansan S, Tekinel M, Yalcin S, Nasioulas G. Analysis of hereditary cancer syndromes by using a panel of genes: Novel and multiple pathogenic mutations [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 P4-03-07.
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Affiliation(s)
- N Tsoulos
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - GN Tsaousis
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - E Papadopoulou
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - K Agiannitopoulos
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - G Pepe
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - S Kambouri
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - A Apessos
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - N Diamantopoulos
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - T Floros
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - R Iosifidou
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - O Katopodi
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - A Koumarianou
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - C Markopoulos
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - K Papazisis
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - V Venizelos
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - I Xanthakis
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - G Xepapadakis
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - E Banu
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - DT Eniu
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - S Negru
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - DL Stanculeanu
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - A Ungureanu
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - V Ozmen
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - S Tansan
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - M Tekinel
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - S Yalcin
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
| | - G Nasioulas
- GeneKor Medical S.A, Athens, Greece; Theagenio Anticancer Hospital, Thessaloniki, Greece; Athens Naval and Veterans Hospital, Athens, Greece; Euroclinic Group, Athens, Greece; Attikon University Hospital, Athens, Greece; Athens Medical Center, Athens, Greece; Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece; Metropolitan Hospital, Athens, Greece; St. Luke's Hospital, Thessaloniki, Greece; IASO, General Maternity and Gynecology Clinic, Athens, Greece; Spitalul Sfantul Constantin Brasov, Brasov, Romania; Institutul Oncologic Prof. Dr. I. Chiricuta, Cluj, Romania; University of Medicine and Pharmacy of Timisoara, Timisoara, Romania; Institutul Oncologic Bucuresti, Bucuresti, Romania; Amethyst Radiotherapy Cluj-Napoca, Cluj, Romania; Faculty of Medicine Istanbul University, Istanbul, Turkey; Tansan Oncology, Istanbul, Turkey; Private Practice, Fulya Sisli, Turkey; Private Practice, Kavaklidere, Turkey
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Ozturk A, Alco G, Sarsenov D, Ilgun S, Ordu C, Koksal U, Nur Pilanci K, Erdogan Z, Izci F, Elbuken F, Agacayak F, Aktepe F, Ozmen V. Synchronous and metachronous bilateral breast cancer: A long-term experience. J BUON 2018; 23:1591-1600. [PMID: 30610782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The objective of this study was to assess the demographic, pathologic and survival characteristics of patients who were diagnosed as having bilateral breast cancer. METHODS A review was conducted of the records pertaining to patients who presented to our clinic and were diagnosed as having breast cancer. Any second cancer diagnosed within 12 months of initial diagnosis was defined as synchronous bilateral breast cancer. Assessment included treatments administered to the patients and survival rates, as well as their demographic, reproductive and pathologic features. RESULTS The total number of patients who were diagnosed as having bilateral breast cancer in the context of the present study was 99. Among the patients with synchronous breast cancer, the median age at the time of initial diagnosis was found as 57 years. The median age of the discovery of first tumor among the patients with metachronous tumor was 52 years and the median age of second tumor detection was 59 years. Family history in metachronous tumor was significantly greater (p=0.041). The median time of metachronous cancer incidence was 96 months. The length of disease-free period among the patients with synchronous tumor was 126.3 months, whereas it was 243.7 months in those with metachronous tumor (p=0.041). CONCLUSION The incidence rate of synchronous breast tumors has been rising thanks to growing awareness and the leading-edge imaging methods. The fact that the second tumor developed after more than 5 years among the patients with metachronous cancer gave rise to the increased rate of survival.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Incidence
- Middle Aged
- Neoplasm Invasiveness
- Neoplasms, Multiple Primary/epidemiology
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
- Prognosis
- Survival Rate
- Turkey/epidemiology
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Affiliation(s)
- Alper Ozturk
- Biruni University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
