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Coty-Fattal Z, Minhas S, Butcher M, Agarwal I, LaBoy C, Blanco L, Novo J. Clinicopathologic and Immunophenotypic Classification of Invasive Lobular Carcinoma with Histiocytoid Features. Int J Surg Pathol 2024; 32:719-725. [PMID: 37525567 DOI: 10.1177/10668969231189714] [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] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Histiocytoid lobular breast carcinoma is a rare subtype of invasive lobular carcinoma characterized by relatively bland, uniform nuclei, single small eosinophilic nucleolus, and ample granular cytoplasm. These cancers are typically triple negative, show frequent androgen receptor (AR) positivity, and are therefore theorized to represent a variant of apocrine differentiation in invasive lobular carcinoma. Anecdotal evidence suggests that these tumors have excellent outcomes, though some studies suggest a variable clinical outcome. METHODS Inclusion criteria included women with a histologic diagnosis of invasive lobular carcinoma with histiocytoid features, regardless of immunohistochemical profile, diagnosed at our institution between 2008 and 2021 with additional tissue still available for ancillary studies. We reviewed patients meeting these criteria and investigated hematoxylin and eosin-stained slides and a panel of immunohistochemical stains (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 [HER2], AR, endothelial growth factor receptor, and keratin 5/6), as well as outcomes including survival and metastatic disease. RESULTS Overall, 12 eligible patients were identified. The classical immunophenotype (triple negative with AR positivity) was noted in 4 out of 12 tumors. The majority of the remaining tumors (7 out of 12) showed a luminal B immunohistochemical profile, while 1 out of 12 was HER2-enriched. No patients in the cohort died from disease-related causes and 2 out of 12 presented with distant metastatic disease during their disease course. CONCLUSION Histiocytoid lobular breast carcinoma is a morphologic variant of lobular carcinoma with apocrine features that shows a variable immunohistochemical profile and variable clinical behavior. Further subclassification and stricter diagnostic criteria may be helpful in the distinction between truly indolent tumors and those with more aggressive clinical features.
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MESH Headings
- Humans
- Female
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/classification
- Carcinoma, Lobular/metabolism
- Middle Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/classification
- Aged
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Immunohistochemistry
- Adult
- Immunophenotyping
- Receptors, Androgen/analysis
- Receptors, Androgen/metabolism
- Receptors, Progesterone/metabolism
- Receptors, Progesterone/analysis
- Receptors, Estrogen/metabolism
- Receptors, Estrogen/analysis
- Aged, 80 and over
- Retrospective Studies
- Receptor, ErbB-2/metabolism
- Receptor, ErbB-2/analysis
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Affiliation(s)
- Zachary Coty-Fattal
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Monica Butcher
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Indu Agarwal
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carissa LaBoy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luis Blanco
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jorge Novo
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Miyazaki N, Iwasaki T, Sakai H, Watanuki R, Tanizawa Y, Cai Z, Kawaguchi T, Tsurutani J, Nagashima K. Risk factors for recurrence in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative early breast cancer in Japan: a systematic literature review and meta-analysis. Curr Med Res Opin 2024; 40:827-837. [PMID: 38597173 DOI: 10.1080/03007995.2024.2332436] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The clinicopathological factors indicating risk of recurrence are used to guide the choice of perioperative therapy in patients with breast cancer. Although several risk factors for recurrence have been reported in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) early breast cancer in Japan, there has been no systematic review quantifying potential risk factors. METHODS We performed a systematic literature review and meta-analysis using the MEDLINE, Embase, Cochrane CENTRAL, and Japan Medical Abstract Society databases to identify risk factors for recurrence in HR+/HER2- early breast cancer in Japan. The primary outcome was relapse-free or disease-free survival (RFS/DFS), and the secondary outcomes were overall survival and breast cancer-specific survival (BCSS). RESULTS Searches identified 42 eligible publications. Meta-analyses identified lymph node metastasis (hazard ratio: 2.76 [95% confidence interval: 1.97-3.88]), large tumor size (1.67 [1.24-2.23]), high histological grade (1.50 [1.04-2.16]), and high nuclear grade (2.02 [1.61-2.54]) as risk factors for RFS/DFS. Lymph node metastasis (2.43 [1.28-4.63]), large tumor size (1.80 [1.24-2.62]), and high histological grade (2.02 [1.44-2.84]) were also risk factors for overall survival, and high progesterone status was a possible favorable prognostic factor for BCSS (0.20 [0.10-0.42]). CONCLUSIONS Identified risk factors were consistent with the previous reports, and this study provides quantitative summary of risk factors for HR+/HER2- early breast cancer recurrence in Japan. (PROSPERO Registration ID, CRD42022338391.).
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Affiliation(s)
- Naoki Miyazaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Toshiki Iwasaki
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Hitomi Sakai
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Rurina Watanuki
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshinori Tanizawa
- Japan Drug Development and Medical Affairs, Eli Lilly Japan, Kobe, Japan
| | - Zhihong Cai
- Japan Drug Development and Medical Affairs, Eli Lilly Japan, Kobe, Japan
| | - Tsutomu Kawaguchi
- Japan Drug Development and Medical Affairs, Eli Lilly Japan, Kobe, Japan
| | - Junji Tsurutani
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
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Vanni G, Selntigia A, Marsella VE, Russo C, Pellicciaro M, Materazzo M, Rizzo G, Buonomo OC, Exacoustos C. Breast Cancer in Patients with Previous Endometriosis Showed Low Aggressive Subtype. Medicina (Kaunas) 2024; 60:625. [PMID: 38674271 PMCID: PMC11051959 DOI: 10.3390/medicina60040625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: The association between endometriosis and breast cancer still remains controversial. The aim of this study was to investigate the different subtypes of breast cancer, immunohistochemical markers, hormone receptors, and ki67 proliferation indexes in patients with and without endometriosis and/or adenomyosis. Materials and Methods: All patients with endometriosis and breast cancer were enrolled. Women with endometriosis and breast cancer (Group BC+EN+) were compared to patients with breast cancer without endometriosis (group BC+EN-) and those with endometriosis without breast cancer (group BC-EN+). General population characteristics and histological and immunohistochemical subtypes of breast cancer were compared between groups. Results: Our study included 41 cases affected by both endometriosis and/or adenomyosis and breast cancer (Group BC+EN+) that were matched (1:2) with 82 patients affected only by breast cancer (group BC+EN-) and 82 patients affected only by endometriosis and/or adenomyosis (group BC-EN+). Group BC+EN+ presented a higher percentage of ER receptor expression (83% vs. 70%, p = 0.02), as well as lower values of Ki 67% (15% vs. 24%, p < 0.0001) and HER2+ (9.8% vs. 28%, p = 0.022). These findings were more evident when comparing patients with premenopausal status, while in postmenopausal patients, this difference was no longer significant. Regarding endometriosis, no statistical differences were observed in type or specific localization of the disease among the groups with and without breast cancer. Conclusions: Patients with endometriosis presented lower aggressive breast cancer rates with higher values of ER% and lower values of Ki 67 and HER2neu+. The type and severity of endometriotic diseases seemed not to influence breast cancer occurrence.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (M.M.); (O.C.B.)
| | - Aikaterini Selntigia
- Obstetrics and Gynecological Unit, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (A.S.); (C.R.); (C.E.)
| | - Valentina Enrica Marsella
- Breast Unit, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (M.M.); (O.C.B.)
| | - Consuelo Russo
- Obstetrics and Gynecological Unit, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (A.S.); (C.R.); (C.E.)
- Ph.D. Program in Translation Medicine, Department Biomedicine and Prevention, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (M.M.); (O.C.B.)
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (M.M.); (O.C.B.)
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Rizzo
- Obstetrics and Gynecological Unit, Department Biomedicine and Prevention, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy;
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (M.M.); (O.C.B.)
- General Surgery Program, UNIBAS, University of Basilicata, Via dell’Ateneo Lucano, 10, 85100 Potenza, Italy
| | - Caterina Exacoustos
- Obstetrics and Gynecological Unit, Department of Surgical Science, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (A.S.); (C.R.); (C.E.)
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Li M, Zhou S, Lv H, Cai M, Wan X, Lu H, Shui R, Yang W. FOXC1 and SOX10 in Estrogen Receptor-Low Positive/HER2-Negative Breast Cancer: Potential Biomarkers for the Basal-like Phenotype Prediction. Arch Pathol Lab Med 2024; 148:461-470. [PMID: 37406289 DOI: 10.5858/arpa.2022-0370-oa] [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] [Accepted: 03/28/2023] [Indexed: 07/07/2023]
Abstract
CONTEXT.— Breast cancer with low (1%-10%) estrogen receptor (ER) expression (ER-low positive) constitutes a small portion of invasive breast cancers, and the treatment strategy for these tumors remains debatable. OBJECTIVE.— To characterize the features and outcomes of ER-low positive patients, and clarify the clinical significance of FOXC1 and SOX10 expression in ER-low positive/HER2-negative tumors. DESIGN.— Among 9082 patients diagnosed with primary invasive breast cancer, the clinicopathologic features of those with ER-low positive breast cancer were characterized. FOXC1 and SOX10 mRNA levels were analyzed in ER-low positive/HER2-negative cases from public data sets. The expression of FOXC1 and SOX10 in ER-low positive/HER2-negative tumors was evaluated by immunohistochemistry. RESULTS.— The clinicopathologic study of ER-low positive tumors indicated more aggressive characteristics compared with those tumors with ER >10%, while they had more overlapping features with ER-negative tumors irrespective of the HER2 status. The intrinsic molecular subtype of ER-low positive cases with high FOXC1 and SOX10 mRNA expression was more likely to be nonluminal. Among the ER-low positive/HER2-negative tumors, 56.67% (51 of 90) and 36.67% (33 of 90) were positive for FOXC1 and SOX10, respectively, which was significantly positively correlated with CK5/6 expression. In addition, the survival analysis demonstrated no significant difference between patients who received and who did not receive endocrine therapy. CONCLUSIONS.— ER-low positive breast cancers biologically overlap more with ER-negative tumors. ER-low positive/HER2-negative cases demonstrate a high rate of FOXC1 or SOX10 expression, and these cases might be better categorized as a basal-like phenotype/subtype. FOXC1 and SOX10 testing may be used for the intrinsic phenotype prediction for ER-low positive/HER2-negative patients.
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Affiliation(s)
- Ming Li
- From the Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- the Institute of Pathology, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
| | - Shuling Zhou
- From the Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- the Institute of Pathology, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
| | - Hong Lv
- From the Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- the Institute of Pathology, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
| | - Mengyuan Cai
- From the Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- the Institute of Pathology, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
| | - Xiaochun Wan
- From the Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- the Institute of Pathology, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
| | - Hongfen Lu
- From the Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- the Institute of Pathology, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
| | - Ruohong Shui
- From the Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- the Institute of Pathology, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
| | - Wentao Yang
- From the Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
- the Institute of Pathology, Fudan University, Shanghai, China (Li, Zhou, Lv, Cai, Wan, Lu, Shui, Yang)
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Abele N, Tiemann K, Krech T, Wellmann A, Schaaf C, Länger F, Peters A, Donner A, Keil F, Daifalla K, Mackens M, Mamilos A, Minin E, Krümmelbein M, Krause L, Stark M, Zapf A, Päpper M, Hartmann A, Lang T. Noninferiority of Artificial Intelligence-Assisted Analysis of Ki-67 and Estrogen/Progesterone Receptor in Breast Cancer Routine Diagnostics. Mod Pathol 2023; 36:100033. [PMID: 36931740 DOI: 10.1016/j.modpat.2022.100033] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/12/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 03/17/2023]
Abstract
Image analysis assistance with artificial intelligence (AI) has become one of the great promises over recent years in pathology, with many scientific studies being published each year. Nonetheless, and perhaps surprisingly, only few image AI systems are already in routine clinical use. A major reason for this is the missing validation of the robustness of many AI systems: beyond a narrow context, the large variability in digital images due to differences in preanalytical laboratory procedures, staining procedures, and scanners can be challenging for the subsequent image analysis. Resulting faulty AI analysis may bias the pathologist and contribute to incorrect diagnoses and, therefore, may lead to inappropriate therapy or prognosis. In this study, a pretrained AI assistance tool for the quantification of Ki-67, estrogen receptor (ER), and progesterone receptor (PR) in breast cancer was evaluated within a realistic study set representative of clinical routine on a total of 204 slides (72 Ki-67, 66 ER, and 66 PR slides). This represents the cohort with the largest image variance for AI tool evaluation to date, including 3 staining systems, 5 whole-slide scanners, and 1 microscope camera. These routine cases were collected without manual preselection and analyzed by 10 participant pathologists from 8 sites. Agreement rates for individual pathologists were found to be 87.6% for Ki-67 and 89.4% for ER/PR, respectively, between scoring with and without the assistance of the AI tool regarding clinical categories. Individual AI analysis results were confirmed by the majority of pathologists in 95.8% of Ki-67 cases and 93.2% of ER/PR cases. The statistical analysis provides evidence for high interobserver variance between pathologists (Krippendorff's α, 0.69) in conventional immunohistochemical quantification. Pathologist agreement increased slightly when using AI support (Krippendorff α, 0.72). Agreement rates of pathologist scores with and without AI assistance provide evidence for the reliability of immunohistochemical scoring with the support of the investigated AI tool under a large number of environmental variables that influence the quality of the diagnosed tissue images.
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Affiliation(s)
- Niklas Abele
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Pathologie, Erlangen, Germany.
| | | | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
| | | | - Christian Schaaf
- Department of Internal Medicine II, Klinikum rechts der Isar of the TU Munich, Munich, Germany
| | - Florian Länger
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Anja Peters
- Institut für Pathologie, Städtisches Klinikum Lüneburg gGmbH, Lüneburg, Germany
| | - Andreas Donner
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss, Germany
| | - Felix Keil
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | | | | | - Andreas Mamilos
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Evgeny Minin
- Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
| | | | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Arndt Hartmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Pathologie, Erlangen, Germany
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Ilyalov SR, Ryzhova MV, Galkin MV, Banov SM, Golanov AV, Usachev DY. [Expression of estrogen and progesterone receptors in vestibular schwannomas]. Zh Vopr Neirokhir Im N N Burdenko 2023; 87:44-48. [PMID: 36763552 DOI: 10.17116/neiro20238701144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Stereotactic radiosurgery is one of the main treatments for vestibular schwannomas (VS). Their feature is frequent post-radiation pseudoprogression. This may be due to hormonal status of patients. OBJECTIVE To analyze expression of progesterone and estrogen receptors in women and men with VS. MATERIAL AND METHODS Immunohistochemical analysis of expression of progesterone (PR) and estrogen receptors (ER) after biopsy was performed in 240 patients with VS between 2018 and 2021. ER/PR expression was assessed in men (n=120) and women (n=120) in 3 age subgroups: young age (18-44 years), middle age (45-59 years) and old age (60-79 years). Each subgroup included 40 patients. Statistical analysis was performed using the Mann-Whitney test and MedCalc software. RESULTS ER expression is not typical for VS (men - 1 (0.01%), women - 3 (2.5%)). At the same time, PR expression was found in 29 (24.2%) men and 21 (17.5%) women. We found no significant difference in expression of ER and PR between men and women. However, variability in PR expression was revealed, i.e. predominance of this indicator in young women (p=0.0463) and middle-aged men (p=0.0110). Expression of PR was similar in elderly patients (p=0.2382). CONCLUSION The established incidence of PR expression may be one of the probable causes affecting development and duration of VS pseudoprogression after radiosurgery without clear relationship between sex and age. Further prospective research is needed to predict the risks of pseudoprogression.
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Affiliation(s)
- S R Ilyalov
- Gamma Clinic center of high precision radiology (Gamma Medtechnology LLC), Obninsk, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - S M Banov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A V Golanov
- Burdenko Neurosurgical Center, Moscow, Russia
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7
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王 跃, 张 爽, 张 虹, 梁 丽, 徐 玲, 程 元, 段 学, 刘 荫, 李 挺. [Clinicopathological features and prognosis of hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer]. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54:853-862. [PMID: 36241228 PMCID: PMC9568399 DOI: 10.19723/j.issn.1671-167x.2022.05.013] [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] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the clinicopathological features and prognosis of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2 -) breast cancer. METHODS In the study, 3 035 consecutive breast cancer patients diagnosed in Breast Disease Center, Peking University First Hospital from January 2008 to December 2017 were collected. The prognostic signi-ficance of important pathological factors in HR +/HER2 - patients with complete clinicopathological information was analyzed. RESULTS Within the 1 920 (63.26%) cases of HR +/HER2 - breast cancer, there were 1 624 cases with complete clinicopathological data, of which, 124 cases (7.64%) recurred and/or metastasized and 63 cases died of the disease, and the 5-year overall survival (OS) rate and disease-free survival (DFS) rate was 93.0% and 92.6% respectively. The stage of pT1-2 was 92.80%, while pN0 was 69.03%. 89.66% cases belonged to histologically non-specific type and 30.11%, 55.60%, 14.29% were credited to Grade 1, 2 and 3 respectively. The distribution of ER negative, low or high expression groups were 1.60%, 2.09% and 96.31%, while PR were 6.83%, 10.47%, 82.70%, respectively. The group of Ki67 index < 10% was 19.52%, ≥10% & < 20% for 32.02%, ≥20% for 48.46%. Survival analysis showed that cases with pT1 stage had lower risk of recurrence than those with pT3, while cases with pT2 and pT3 had shorter DFS than those with pT1, with higher risk of recurrence and metastasis. Analysis proved that both pN stage and histological grade were negatively correlated with DFS. The cases with pN0, pN1 and pN2 were lower risk of recurrence than those with pN3, while cases with Grade 1 and 2 had lower risk of recurrence than cases with Grade 3. And the group of Ki67 index ≥20% showed higher risk of recurrence and metastasis. The prognostic significance of ER expression in HR+/HER2- breast cancer was not significant. However, the negative/low PR expression groups showed higher risk of recurrence and metastasis, of which PR < 10% group had shortest DFS and OS, followed by 10%-60% group and then > 60% group. The most common site of metastasis was bone (55 cases, 44.35%), while cases with liver metastasis (30 cases, 24.20%) had the worst outcome. CONCLUSION Our study revealed that pT, pN, Grade, HR expression level and Ki67 index were important prognostic factors for HR +/HER2 - breast cancer, although there are variables in prognostic value. Factors of pN and Grade showed independent prognostic significance. PR expression level had prognostic significance for the risk of recurrence and metastasis. The stratified level of PR expression (< 10%, 10%-60%, >60%) had independent prognostic value, showing successively longer DFS and OS, lower risk of recurrence. PR>60% group had the longest DFS and OS as well as the lowest risk of recurrence.