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45
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Cabuk FK, Aktepe F, Kapucuoglu FN, Coban I, Sarsenov D, Ozmen V. Interobserver reproducibility of tumor-infiltrating lymphocyte evaluations in breast cancer. INDIAN J PATHOL MICR 2018; 61:181-186. [PMID: 29676353 DOI: 10.4103/ijpm.ijpm_131_17] [Citation(s) in RCA: 4] [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] [Indexed: 11/04/2022] Open
Abstract
Aim Tumor-infiltrating lymphocytes (TILs) have a prognostic value in breast cancer (BC); however, because of the lack of standard evaluation methods, we aimed to assess the interobserver agreement of stromal TILs (sTILs) and intratumoral TILs (iTILs) as well as the effect of hot spot areas and molecular subtyping on the overall agreement. Methods The study consisted of 121 haematoxylin and eosin (H and E)-stained slides of invasive BC samples obtained from the pathology archives. The TIL assessment was based on the International TIL Working Group recommendations for the percentage of sTILs and was conducted by four pathologists. The percentage of iTILs, the number of lymphocytes in hot spot areas (iTILs-HS), and the overall interobserver agreement for the molecular subtypes were evaluated. The interclass correlation coefficient (ICC) was used to assess interobserver agreement among the four pathologists. Results: The ICC score among the observers for the sTIL percentages was 0.74, and the individual ICC values for each molecular subtype were 0.55, 0.88, and 0.79 for luminal, HER2-positive, and triple-negative tumors, respectively. The compliance value for the iTILs was 0.29 (95% confidence interval (CI) = 0.06-0.48], whereas the compliance value for the iTILs-HS was 0.63 (95% CI = 0.49-0.71). The compliance values for the iTILs-HS subtypes were 0.72, 0.43, and 0.55 for luminal, HER2-positive, and triple-negative tumors, respectively. Conclusion The IWTILG recommendations are reproducible and reliable. The interobserver agreement of the sTIL percentages was considerably higher for the triple-negative and HER2-positive cases than the luminal cases, whereas the interobserver agreement for the assessment of iTILs-HS in tumors was higher for the luminal subtype.
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Affiliation(s)
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | | | - Ipek Coban
- Department of Pathology, Istanbul Bilim University, Istanbul, Turkey
| | - Dauren Sarsenov
- Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Vahit Ozmen
- Department of General Surgery, Istanbul University, Istanbul, Turkey
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46
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Cabıoğlu N, Ozkan-Gurdal S, Kayhan A, Ozaydın AN, Şahin C, Ozcinar B, Aribal E, Ozmen V. Characteristics of Screen-Detected Breast Cancer of Turkish Bahcesehir (Istanbul) Screening Project. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10070] [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: 11/20/2022] Open
Abstract
Purpose The Turkish Bahcesehir Breast Cancer Screening Project is a 10-year organized population-based screening program carried out in one of the largest counties of Istanbul, Turkey. The aim of the current study was to examine the biologic features of screen-detected and interval breast cancers for the first 9-year study period. Methods Between January 2009 and January 2018, 26,040 mammographies were performed with 2-year intervals for 8,408 women age 40 to 69 years. Clinicopathologic and biologic tumor characteristics—estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2-neu, and protein encoded by the MKI67 gene (Ki-67) —were analyzed for those patients who were diagnosed with breast cancer. Interval cancer was defined as symptomatic cancer diagnosed within 24 months of a negative screening. Ki-67 level > 20% was considered a high score. Results Median age was 52.5 years, and 37% were younger than age 50 years. Of 8,408 women, 113 breast cancers (1.3%) were detected. There were 14 ductal carcinoma in situ (12.4%) and 99 invasive cancers (87.6%). The majority of patients with invasive cancer had stage 1 (49.1%) or stage 2 (31.8%) disease. The majority of patients underwent breast-conserving therapy (83%) with sentinel lymph node biopsy alone (74.1%). Interval cancers (n = 11) were more likely to have multifocality or multicentricity ( P = .002) and high Ki-67 score ( P = .05). Furthermore, diagnosis with interval cancer was associated with more advanced disease, including stage II to IV disease and axillary positivity, and patients were more likely to have nonluminal cancers or tumors with lymphovascular invasion. However, these associations did not reach statistical significance. Multivariable logistic regression analysis identified multifocality or multicentricity as the only significant factor to be associated with interval cancers (odds ratio, 5.94; 95% CI, 1.4 to 25.4; P = .016). Conclusion Our findings suggest that the majority of screen-detected breast cancers exhibit either luminal A or B subtype with low Ki-67 scores and unifocal tumors. However, interval cancers were more likely to have aggressive biology and multicentricity that was less likely to be detected by mammographic screening programs and that required more aggressive surgical and systemic therapies. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Neslihan Cabioğlu Research Funding: Roche (Inst) Travel, Accommodations, Expenses: Genomic Health Sibel Ozkan-Gurdal Research Funding: Roche (Inst) Arda Kayhan Research Funding: Roche (Inst) Ayse Nilufer Ozaydin Research Funding: Roche (Inst) Cennet Şahin Research Funding: Roche (Inst) Beyza Ozcinar Research Funding: Roche (Inst) Erkin Aribal Employment: Nutricia – Danone and TRPharm (I) Leadership: Nutricia – Danone and TRPharm (I) Stock or Other Ownership: Roche (I) Honoraria: GE Healthcare, Fuji, Roche Travel, Accommodations, Expenses: Bayer Vahit Ozmen Honoraria: Pfizer, Roche Research Funding: Roche (Inst), Genekor, Roche Travel, Accommodations, Expenses: Pfizer