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Affiliation(s)
- 跃 王
- 北京大学第一医院病理科,北京 100034Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - 爽 张
- 北京大学第一医院病理科,北京 100034Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - 虹 张
- 北京大学第一医院病理科,北京 100034Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - 丽 梁
- 北京大学第一医院病理科,北京 100034Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - 玲 徐
- 北京大学第一医院乳腺疾病中心,北京 100034Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - 元甲 程
- 北京大学第一医院乳腺疾病中心,北京 100034Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - 学宁 段
- 北京大学第一医院乳腺疾病中心,北京 100034Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - 荫华 刘
- 北京大学第一医院乳腺疾病中心,北京 100034Breast Disease Center, Peking University First Hospital, Beijing 100034, China
| | - 挺 李
- 北京大学第一医院病理科,北京 100034Department of Pathology, Peking University First Hospital, Beijing 100034, China
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8
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Trott JF, Schennink A, Horigan KC, Lemay DG, Cohen JR, Famula TR, Dragon JA, Hovey RC. Unique Transcriptomic Changes Underlie Hormonal Interactions During Mammary Histomorphogenesis in Female Pigs. Endocrinology 2022; 163:bqab256. [PMID: 34918063 PMCID: PMC10409904 DOI: 10.1210/endocr/bqab256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/19/2022]
Abstract
Successful lactation and the risk for developing breast cancer depend on growth and differentiation of the mammary gland (MG) epithelium that is regulated by ovarian steroids (17β-estradiol [E] and progesterone [P]) and pituitary-derived prolactin (PRL). Given that the MG of pigs share histomorphogenic features present in the normal human breast, we sought to define the transcriptional responses within the MG of pigs following exposure to all combinations of these hormones. Hormone-ablated female pigs were administered combinations of E, medroxyprogesterone 17-acetate (source of P), and either haloperidol (to induce PRL) or 2-bromo-α-ergocryptine. We subsequently monitored phenotypic changes in the MG including mitosis, receptors for E and P (ESR1 and PGR), level of phosphorylated STAT5 (pSTAT5), and the frequency of terminal ductal lobular unit (TDLU) subtypes; these changes were then associated with all transcriptomic changes. Estrogen altered the expression of approximately 20% of all genes that were mostly associated with mitosis, whereas PRL stimulated elements of fatty acid metabolism and an inflammatory response. Several outcomes, including increased pSTAT5, highlighted the ability of E to enhance PRL action. Regression of transcriptomic changes against several MG phenotypes revealed 1669 genes correlated with proliferation, among which 29 were E inducible. Additional gene expression signatures were associated with TDLU formation and the frequency of ESR1 or PGR. These data provide a link between the hormone-regulated genome and phenome of the MG in a species having a complex histoarchitecture like that in the human breast, and highlight an underexplored synergy between the actions of E and PRL during MG development.
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Affiliation(s)
- Josephine F Trott
- Department of Animal Science, University of California, Davis, Davis, California 95616, USA
| | - Anke Schennink
- Department of Animal Science, University of California, Davis, Davis, California 95616, USA
| | - Katherine C Horigan
- Department of Animal Science, University of Vermont, Burlington, Vermont 05405, USA
| | - Danielle G Lemay
- US Department of Agriculture ARS Western Human Nutrition Research Center, Davis, California 95616, USA
| | - Julia R Cohen
- Department of Animal Science, University of California, Davis, Davis, California 95616, USA
| | - Thomas R Famula
- Department of Animal Science, University of California, Davis, Davis, California 95616, USA
| | - Julie A Dragon
- Vermont Integrative Genomics Resource, University of Vermont, Burlington, Vermont 05405, USA
| | - Russell C Hovey
- Department of Animal Science, University of California, Davis, Davis, California 95616, USA
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9
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Abstract
Meningiomas are common intracranial tumors with a female predominance. Their etiology is still poorly documented. The role of sexual hormones has long been evoked, and data have been conflicting across studies. However, a dose-dependent relationship between the incidence and growth of meningiomas and hormonal treatment with the progestin cyproterone acetate (CPA) has recently been established. CPA-associated meningiomas seem to be mainly located in the anterior and middle skull base, are more likely to be multiple, may harbor P1K3CA mutations in up to one-third of cases, and are more common with a longer duration of treatment. A similar but lower risk of meningiomas has been recently reported with the use of chlormadinone acetate and nomegestrol acetate as progestin treatments. Concerning hormonal replacement therapy (HRT) in menopausal patients, evidence from epidemiological studies seem to favor an increased risk of meningiomas in treated patients although a recent study failed to show an increased growth of meningiomas in HRT treated vs nontreated patients. Until larger studies are available, it seems wise to recommend avoiding HRT in patients with meningiomas. Evidence from published data does not seem to support an increased risk of meningiomas with oral contraceptive oral contraceptive (OR) use. Data are too scarce to conclude on fertility treatments. Based on studies demonstrating the expression of hormonal receptors in meningiomas, therapies targeting these receptors have been tried but have failed to show an overall favorable clinical outcome in meningioma treatment.
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Affiliation(s)
- Mirella Hage
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
| | - Oana Plesa
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
| | - Isabelle Lemaire
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
| | - Marie Laure Raffin Sanson
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
- EA4340, Université de Versailles Saint-Quentin-en-Yvelines, UFR des Sciences de la Santé Simone Veil, F-78423 Montigny-le-Bretonneux, France
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Salama AM, Hanna MG, Giri D, Kezlarian B, Jean MH, Lin O, Vallejo C, Brogi E, Edelweiss M. Digital validation of breast biomarkers (ER, PR, AR, and HER2) in cytology specimens using three different scanners. Mod Pathol 2022; 35:52-59. [PMID: 34518629 PMCID: PMC8702445 DOI: 10.1038/s41379-021-00908-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/03/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
Progression in digital pathology has yielded new opportunities for a remote work environment. We evaluated the utility of digital review of breast cancer immunohistochemical prognostic markers (IHC) using whole slide images (WSI) from formalin fixed paraffin embedded (FFPE) cytology cell block specimens (CB) using three different scanners.CB from 20 patients with breast cancer diagnosis and available IHC were included. Glass slides including 20 Hematoxylin and eosin (H&E), 20 Estrogen Receptor (ER), 20 Progesterone Receptor (PR), 16 Androgen Receptor (AR), and 20 Human Epidermal Growth Factor Receptor 2 (HER2) were scanned on 3 different scanners. Four breast pathologists reviewed the WSI and recorded their semi-quantitative scoring for each marker. Kappa concordance was defined as complete agreement between glass/digital pairs. Discordances between microscopic and digital reads were classified as a major when a clinically relevant change was seen. Minor discordances were defined as differences in scoring percentages/staining pattern that would not have resulted in a clinical implication. Scanner precision was tabulated according to the success rate of each scan on all three scanners.In total, we had 228 paired glass/digital IHC reads on all 3 scanners. There was strong concordance kappa ≥0.85 for all pathologists when comparing paired microscopic/digital reads. Strong concordance (kappa ≥0.86) was also seen when comparing reads between scanners.Twenty-three percent of the WSI required rescanning due to barcode detection failures, 14% due to tissue detection failures, and 2% due to focus issues. Scanner 1 had the best average precision of 92%. HER2 IHC had the lowest intra-scanner precision (64%) among all stains.This study is the first to address the utility of WSI in breast cancer IHC in CB and to validate its reporting using 3 different scanners. Digital images are reliable for breast IHC assessment in CB and offer similar reproducibility to microscope reads.
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Affiliation(s)
- Abeer M Salama
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Dilip Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Brie Kezlarian
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Marc-Henri Jean
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Christina Vallejo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Marcia Edelweiss
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
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Yamaguchi K, Matsunuma R, Hayami R, Tsuneizumi M. Comparison of the Modified IHC4 Score and 21-Gene Recurrence Score Assay in Patients with Estrogen Receptor-Positive Breast Cancer. Oncology 2021; 100:155-162. [PMID: 34875664 DOI: 10.1159/000521287] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Not only the 21-gene recurrence score (RS) assay but also online prognostic tools and immunohistochemical prognostic models predict chemotherapy benefits for women with early breast cancer. Multi-gene assays, including Oncotype DX, are expensive and not covered by insurance in some countries. METHODS In this study, we retrospectively analyzed a series of 155 patients with estrogen receptor-positive primary breast cancer for whom an Oncotype DX assay was performed between January 2016 and August 2021. The patients' modified immunohistochemical marker (mIHC4) scores were calculated on the basis of their pathological reports. The correlations of the RS with the online tool PREDICT and mIHC4 scores were evaluated. RESULTS Of the patients, 43.9% were premenopausal, 147 (94.8%) had T1 or T2 tumor, and 55.5% had no positive lymph nodes. Low (0-10), intermediate (11-25), and high RSs (26-100) were obtained in 16.1%, 61.9%, and 21.9% of the patients, respectively. The RS showed no correlation with the PREDICT score (r = 0.2720) but correlated with the mIHC4 score (r = 0.6356). In addition, a stronger correlation was observed in the patients with no node involvement and in the postmenopausal patients (r = 0.6609 and r = 0.7277, respectively). CONCLUSIONS A relatively strong correlation was observed between the RS and the mIHC4 score. The mIHC4 score is a potentially easy and useful tool to guide adjuvant chemotherapy decision making especially for postmenopausal patients with no node involvement if a genomic test could not be performed for some reason.
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Affiliation(s)
- Kei Yamaguchi
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryoichi Matsunuma
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Ryosuke Hayami
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
| | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka Prefectural Hospital Organization, Shizuoka General Hospital, Shizuoka, Japan
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Connolly RM, Zhao F, Miller KD, Lee MJ, Piekarz RL, Smith KL, Brown-Glaberman UA, Winn JS, Faller BA, Onitilo AA, Burkard ME, Budd GT, Levine EG, Royce ME, Kaufman PA, Thomas A, Trepel JB, Wolff AC, Sparano JA. E2112: Randomized Phase III Trial of Endocrine Therapy Plus Entinostat or Placebo in Hormone Receptor-Positive Advanced Breast Cancer. A Trial of the ECOG-ACRIN Cancer Research Group. J Clin Oncol 2021; 39:3171-3181. [PMID: 34357781 PMCID: PMC8478386 DOI: 10.1200/jco.21.00944] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/14/2021] [Accepted: 06/30/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Endocrine therapy resistance in advanced breast cancer remains a significant clinical problem that may be overcome with the use of histone deacetylase inhibitors such as entinostat. The ENCORE301 phase II study reported improvement in progression-free survival (PFS) and overall survival (OS) with the addition of entinostat to the steroidal aromatase inhibitor (AI) exemestane in advanced hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. PATIENTS AND METHODS E2112 is a multicenter, randomized, double-blind, placebo-controlled phase III study that enrolled men or women with advanced HR-positive, HER2-negative breast cancer whose disease progressed after nonsteroidal AI. Participants were randomly assigned to exemestane 25 mg by mouth once daily and entinostat (EE) or placebo (EP) 5 mg by mouth once weekly. Primary end points were PFS by central review and OS. Secondary end points included safety, objective response rate, and lysine acetylation change in peripheral blood mononuclear cells between baseline and cycle 1 day 15. RESULTS Six hundred eight patients were randomly assigned during March 2014-October 2018. Median age was 63 years (range 29-91), 60% had visceral disease, and 84% had progressed after nonsteroidal AI in metastatic setting. Previous treatments included chemotherapy (60%), fulvestrant (30%), and cyclin-dependent kinase inhibitor (35%). Most common grade 3 and 4 adverse events in the EE arm included neutropenia (20%), hypophosphatemia (14%), anemia (8%), leukopenia (6%), fatigue (4%), diarrhea (4%), and thrombocytopenia (3%). Median PFS was 3.3 months (EE) versus 3.1 months (EP; hazard ratio = 0.87; 95% CI, 0.67 to 1.13; P = .30). Median OS was 23.4 months (EE) versus 21.7 months (EP; hazard ratio = 0.99; 95% CI, 0.82 to 1.21; P = .94). Objective response rate was 5.8% (EE) and 5.6% (EP). Pharmacodynamic analysis confirmed target inhibition in entinostat-treated patients. CONCLUSION The combination of exemestane and entinostat did not improve survival in AI-resistant advanced HR-positive, HER2-negative breast cancer.
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Affiliation(s)
- Roisin M. Connolly
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Cancer Research at UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | | | - Kathy D. Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Min-Jung Lee
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Richard L. Piekarz
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Karen L. Smith
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | | | - Bryan A. Faller
- Heartland NCORP, Missouri Baptist Medical Centre, Saint Louis, MO
| | | | | | | | | | | | | | | | - Jane B. Trepel
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Antonio C. Wolff
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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13
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Wang L, Zhang J, Zhang H, Li R, Li C, Zhao X, Li M. Low-dose aspirin can downregulate progesterone resistance and increase the expression of LIF in endometriosis during the implantation window. Gynecol Endocrinol 2021; 37:725-729. [PMID: 33974468 DOI: 10.1080/09513590.2021.1918663] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIM Study the effect of low-dose aspirin on the endometrial receptivity in endometriosis rat models. MATERIALS AND METHODS This study is to explore the expressions of progesterone receptor and LIF among three groups of endometriosis rat models: control group (n = 12), EMs group (n = 15), and aspirin group (n = 17). The expressions of progesterone receptor (PR), PRA, PRB, and leukemia inhibitory factor receptor (LIFR) in eutopic endometrium were determined using immunohistochemistry technology, western blot, and qRT-PCR. The levels of LIF in eutopic endometrium and serum were detected by western blot, qRT-PCR, and ELISA. RESULTS The expressions of PR, PRA, and PRB protein were significantly increased in the eutopic endometrium after low-dose aspirin treatment, and the level of PRB mRNA was also increased while the ratio of PRA/PRB mRNA was decreased in the eutopic endometrium. The levels of LIF in eutopic endometrium and serum were increased compared with the untreated endometriosis rats. However, the expression of LIFR was not statistically different among the three groups. CONCLUSIONS The results suggest that the low-dose aspirin treatment could downregulate progesterone resistance and increase the expression of LIF of endometriosis rats during the implantation window, which could improve endometrial receptivity and enhance the pregnant rate of endometriosis. It may provide a potential treatment method for endometriosis-related infertility.
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Affiliation(s)
- Lihui Wang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Jing Zhang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Hui Zhang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Rui Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Chunyan Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Xingbo Zhao
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Mingjiang Li
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
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14
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Schoenherr RM, Voytovich UJ, Whiteaker JR, Gadi VK, Gralow JR, Paulovich AG. Quantification of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Protein Expression in Bone Biopsies by Targeted Mass Spectrometry without Acid Decalcification. Clin Chem 2021; 66:1459-1461. [PMID: 33106847 DOI: 10.1093/clinchem/hvaa220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Regine M Schoenherr
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Uliana J Voytovich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jeffrey R Whiteaker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Vijayakrishna K Gadi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
- Seattle Cancer Care Alliance, Seattle, WA
- Department of Medicine, University of Illinois at Chicago, IL
| | - Julie R Gralow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
- Seattle Cancer Care Alliance, Seattle, WA
| | - Amanda G Paulovich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
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15
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Wu L, Zhao Y, Lin P, Qin H, Liu Y, Wan D, Li X, He Y, Yang H. Preoperative ultrasound radiomics analysis for expression of multiple molecular biomarkers in mass type of breast ductal carcinoma in situ. BMC Med Imaging 2021; 21:84. [PMID: 34001017 PMCID: PMC8130392 DOI: 10.1186/s12880-021-00610-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The molecular biomarkers of breast ductal carcinoma in situ (DCIS) have important guiding significance for individualized precision treatment. This study was intended to explore the significance of radiomics based on ultrasound images to predict the expression of molecular biomarkers of mass type of DCIS. METHODS 116 patients with mass type of DCIS were included in this retrospective study. The radiomics features were extracted based on ultrasound images. According to the ratio of 7:3, the data sets of molecular biomarkers were split into training set and test set. The radiomics models were developed to predict the expression of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki67, p16, and p53 by using combination of multiple feature selection and classifiers. The predictive performance of the models were evaluated using the area under the curve (AUC) of the receiver operating curve. RESULTS The investigators extracted 5234 radiomics features from ultrasound images. 12, 23, 41, 51, 31 and 23 features were important for constructing the models. The radiomics scores were significantly (P < 0.05) in each molecular marker expression of mass type of DCIS. The radiomics models showed predictive performance with AUC greater than 0.7 in the training set and test set: ER (0.94 and 0.84), PR (0.90 and 0.78), HER2 (0.94 and 0.74), Ki67 (0.95 and 0.86), p16 (0.96 and 0.78), and p53 (0.95 and 0.74), respectively. CONCLUSION Ultrasonic-based radiomics analysis provided a noninvasive preoperative method for predicting the expression of molecular markers of mass type of DCIS with good accuracy.
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Affiliation(s)
- Linyong Wu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Yujia Zhao
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Peng Lin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Hui Qin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Yichen Liu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Da Wan
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China
| | - Xin Li
- GE Healthcare, Shanghai, People's Republic of China
| | - Yun He
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
| | - Hong Yang
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People's Republic of China.
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Yan M, Bomeisl P, Gilmore H, Harbhajanka A. Clinicopathological Follow-up of Breast DCIS Diagnosed on Biopsies: A Single Institutional Study of 575 Patients. Int J Surg Pathol 2021; 29:836-843. [PMID: 33890815 DOI: 10.1177/10668969211012088] [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] [Indexed: 11/15/2022]
Abstract
Stratifying ductal carcinoma in situ (DCIS) patients into different upgrading risk groups is important in exploiting more precise therapeutic options. Evaluation of estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (ER/PR/HER2) status and axillary lymph node metastatic status for DCIS and their upgraded invasive counterparts can also provide diagnostic and therapeutic implications. We retrospectively studied 575 patients with first-time diagnosis of DCIS on biopsies, and followed up their final diagnosis, ER/PR/HER2 status, and axillary lymph node involvement on excisions. As a result, biopsy-diagnosed DCIS had an overall 19.1% risk to be upgraded on subsequent excisions, with 4.7% being upgraded to microinvasive carcinoma (pT1mi) and 14.4% to overt invasive carcinoma (⩾pT1a). Factors significantly associated with higher upgrading risk on multivariate analysis include biopsy guidance by ultrasound (P <.001), DCIS with suspicious microinvasion (P < .001), and DCIS diagnosed in left breast (P = .026). DCIS diagnosed in younger patients (⩽40 years old) or DCIS with high nuclear grade showed higher upgrading risk only on univariate analysis. About 80% ER + /PR + and ER-/PR- DCIS remained the same ER/PR status after being upgraded, and ER + /PR - DCIS had the highest risk (63.6%) of having HER2 amplification in upgraded invasive carcinoma. For upgraded DCIS, microinvasive carcinoma was more likely to have HER2 amplification (50%) than overt invasive carcinoma (29.5%). Besides, pure DCIS had a low risk of axillary lymph node macrometastasis (0.74%), while the risk increased in DCIS with microinvasion (4.4%) and was highest in overt invasive carcinoma (14.7%). The findings of this study are clinically relevant with respect to criteria that might be used in selecting patients for de-escalation trials.
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MESH Headings
- Adult
- Axilla
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Biopsy
- Breast/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Lymph Nodes/pathology
- Mastectomy
- Neoplasm Invasiveness/pathology
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Retrospective Studies
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Affiliation(s)
- Mingfei Yan
- 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Phillip Bomeisl
- 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Hannah Gilmore
- 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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17
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Arain SA, Arafah M, Said Raddaoui EM, Tulba A, Alkhawaja FH, Al Shedoukhy A. Immunohistochemistry of mammary Paget's disease. Cytokeratin 7, GATA3, and HER2 are sensitive markers. Saudi Med J 2021; 41:232-237. [PMID: 32114594 PMCID: PMC7841564 DOI: 10.15537/smj.2020.3.24949] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate the expression of various immunohistochemical markers in Mammary Paget's disease (MPD) and MPD-associated breast carcinoma and to evaluate their value in establishing the diagnosis. METHODS This retrospective descriptive study was carried out at King Faisal Specialist Hospital and Research Center and King Khalid University Hospital, Riyadh, Saudi Arabia. All MPD cases reported between January 2010 and June 2016 were selected from the surgical pathology records. Immunohistochemical staining was carried out for cytokeratin 7 (CK7), GATA-binding protein 3 (GATA3), human epidermal growth factor receptor 2 (HER2), and estrogen, and progesterone receptors. Results: Twenty-two cases of MPD and 20 cases of MPD-associated breast carcinoma were included. CK7 was positive in 95% (21/22) cases of MPD and in all (20/20) cases of associated breast carcinoma. Similarly, GATA3 was expressed in 95% cases of both MPD (21/22) and associated breast carcinoma (19/20). Human epidermal growth factor receptor 2 was also overexpressed in 90% cases of MPD (20/22) and associated breast carcinoma (18/20). Estrogen stained positive in 27% cases of MPD (6/22) and 30% of cases of associated breast carcinoma (6/20). Progesterone receptors was not positive in any case of MPD; however, it was seen positive in 25% cases of MPD-associated breast carcinoma (5/20). CONCLUSIONS CK7, GATA3, and HER2 are widely expressed in MPD and MPD-associated breast carcinoma. These markers can be used for the immunohistochemical confirmation of MPD including CK7-negative cases.