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Affiliation(s)
- Neslihan Cabıoğlu
- Neslihan Cabıoğlu, B. Ozcinar, and V. Ozmen, Istanbul University; A. Kayhan, Kanuni Sultan Suleyman Research and Teaching Hospital; N. Ozaydın and E. Aribal, Marmara University; C. Şahin, Şişli Etfal Research and Teaching Hospital, Istanbul; and S. Ozkan-Gurdal, Namık Kemal University, Tekirdag, Turkey
| | - Sibel Ozkan-Gurdal
- Neslihan Cabıoğlu, B. Ozcinar, and V. Ozmen, Istanbul University; A. Kayhan, Kanuni Sultan Suleyman Research and Teaching Hospital; N. Ozaydın and E. Aribal, Marmara University; C. Şahin, Şişli Etfal Research and Teaching Hospital, Istanbul; and S. Ozkan-Gurdal, Namık Kemal University, Tekirdag, Turkey
| | - Arda Kayhan
- Neslihan Cabıoğlu, B. Ozcinar, and V. Ozmen, Istanbul University; A. Kayhan, Kanuni Sultan Suleyman Research and Teaching Hospital; N. Ozaydın and E. Aribal, Marmara University; C. Şahin, Şişli Etfal Research and Teaching Hospital, Istanbul; and S. Ozkan-Gurdal, Namık Kemal University, Tekirdag, Turkey
| | - Ayse Nilufer Ozaydın
- Neslihan Cabıoğlu, B. Ozcinar, and V. Ozmen, Istanbul University; A. Kayhan, Kanuni Sultan Suleyman Research and Teaching Hospital; N. Ozaydın and E. Aribal, Marmara University; C. Şahin, Şişli Etfal Research and Teaching Hospital, Istanbul; and S. Ozkan-Gurdal, Namık Kemal University, Tekirdag, Turkey
| | - Cennet Şahin
- Neslihan Cabıoğlu, B. Ozcinar, and V. Ozmen, Istanbul University; A. Kayhan, Kanuni Sultan Suleyman Research and Teaching Hospital; N. Ozaydın and E. Aribal, Marmara University; C. Şahin, Şişli Etfal Research and Teaching Hospital, Istanbul; and S. Ozkan-Gurdal, Namık Kemal University, Tekirdag, Turkey
| | - Beyza Ozcinar
- Neslihan Cabıoğlu, B. Ozcinar, and V. Ozmen, Istanbul University; A. Kayhan, Kanuni Sultan Suleyman Research and Teaching Hospital; N. Ozaydın and E. Aribal, Marmara University; C. Şahin, Şişli Etfal Research and Teaching Hospital, Istanbul; and S. Ozkan-Gurdal, Namık Kemal University, Tekirdag, Turkey
| | - Erkin Aribal
- Neslihan Cabıoğlu, B. Ozcinar, and V. Ozmen, Istanbul University; A. Kayhan, Kanuni Sultan Suleyman Research and Teaching Hospital; N. Ozaydın and E. Aribal, Marmara University; C. Şahin, Şişli Etfal Research and Teaching Hospital, Istanbul; and S. Ozkan-Gurdal, Namık Kemal University, Tekirdag, Turkey
| | - Vahit Ozmen
- Neslihan Cabıoğlu, B. Ozcinar, and V. Ozmen, Istanbul University; A. Kayhan, Kanuni Sultan Suleyman Research and Teaching Hospital; N. Ozaydın and E. Aribal, Marmara University; C. Şahin, Şişli Etfal Research and Teaching Hospital, Istanbul; and S. Ozkan-Gurdal, Namık Kemal University, Tekirdag, Turkey
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Oner G, Onder S, Karatay H, Tukenmez M, Muslumanoglu M, Igci A, Dinccag A, Ozmen V, Aydiner A, Yavuz E, Cabioglu N. High expression of pdl-1 in patients with triple negative breast cancer with residual tumor burden after neoadjuvant chemotherapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e24136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Soran A, Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk Z, Utkan Z, Ozaslan C, Evrensel T, Uras C, Aksaz E, Soyder A, Ugurlu U, Col C, Cabioglu N, Bozkurt B, Uzunkoy A, Koksal N, Gulluoglu BM, Unal B, Atalay C, Yıldırım E, Erdem E, Salimoglu S, Sezer A, Koyuncu A, Gurleyik G, Alagol H, Ulufi N, Berberoglu U, Dulger M, Cengiz O, Sezgin E, Johnson R. Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol 2018; 25:3141-3149. [PMID: 29777404 DOI: 10.1245/s10434-018-6494-6] [Citation(s) in RCA: 200] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-naïve stage IV breast cancer (BC) patients. METHODS At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. RESULTS The trial enrolled 274 patients: 138 in the LRT group and 136 in the ST group. Hazard of death was 34% lower in the LRT group than in the ST group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.49-0.88; p = 0.005). Unplanned subgroup analyses showed that the risk of death was statistically lower in the LRT group than in the ST group with respect to estrogen receptor (ER)/progesterone receptor (PR)(+) (HR 0.64; 95% CI 0.46-0.91; p = 0.01), human epidermal growth factor 2 (HER2)/neu(-) (HR 0.64; 95% CI 0.45-0.91; p = 0.01), patients younger than 55 years (HR 0.57; 95% CI 0.38-0.86; p = 0.007), and patients with solitary bone-only metastases (HR 0.47; 95% CI 0.23-0.98; p = 0.04). CONCLUSION In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden.