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Affiliation(s)
- Shoukat A Arain
- Department of Pathology, Alfaisal University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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18
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Abdelhakiem MK, Johnstone C, Bergom C, Currey A, Robbins JR. The influence of breast cancer subtype on survival after palliative radiation for osseous metastases. Cancer Med 2020; 9:8979-8988. [PMID: 33146466 PMCID: PMC7724488 DOI: 10.1002/cam4.3597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/01/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background Among patients with osseous metastases, breast cancer (BC) patients typically have the best prognosis. In the palliative setting, BC is often considered a single disease, but based on receptor status there are four distinct subtypes: luminal A (LA), luminal B (LB), triple negative (TN), and HER2‐enriched (HER2). We hypothesize that survival and palliative outcomes following palliative RT for osseous metastases correlate with breast cancer subtype (BCS). Methods We identified 3,895 BC patients with known receptor status who received palliative RT for osseous metastases from 2004–2013 in the National Cancer Database. Kaplan–Meier method with log‐rank testing and univariate/multivariate Cox‐regression was used to identify survival factors. Incomplete radiation courses, 30‐day mortality rate, and percentage remaining life spent receiving RT (PRLSRT) were calculated. Results Subtypes were 54% LA, 33% LB, 8% TN, and 5% HER2 with median survival of 34.1, 28.2, 5.3, and 15.7 months, respectively (p < 0.001). Overall 82% of patients received ≥10 fractions. Although BCS had limited effect on radiation regimens, TN received nearly twice as many single or hypofractionated (≤5 fractions) treatments, but the overall rate of these fraction schemes was low at 3.7 and 13.7%, respectively. Compared to LA and LB, TN and HER2 patients had worse palliative outcomes; higher rates of incomplete courses at 18.8% and 18.3% versus 12.7%–14.4%; higher 30‐day mortality post‐radiotherapy at 21.5% and 16.0% versus 6.3%–7.9%, and higher median PRLSRT of 7.7% and 3.7% versus 2.2%–2.4% for LA and LB. On multivariate analysis, BCS was associated with overall survival with TN (HR 3.7), HER2 (HR 1.75), and LB (HR 1.28) fairing worse than LA (p < 0.001). Conclusions BCS correlated with survival and palliative outcome following radiation to osseous metastases. BCS should be considered by physicians when planning palliative RT to maximize quality‐of‐life, avoid unnecessary treatment, and ensure palliative benefits.
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Affiliation(s)
- Mohamed K. Abdelhakiem
- Department of Radiation OncologyUniversity of PittsburghUPMC Hillman Cancer CenterPittsburghPAUSA
| | - Candice Johnstone
- Department of Radiation OncologyMedical College of WisconsinMilwaukeeWIUSA
| | - Carmen Bergom
- Department of Radiation OncologyMedical College of WisconsinMilwaukeeWIUSA
| | - Adam Currey
- Department of Radiation OncologyMedical College of WisconsinMilwaukeeWIUSA
| | - Jared R. Robbins
- Department of Radiation OncologyUniversity of ArizonaTucsonAZUSA
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19
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Tolaney SM, Barroso-Sousa R, Keenan T, Li T, Trippa L, Vaz-Luis I, Wulf G, Spring L, Sinclair NF, Andrews C, Pittenger J, Richardson ET, Dillon D, Lin NU, Overmoyer B, Partridge AH, Van Allen E, Mittendorf EA, Winer EP, Krop IE. Effect of Eribulin With or Without Pembrolizumab on Progression-Free Survival for Patients With Hormone Receptor-Positive, ERBB2-Negative Metastatic Breast Cancer: A Randomized Clinical Trial. JAMA Oncol 2020; 6:1598-1605. [PMID: 32880602 PMCID: PMC7489368 DOI: 10.1001/jamaoncol.2020.3524] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [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: 03/06/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022]
Abstract
Importance Prior studies have shown that only a small proportion of patients with hormone receptor (HR)-positive metastatic breast cancer (MBC) experience benefit from programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors given as monotherapy. There are data suggesting that activity may be greater with combination strategies. Objective To compare the efficacy of eribulin plus pembrolizumab vs eribulin alone in patients with HR-positive, ERBB2 (formerly HER2)-negative MBC. Design, Setting, and Participants Multicenter phase 2 randomized clinical trial of patients with HR-positive, ERBB2-negative MBC who had received 2 or more lines of hormonal therapy and 0 to 2 lines of chemotherapy. Interventions Patients were randomized 1:1 to eribulin, 1.4 mg/m2 intravenously, on days 1 and 8 plus pembrolizumab, 200 mg/m2 intravenously, on day 1 of a 21-day cycle or eribulin alone. At time of progression, patients in the eribulin monotherapy arm could cross over and receive pembrolizumab monotherapy. Main Outcomes and Measures The primary end point was progression-free survival (PFS). Secondary end points were objective response rate (ORR) and overall survival (OS). Exploratory analyses assessed the association between PFS and PD-L1 status, tumor-infiltrating lymphocytes (TILs), tumor mutational burden (TMB), and genomic alterations. Results Eighty-eight patients started protocol therapy; the median (range) age was 57 (30-76) years, median (range) number of prior lines of chemotherapy was 1 (0-2), and median (range) number of prior lines of hormonal therapy was 2 (0-5). Median follow-up was 10.5 (95% CI, 0.4-22.8) months. Median PFS and ORR were not different between the 2 groups (PFS, 4.1 vs 4.2 months; hazard ratio, 0.80; 95% CI, 0.50-1.26; P = .33; ORR, 27% vs 34%, respectively; P = .49). Fourteen patients started crossover treatment with pembrolizumab; 1 patient experienced stable disease. All-cause adverse events occurred in all patients (grade ≥3, 65%) including 2 treatment-related deaths in the combination group, both from immune-related colitis in the setting of sepsis, attributed to both drugs. The PD-L1 22C3 assay was performed on archival tumor samples in 65 patients: 24 (37%) had PD-L1-positive tumors. Analysis indicated that PD-L1 status, TILs, TMB, and genomic alterations were not associated with PFS. Conclusions and Relevance In this randomized clinical trial of patients with HR-positive, ERBB2-negative MBC, the addition of pembrolizumab to eribulin did not improve PFS, ORR, or OS compared with eribulin alone in either the intention-to-treat or PD-L1-positive populations. Further efforts to explore the benefits of adding checkpoint inhibition to chemotherapy among less heavily pretreated patients are needed. Trial Registration ClinicalTrials.gov Identifier: NCT03051659.
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Affiliation(s)
- Sara M. Tolaney
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Romualdo Barroso-Sousa
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Oncology Center, Hospital Sírio-Libanês, Brasília, Brazil
| | - Tanya Keenan
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Boston, Massachusetts
| | - Tianyu Li
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lorenzo Trippa
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Gerburg Wulf
- Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Laura Spring
- Medical Oncology, Massachusetts General Hospital, Boston
| | | | - Chelsea Andrews
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jessica Pittenger
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Deborah Dillon
- Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nancy U. Lin
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Beth Overmoyer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann H. Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eliezer Van Allen
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Boston, Massachusetts
| | - Elizabeth A. Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, Massachusetts
| | - Eric P. Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ian E. Krop
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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20
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Kong X, Liu Z, Cheng R, Sun L, Huang S, Fang Y, Wang J. Variation in Breast Cancer Subtype Incidence and Distribution by Race/Ethnicity in the United States From 2010 to 2015. JAMA Netw Open 2020; 3:e2020303. [PMID: 33074325 PMCID: PMC7573683 DOI: 10.1001/jamanetworkopen.2020.20303] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Breast cancer is the most commonly diagnosed cancer and the leading cause of death in women worldwide. Yet the racial/ethnic disparity in incidences and distributions of breast cancer remains largely unknown. OBJECTIVE To examine the racial/ethnic patterns associated with the incidence of the subtypes of breast cancer and distribution of patients across clinicopathological variables. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database, which collected data from 18 SEER cancer registries that identified patients with breast cancer in the US diagnosed between January 1, 2010, and December 31, 2015. The inclusion criteria were (1) female patients with primary unilateral breast cancer who underwent surgical treatment; (2) record of estrogen receptor, progesterone receptor, and ERBB2 status; (3) record of medical history and histological subtype of the specified tumor location; and (4) data on patient race/ethnicity, lateral tumor position, tumor size, tumor TNM stage, and number of tumors. Incidence and distribution rates were identified and compared for different molecular subtypes, histological grades, pathological patterns, T stages, TNM stages, and tumor sites of breast cancers for each racial/ethnic group. Patient race/ethnicity was classified as follows: non-Hispanic White, Hispanic White, Black, Asian/Pacific Islander, American Indian/Alaskan Native, and unknown. Data were analyzed from January 1, 2010, to December 31, 2015. MAIN OUTCOMES AND MEASURES Incidence rates of 4 molecular subtypes: hormone receptor (HR)-positive and ERBB2-negative, HR-positive and ERBB2-positive, HR-negative and ERBB2-positive, and triple-negative breast cancer (TNBC). Data on distribution by histological grades (grades 1-4 and unknown), pathological patterns, T stages, TNM stages, and tumor sites was also extracted. Annual age-standardized incidence rates and incidence rate ratios (IRRs) were calculated with 95% CIs. Race/ethnicity case-to-case odds ratios were estimated using polytomous regression. RESULTS A total of 239 211 women with breast cancer were analyzed (median [interquartile range]) age, 60 [50-69] years). The annual incidence rate of all breast cancers was 31.3 (95% CI, 31.2- 31.5) per 100 000 people in non-Hispanic White women (the reference group), which was higher compared with the incidence among Black women (IRR, 1.04; 95% CI, 1.02-1.05; P < .001). The incidence rates were also lower in Asian/Pacific Islander (IRR, 0.90; 95% CI, 0.89-0.92; P < .001), American Indian/Alaskan native (IRR, 0.82; 95% CI, 0.81-0.83; P < .001), and Hispanic White women (IRR, 0.79; 95% CI, 0.75-0.83; P < .001). In Black patients, the incidences of the HR-positive and ERBB2-positive (IRR, 1.12; 95% CI, 1.08-1.16; P < .001), HR-negative and ERBB2-positive (IRR, 1.46; 95% CI, 1.38-1.54; P < .001), and TNBC (IRR, 2.07; 95% CI, 2.01-2.14; P < .001) subtypes were higher than those in non-Hispanic White patients, but the incidence of the HR-positive and ERBB2-negative subtype in Black women was lower (IRR, 0.86; 95% CI, 0.84-0.87; P < .001). The incidences of histological grade 1 (IRR, 0.75; 95% CI, 0.73-0.78; P < .001) and grade 2 (IRR, 0.91; 95% CI, 0.89-0.93; P < .001) were lower in Asian/Pacific Islander vs non-Hispanic White patients. Non-Hispanic White patients had a higher proportion of lobular carcinoma (9.7% [n = 15 718]) and tubular adenocarcinoma (0.6% [n = 997]) than Black (7.2% [n = 1933]; 0.3% [n = 81]), Asian/Pacific Islander (5.7% [n = 1202]; 0.3% [n = 55]), Hispanic White (7.2% [n = 1985]; 0.3% [n = 88]), and American Indian/Alaskan Native patients (7.2% [n = 101]; 0.4% [n = 5]). CONCLUSIONS AND RELEVANCE This cohort study found notable disparities in incidences and proportions of different molecular subtypes, histological grades, pathological patterns, T stages, TNM stages, and tumor sites associated with race/ethnicity. The findings suggest that combining epidemiologic with genomic and molecular profiling data warrants further research.
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Affiliation(s)
- Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Zhiqiang Liu
- Department of Radiotherapy, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Ran Cheng
- Department of Breast Surgical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Li Sun
- Wolfson Institute of Preventive Medicine, Barts Cancer Institute, Queen Mary University of London Charterhouse Square, London, United Kingdom
| | - Shaolong Huang
- Department of Breast Surgery, Tongren Municipal People’s Hospital, Tongren, Guizhou, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China
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21
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Sestak I, Filipits M, Buus R, Rudas M, Balic M, Knauer M, Kronenwett R, Fitzal F, Cuzick J, Gnant M, Greil R, Dowsett M, Dubsky P. Prognostic Value of EndoPredict in Women with Hormone Receptor-Positive, HER2-Negative Invasive Lobular Breast Cancer. Clin Cancer Res 2020; 26:4682-4687. [PMID: 32561662 DOI: 10.1158/1078-0432.ccr-20-0260] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/25/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Invasive lobular carcinoma (ILC) accounts for approximately 5%-15% of all invasive breast cancer cases. Most of the correlations between multigene assays and patient outcome were derived from studies based on patients with invasive ductal carcinoma (IDC) or without distinction between the subtypes. Here, we investigate the prognostic value of EndoPredict (EPclin) in a large cohort of ILCs pooled from three phase III randomized trials (ABCSG-6, ABCSG-8, TransATAC). EXPERIMENTAL DESIGN The primary objective of this analysis was to determine the prognostic value of EPclin for distant recurrence (DR) in years 0-10 in postmenopausal women with ILC. The primary outcome was DR. RESULTS 470 women (17.9%) presented with ILC, 1,944 (73.9%) with IDC, and 216 (8.2%) with other histologic types. EPclin was highly prognostic in women with ILC [HR = 3.32 (2.54-4.34)] and provided more prognostic value than the Clinical Treatment Score [CTS; HR = 2.17 (1.73-2.72)]. 63.4% of women were categorized into the low EPclin risk group and they had a 10-year DR of 4.8% (2.7-8.4) compared with 36.6% of women in the high-risk group with a 10-year DR risk of 26.6% (20.0-35.0). EPclin also provided highly prognostic information in women with node-negative disease [HR = 2.56 (1.63-4.02)] and node-positive disease [HR = 3.70 (2.49-5.50)]. CONCLUSIONS EPclin provided highly significant prognostic value and significant risk stratification for women with ILC. Ten-year DR risk in the EPclin low-risk groups were similar between ILC and IDC. Our results show that EPclin is informative in women with ILC and suggest that it is equally valid in both histologic subtypes.
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MESH Headings
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Chemotherapy, Adjuvant/methods
- Clinical Trials, Phase III as Topic
- Datasets as Topic
- Disease-Free Survival
- Female
- Follow-Up Studies
- Gene Expression Profiling
- Humans
- Kaplan-Meier Estimate
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Randomized Controlled Trials as Topic
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Risk Assessment/methods
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Affiliation(s)
- Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom.
| | - Martin Filipits
- Medical University of Vienna, Cancer Research Institute, Department for Internal Medicine I and Comprehensive Cancer Centre, Vienna, Austria
| | - Richard Buus
- The Breast Cancer Now Research Centre, Institute of Cancer, London, United Kingdom
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, United Kingdom
| | - Margaretha Rudas
- Medical University of Vienna, Cancer Research Institute, Department for Internal Medicine I and Comprehensive Cancer Centre, Vienna, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Oncology and Comprehensive Cancer Centre Graz, Medical University of Graz, Graz, Austria
| | | | | | - Florian Fitzal
- Medical University of Vienna, Department of Surgery and Comprehensive Cancer Centre, Vienna, Austria
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom
| | - Michael Gnant
- Medical University of Vienna, Comprehensive Cancer Centre, Vienna, Austria
| | - Richard Greil
- Department of Internal Medicine III, Oncologic Center, Salzburg Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mitch Dowsett
- The Breast Cancer Now Research Centre, Institute of Cancer, London, United Kingdom
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, United Kingdom
| | - Peter Dubsky
- Medical University of Vienna, Department of Surgery and Comprehensive Cancer Centre, Vienna, Austria
- St. Anna Breast Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland
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22
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Thomas A, Rhoads A, Suhl J, Conway KM, Hundley WG, McNally LR, Oleson J, Melin SA, Lynch CF, Romitti PA. Incidence and Survival by Human Epidermal Growth Factor Receptor 2 Status in Young Women With Stage I-III Breast Cancer: SEER, 2010-2016. Clin Breast Cancer 2020; 20:e410-e422. [PMID: 32278642 PMCID: PMC7398833 DOI: 10.1016/j.clbc.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/10/2020] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Young premenopausal women with breast cancer often experience more aggressive disease biology and poorer survival than older women. Diagnostic and therapeutic advances, including human epidermal growth factor receptor 2 (HER2)-directed therapy, may lessen treatment burden and improve survival for these young women, but contemporary incidence and survival data by HER2 status are limited. PATIENTS AND METHODS We identified women aged 20-49 years (n = 68,530) diagnosed with stage I-III breast cancer during 2010-2016 from the United States Surveillance, Epidemiology, and End Results 18 registries database. Age-adjusted average annual percent changes in incidence (diagnosis 2010-2016) and 5-year Kaplan-Meier survival curves (diagnosis 2010-2015) were estimated by HER2 and hormone receptor (HR) status and stratified independently by cancer stage and race/ethnicity. RESULTS With increasing age decade, proportions of HER2-/HR+ cancer increased, whereas proportions of HER2+/HR+, HER2+/HR-, and HER2-/HR- decreased. The greatest increases in incidence during 2010-2016 were observed for HER2+ among women aged 20-49 years and HER2-/HR- among women aged 20-29 years. Incidence decreased for HER2-/HR- among women aged 40-49 years. Five-year survival was lowest for HER2-/HR- status compared to other receptor-based subtypes among women aged 20-49 years. HER2+ status was more beneficial for 5-year survival than HR+ status among women aged 20-29 years, with the opposite observed among women aged 30-49 years, particularly those aged 40-49 years. CONCLUSION HER2+ breast cancer increased among premenopausal women and was also associated with higher early survival within each HR status. HER2-/HR- cancer also increased among women aged 20-29 years and was associated with lower early survival. Our contemporary data provide important insights to help inform preventive and therapeutic strategies for premenopausal women.
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Affiliation(s)
- Alexandra Thomas
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Anthony Rhoads
- Department of Epidemiology, University of Iowa, Iowa City, IA
| | - Jonathan Suhl
- Department of Epidemiology, University of Iowa, Iowa City, IA
| | | | - William G Hundley
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Lacey R McNally
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jacob Oleson
- Department of Biostatistics, University of Iowa, Iowa City, IA
| | - Susan A Melin
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA
| | - Paul A Romitti
- Department of Epidemiology, University of Iowa, Iowa City, IA; Department of Biostatistics, University of Iowa, Iowa City, IA.
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23
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Hwang GS, Paranjpe R, Opsomer C, Lu K, Abajue U, Abughosh S, Zaghloul H, Trivedi MV. Oral Endocrine Therapy Agent, Race/Ethnicity, and Time on Therapy Predict Adherence in Breast Cancer Patients in a Large Academic Institution. Clin Breast Cancer 2020; 20:520-526. [PMID: 32669209 DOI: 10.1016/j.clbc.2020.06.004] [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: 01/09/2020] [Revised: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Adherence to oral endocrine therapy (OET) reduces recurrence risk for hormone receptor (HR)-positive breast cancer (BC). Refill data accessed through electronic health records may provide objective assessment of OET adherence. Our goal was to (1) determine the feasibility of reviewing electronic health records for assessing OET adherence, (2) evaluate 6 months' OET adherence in HR-positive BC patients, and (3) identify predictors of low adherence. PATIENTS AND METHODS A single-center, retrospective study from May through December 2018 was conducted. Primary end point was adherance rate at 6 months. Chi-square and Student t tests were used to compare adherent and nonadherent groups. Multivariable logistic regression models were used to assess predictors of adherence. RESULTS Of 492 patients, 338 patients were included in adherence analysis. Of 338 patients identified, 82% (n = 277) were adherent at 6 months. In the multivariable logistic model, race/ethnicity, type of endocrine therapy, and time on therapy were found to be significantly associated with adherence. Asian/non-Hispanic and white/Hispanic patients were less likely to be adherent compared to white/non-Hispanics (Asian/non-Hispanic: odds ratio [OR], 0.3; 95% confidence interval [CI], 0.11-0.82; white/Hispanic: OR, 0.27; 95% CI, 0.11-0.64). Patients prescribed aromatase inhibitors were more likely to be adherent compared to patients prescribed tamoxifen (OR, 2.06; 95% CI, 1.02-4.14). Last, patients prescribed OET for 3 to 5 years had lower adherence compared to patients given OET for 2 years or less (OR, 0.29; 95% CI, 0.09-0.91). CONCLUSION Accessing refill data through electronic health records was found to be feasible. Tamoxifen therapy, Asian/non-Hispanic and white/Hispanic origin, and longer time on therapy predicted nonadherence in our patients.