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Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA, USA.
| | - Vahit Ozmen
- Department of Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Serdar Ozbas
- Breast and Endocrine Surgery Unit, Ankara Guven Hospital, Ankara, Turkey
| | - Hasan Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Capa, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Department of Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Abdullah Igci
- Department of Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Zafer Canturk
- Department of Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Zafer Utkan
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Cihangir Ozaslan
- Department of Surgery, Ankara Oncology Teaching and Research Hospital, Ankara, Turkey
| | - Turkkan Evrensel
- Department of Medical Oncology, Uludag University School of Medicine, Bursa, Turkey
| | - Cihan Uras
- Department of Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | | | - Aykut Soyder
- Department of Surgery, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Umit Ugurlu
- Department of Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Cavit Col
- Department of Surgery, Etimed Hospital, Etimesgut, Ankara, Turkey
| | - Neslihan Cabioglu
- Department of Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Betül Bozkurt
- Department of Surgery, Hitit University School of Medicine, Corum, Turkey
| | - Ali Uzunkoy
- Department of Surgery, Harran University School of Medicine, Urfa, Turkey
| | - Neset Koksal
- Department of Surgery, SBU Umraniye Teaching and Research Hospital, Istanbul, Turkey
| | - Bahadir M Gulluoglu
- Department of Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Bulent Unal
- Department of Surgery, School of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Can Atalay
- Department of Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | | | - Ergun Erdem
- Department of Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | - Semra Salimoglu
- Department of Surgery, Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Atakan Sezer
- Department of Surgery, Trakya University School of Medicine, Edirne, Turkey
| | - Ayhan Koyuncu
- Department of Surgery, Medicana Sivas Hospital, Sivas, Turkey
| | - Gunay Gurleyik
- Department of Surgery, Haydarpaşa Numune Teaching and Research Hospital, Istanbul, Turkey
| | - Haluk Alagol
- Department of Surgery, Ankara Oncology Teaching and Research Hospital, Ankara, Turkey
| | - Nalan Ulufi
- Department of Surgery, Ozel Bolge Pendik Hospital, Pendik, Istanbul, Turkey
| | - Uğur Berberoglu
- Department of Surgery, Ankara Oncology Teaching and Research Hospital, Ankara, Turkey
| | | | - Omer Cengiz
- Department of Surgery, Koru Ankara Hospital, Ankara, Turkey
| | - Efe Sezgin
- Department of Food Engineering, Laboratory of Nutrigenomics and Epidemiology, Izmir Institute of Technology, Izmir, Turkey
| | - Ronald Johnson
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, PA, USA
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Can Trabulus D, Ozkurt E, Tukenmez M, Onder S, Muslumanoglu M, Igci A, Ozmen V, Dinccag A, Aydiner A, Cabioglu N. Predictive Factors to Achieve Pathologic Complete Response in Patients with Locally Advanced Breast Cancer in Decision Making for more Conservative Management. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30565-3] [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: 11/29/2022]
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Can Trabulus D, Ozturk E, Cabioglu N, Dogan S, Tukenmez M, Emirikci S, Igci A, Ozmen V, Dinccag A, Muslumanoglu M. Factors Determining Local Recurrence in Locally Advanced Breast Cancer Patients who Received Neoadjuvant Chemotherapy and Breast Conserving Surgery. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30577-x] [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: 10/17/2022]
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