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MESH Headings
- Administration, Oral
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/administration & dosage
- Aromatase Inhibitors/therapeutic use
- Asian/statistics & numerical data
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/therapy
- Chemotherapy, Adjuvant/methods
- Chemotherapy, Adjuvant/statistics & numerical data
- Electronic Health Records/statistics & numerical data
- Feasibility Studies
- Female
- Hispanic or Latino/statistics & numerical data
- Humans
- Male
- Mastectomy
- Medication Adherence/statistics & numerical data
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Tamoxifen/therapeutic use
- White People/statistics & numerical data
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Affiliation(s)
- Grace S Hwang
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX
| | - Rutugandha Paranjpe
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX
| | - Carine Opsomer
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX; Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX
| | - Kelvin Lu
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX; Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX
| | - Uzoamaka Abajue
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX
| | - Susan Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX
| | - Hanna Zaghloul
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX
| | - Meghana V Trivedi
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX.
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Ravi R, Haider G, Ahmed K, Zahoor S, Sami A, Lata R. Frequency Of Hormone Receptors And Her-2/Neu Receptor Positivity In Different Histology In Breast Cancer Patients. J Ayub Med Coll Abbottabad 2020; 32:323-326. [PMID: 32829544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND This study was conducted to see the frequency of hormone receptors and Her-2/Neu positivity in different histology in breast cancer patients. METHODS It was a cross-sectional study conducted at the Department of Medical Oncology, Jinnah Postgraduate Medical Centre from June 2018- March 2019. Total 373 patients of age 22-81 years of which 360 female and 13 males, with histopathological proven diagnosis of breast cancer were included in the study using non-probability consecutive sampling technique. The immunohistochemistry (IHC) was performed on biopsy sample for the status of PR, ER and HER-2/Neu and the confirmation of Her-2/Neu was done by Fluorescent In situ Hybridization (FISH) technique if HER-2/Neu was equivocal by IHC testing. Information regarding demographics, family history, histology, grade, stage, metastatic site and other histopathological parameters were noted on predesigned proforma by the researcher. SPSS-23 was used to analyse data. RESULTS Total of 373 patients were included in the study. The mean patient age was 45.34±12.28 years. ER, PR, Her 2 Neu (IHC) & Her 2 Neu (FISH) were found positive in 206 (55.2%), 182 (48.8%), 121 (32.4%) & 23 (6.2%) patients, respectively. The histology with PR receptor & grade of tumour with ER & PR receptor showed statistical significance (p<0.05). CONCLUSIONS ER, PR & HER-2/NEU expressions in breast cancer vary among different population and it is very important to find out the frequency among different histopathological types as it is of predictive and prognostic value. So, it is recommended to look for these markers and treat them accordingly.
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Affiliation(s)
- Ramchandani Ravi
- Department of Medical Oncology, Jinnah Postgraduate Medical Centre Karachi, Sindh, Pakistan
| | - Ghulam Haider
- Department of Medical Oncology, Jinnah Postgraduate Medical Centre Karachi, Sindh, Pakistan
| | - Khalil Ahmed
- Department of Medical Oncology, Jinnah Postgraduate Medical Centre Karachi, Sindh, Pakistan
| | - Saima Zahoor
- Department of Medical Oncology, Jinnah Postgraduate Medical Centre Karachi, Sindh, Pakistan
| | - Abdus Sami
- Department of Medical Oncology, Jinnah Postgraduate Medical Centre Karachi, Sindh, Pakistan
| | - Ramchandani Lata
- Department of Medical Oncology, Jinnah Postgraduate Medical Centre Karachi, Sindh, Pakistan
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Lischka A, Doberstein N, Freitag-Wolf S, Koçak A, Gemoll T, Heselmeyer-Haddad K, Ried T, Auer G, Habermann JK. Genome Instability Profiles Predict Disease Outcome in a Cohort of 4,003 Patients with Breast Cancer. Clin Cancer Res 2020; 26:4606-4615. [PMID: 32522886 DOI: 10.1158/1078-0432.ccr-20-0566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/16/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The choice of therapy for patients with breast cancer is often based on clinicopathologic parameters, hormone receptor status, and HER2 amplification. To improve individual prognostication and tailored treatment decisions, we combined clinicopathologic prognostic data with genome instabilty profiles established by quantitative measurements of the DNA content. EXPERIMENTAL DESIGN We retrospectively assessed clinical data of 4,003 patients with breast cancer with a minimum postoperative follow-up period of 10 years. For the entire cohort, we established genome instability profiles. We applied statistical methods, including correlation matrices, Kaplan-Meier curves, and multivariable Cox proportional hazard models, to ascertain the potential of standard clinicopathologic data and genome instability profiles as independent predictors of disease-specific survival in distinct subgroups, defined clinically or with respect to treatment. RESULTS In Cox regression analyses, two parameters of the genome instability profiles, the S-phase fraction and the stemline scatter index, emerged as independent predictors in premenopausal women, outperforming all clinicopathologic parameters. In postmenopausal women, age and hormone receptor status were the predominant prognostic factors. However, by including S-phase fraction and 2.5c exceeding rate, we could improve disease outcome prediction in pT1 tumors irrespective of the lymph node status. In pT3-pT4 tumors, a higher S-phase fraction led to poorer prognosis. In patients who received adjuvant endocrine therapy, chemotherapy or radiotherapy, or a combination, the ploidy profiles improved prognostication. CONCLUSIONS Genome instability profiles predict disease outcome in patients with breast cancer independent of clinicopathologic parameters. This applies especially to premenopausal patients. In patients receiving adjuvant therapy, the profiles improve identification of high-risk patients.
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Affiliation(s)
- Annette Lischka
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Natalie Doberstein
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ayla Koçak
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Timo Gemoll
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | | | - Thomas Ried
- Genetics Branch, NCI, NIH, Bethesda, Maryland.
| | - Gert Auer
- Department of Pathology and Oncology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Jens K Habermann
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Germany
- Department of Pathology and Oncology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
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Allison KH, Hammond MEH, Dowsett M, McKernin SE, Carey LA, Fitzgibbons PL, Hayes DF, Lakhani SR, Chavez-MacGregor M, Perlmutter J, Perou CM, Regan MM, Rimm DL, Symmans WF, Torlakovic EE, Varella L, Viale G, Weisberg TF, McShane LM, Wolff AC. Estrogen and Progesterone Receptor Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Guideline Update. Arch Pathol Lab Med 2020; 144:545-563. [PMID: 31928354 DOI: 10.5858/arpa.2019-0904-sa] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE.— To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer guideline. METHODS.— A multidisciplinary international Expert Panel was convened to update the clinical practice guideline recommendations informed by a systematic review of the medical literature. RECOMMENDATIONS.— The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose. Breast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, the Expert Panel acknowledges that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment. A sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive. Additional strategies recommended to promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result include establishing a laboratory-specific standard operating procedure describing additional steps used by the laboratory to confirm/adjudicate results. The status of controls should be reported for cases with 0% to 10% staining. Similar principles apply to PgR testing, which is used primarily for prognostic purposes in the setting of an ER-positive cancer. Testing of ductal carcinoma in situ (DCIS) for ER is recommended to determine potential benefit of endocrine therapies to reduce risk of future breast cancer, while testing DCIS for PgR is considered optional. Additional information can be found at www.asco.org/breast-cancer-guidelines .
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Affiliation(s)
| | | | | | | | | | | | | | - Sunil R Lakhani
- University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland, Brisbane, Queensland, Australia
| | | | | | | | - Meredith M Regan
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Emina E Torlakovic
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Giuseppe Viale
- IEO, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- University of Milan, Milan, Italy
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27
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Allison KH, Hammond MEH, Dowsett M, McKernin SE, Carey LA, Fitzgibbons PL, Hayes DF, Lakhani SR, Chavez-MacGregor M, Perlmutter J, Perou CM, Regan MM, Rimm DL, Symmans WF, Torlakovic EE, Varella L, Viale G, Weisberg TF, McShane LM, Wolff AC. Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update. J Clin Oncol 2020; 38:1346-1366. [PMID: 31928404 DOI: 10.1200/jco.19.02309] [Citation(s) in RCA: 584] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen (ER) and progesterone receptor (PgR) testing in breast cancer guideline. METHODS A multidisciplinary international Expert Panel was convened to update the clinical practice guideline recommendations informed by a systematic review of the medical literature. RECOMMENDATIONS The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose. Breast cancer samples with 1% to 100% of tumor nuclei positive should be interpreted as ER positive. However, the Expert Panel acknowledges that there are limited data on endocrine therapy benefit for cancers with 1% to 10% of cells staining ER positive. Samples with these results should be reported using a new reporting category, ER Low Positive, with a recommended comment. A sample is considered ER negative if < 1% or 0% of tumor cell nuclei are immunoreactive. Additional strategies recommended to promote optimal performance, interpretation, and reporting of cases with an initial low to no ER staining result include establishing a laboratory-specific standard operating procedure describing additional steps used by the laboratory to confirm/adjudicate results. The status of controls should be reported for cases with 0% to 10% staining. Similar principles apply to PgR testing, which is used primarily for prognostic purposes in the setting of an ER-positive cancer. Testing of ductal carcinoma in situ (DCIS) for ER is recommended to determine potential benefit of endocrine therapies to reduce risk of future breast cancer, while testing DCIS for PgR is considered optional. Additional information can be found at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Sunil R Lakhani
- University of Queensland, Brisbane, Queensland, Australia
- Pathology Queensland, Brisbane, Queensland, Australia
| | | | | | | | - Meredith M Regan
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Emina E Torlakovic
- Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Giuseppe Viale
- IEO, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- University of Milan, Milan, Italy
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Hu J, Fung MW, Tsang JY, Poon IK, Chan SK, Cheung SY, Hu H, Zhou D, Tse GM. Improved Prognostication for the Updated AJCC Breast Cancer Pathological Prognostic Staging Varied in Higher-Stage Groups. Clin Breast Cancer 2020; 20:253-261.e7. [PMID: 32205037 DOI: 10.1016/j.clbc.2020.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/19/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In addition to TNM-based anatomical staging (AS), a novel pathological prognostic staging (PPS) has been proposed by the American Joint Committee on Cancer (AJCC). PPS demonstrated better prognostication, but its superiority in breast cancer subtypes and related to staging discrepancies between AS and PPS are not clear. METHODS A cohort of 1729 patients with breast cancer was staged into AS and PPS according to the latest AJCC staging. Patient characteristic and restaging outcomes were compared. RESULTS Compared with AS, 799 and 135 cases were upstaged and downstaged respectively in PPS, mostly involved stage I cases. For the overall cohort, PPS demonstrated superior prognostic power over AS in both disease-free survival (DFS) and breast cancer-specific survival. However, such superiority was found mainly in estrogen receptor (ER)/progesterone receptor (PR)+ but not ER-PR- cancers. Comparing the restaged cases within the same PPS, PPS 1A cases showed similar survival irrespective of the original AS. Interestingly, in other PPS groups (PPS 1B and higher), there was a difference in outcome among patients with same PPS but different AS. Within PPS 1B patients, downstaged cases from higher AS showed worse DFS (3A>1B vs. 2A>1B: χ2 = 4.732, P = .030). CONCLUSIONS PPS may provide a more accurate prognostication, mostly among ER/PR+ cancers and with PPS 1A patients. Patients restaged to higher PPS stages showed significant differential survival even within the same PPS. Also, only limited improvement was observed for ER-PR- cancers. Caution needs to be exercised in using PPS for patient prognostication, as in some cases the outcome can be variable with the same PPS.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/diagnosis
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Chemotherapy, Adjuvant/methods
- Chemotherapy, Adjuvant/statistics & numerical data
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Risk Assessment/methods
- Young Adult
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Affiliation(s)
- Jintao Hu
- Department of Pathology, the Second Affiliated Hospital of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Mei-Wai Fung
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Julia Y Tsang
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Ivan K Poon
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Siu-Ki Chan
- Department of Pathology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - Sai-Yin Cheung
- Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Hong Hu
- Department of Breast Surgery, the Second Affiliated Hospital of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Dongxian Zhou
- Department of Breast Surgery, the Second Affiliated Hospital of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
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Schwartzberg LS, Vidal GA. Targeting PIK3CA Alterations in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor-2-Negative Advanced Breast Cancer: New Therapeutic Approaches and Practical Considerations. Clin Breast Cancer 2020; 20:e439-e449. [PMID: 32278641 DOI: 10.1016/j.clbc.2020.02.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
Abstract
The phosphatidylinositol-3-kinase (PI3K) pathway is frequently dysregulated in human breast cancer. Approximately 30% of all patients with breast cancer will carry mutations of the PIK3CA gene, which encodes the PI3K catalytic subunit isoform p110α. Mutations in PIK3CA have been associated with resistance to endocrine therapy, HER2-directed therapy, and cytotoxic therapy. Early trials of pan-PI3K inhibitors showed little treatment benefit as monotherapy owing to disease resistance arising through enhanced estrogen receptor pathway signaling. Combining PI3K inhibition with endocrine therapy can help overcome resistance. Clinical trials of pan-PI3K inhibitors combined with endocrine therapy demonstrated modest clinical benefits but challenging toxicity profiles, facilitating the development of more selective PI3K-targeting agents. More recent trials of isoform-specific PI3K inhibitors in patients with PIK3CA mutations have shown promising clinical efficacy with a predictable, manageable safety profile. In the present review, we discuss the clinical relevance of mutations of PIK3CA and their potential use as a biomarker to guide treatment choices in patients with HR+ HER2- advanced breast cancer.
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MESH Headings
- Antineoplastic Agents, Hormonal/pharmacology
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Breast/pathology
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Chemotherapy, Adjuvant/methods
- Class I Phosphatidylinositol 3-Kinases/antagonists & inhibitors
- Class I Phosphatidylinositol 3-Kinases/genetics
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- Female
- Humans
- Mastectomy
- Mutation
- Neoplasm Staging
- Phosphoinositide-3 Kinase Inhibitors/pharmacology
- Phosphoinositide-3 Kinase Inhibitors/therapeutic use
- Progression-Free Survival
- Randomized Controlled Trials as Topic
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
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30
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Valkonen M, Isola J, Ylinen O, Muhonen V, Saxlin A, Tolonen T, Nykter M, Ruusuvuori P. Cytokeratin-Supervised Deep Learning for Automatic Recognition of Epithelial Cells in Breast Cancers Stained for ER, PR, and Ki-67. IEEE Trans Med Imaging 2020; 39:534-542. [PMID: 31398111 DOI: 10.1109/tmi.2019.2933656] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Immunohistochemistry (IHC) of ER, PR, and Ki-67 are routinely used assays in breast cancer diagnostics. Determination of the proportion of stained cells (labeling index) should be restricted on malignant epithelial cells, carefully avoiding tumor infiltrating stroma and inflammatory cells. Here, we developed a deep learning based digital mask for automated epithelial cell detection using fluoro-chromogenic cytokeratin-Ki-67 double staining and sequential hematoxylin-IHC staining as training material. A partially pre-trained deep convolutional neural network was fine-tuned using image batches from 152 patient samples of invasive breast tumors. Validity of the trained digital epithelial cell masks was studied with 366 images captured from 98 unseen samples, by comparing the epithelial cell masks to cytokeratin images and by visual evaluation of the brightfield images performed by two pathologists. A good discrimination of epithelial cells was achieved (AUC of mean ROC = 0.93; defined as the area under mean receiver operating characteristics), and well in concordance with pathologists' visual assessment (4.01/5 and 4.67/5). The effect of epithelial cell masking on the Ki-67 labeling index was substantial. 52 tumor images initially classified as low proliferation (Ki-67 < 14%) without epithelial cell masking were re-classified as high proliferation (Ki-67 ≥ 14%) after applying the deep learning based epithelial cell mask. The digital epithelial cell masks were found applicable also to IHC of ER and PR. We conclude that deep learning can be applied to detect carcinoma cells in breast cancer samples stained with conventional brightfield IHC.
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31
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Rashad N, Abdelhamid T, Shouman SA, Nassar H, Omran MA, El Desouky ED, Khaled H. Capecitabine-Based Chemoendocrine Combination as First-Line Treatment for Metastatic Hormone-Positive Metastatic Breast Cancer: Phase 2 Study. Clin Breast Cancer 2020; 20:228-237. [PMID: 32005499 DOI: 10.1016/j.clbc.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/07/2019] [Revised: 12/21/2019] [Accepted: 12/31/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Preclinical studies have suggested a synergistic effect of tamoxifen and capecitabine in estrogen receptor-positive cell lines. We evaluated the safety and efficacy of first-line chemoendocrine treatment in patients with metastatic breast cancer. Biochemical assessment was performed of serum levels of thymidine phosphorylase enzyme (TP), serum tamoxifen, hydroxytamoxifen, and 5-fluorouracil in relationship to efficacy. PATIENTS AND METHODS This prospective phase 2 interventional study studied patients with estrogen receptor-positive, HER2- metastatic breast cancer who received either tamoxifen/capecitabine or letrozole/capecitabine as first-line treatment. The dose of capecitabine provided at 2000 mg per day continuously as a fixed dose. RESULTS Forty women with a median age of 49.3 years were enrolled. For the whole study group, median progression-free survival (PFS) was 10 months and median overall survival (OS) was 23.3 months. The overall response rate was 60% and the clinical benefit rate 82.5%. Progesterone receptor positivity was associated with significantly longer PFS (12 vs. 7 months, P = .021). The most frequent adverse events were palmar-plantar erythrodysesthesia (62.5%), fatigue (62.5%), diarrhea (30%), abdominal pain (12.5%), and constipation (10%). Changes in serum level of TP were not correlated to response to treatment, PFS, or OS. Higher serum levels of tamoxifen and hydroxytamoxifen were correlated with higher response rates and longer PFS but not OS. CONCLUSION Chemoendocrine treatment is well tolerated, with no evidence of contradictory effects between the combination components. However, the efficacy data need more validation.
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MESH Headings
- Abdominal Pain/chemically induced
- Abdominal Pain/epidemiology
- Adult
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antineoplastic Agents, Hormonal/administration & dosage
- Antineoplastic Agents, Hormonal/adverse effects
- Antineoplastic Agents, Hormonal/pharmacokinetics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/pharmacokinetics
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/blood
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Capecitabine/administration & dosage
- Capecitabine/adverse effects
- Capecitabine/pharmacokinetics
- Constipation/chemically induced
- Constipation/epidemiology
- Diarrhea/chemically induced
- Diarrhea/epidemiology
- Female
- Hand-Foot Syndrome/epidemiology
- Hand-Foot Syndrome/etiology
- Humans
- Letrozole/administration & dosage
- Letrozole/adverse effects
- Letrozole/pharmacokinetics
- Middle Aged
- Progression-Free Survival
- Prospective Studies
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Tamoxifen/administration & dosage
- Tamoxifen/adverse effects
- Tamoxifen/pharmacokinetics
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Affiliation(s)
- Noha Rashad
- Department of Medical Oncology, Maadi Armed Forces Hospital, Cairo, Egypt.
| | - Thoraya Abdelhamid
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Samia A Shouman
- Pharmacology Unit, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hanan Nassar
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mervat A Omran
- Pharmacology Unit, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Eman D El Desouky
- Department of Biostatistics and Epidemiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hussein Khaled
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Zodinpuii D, Pautu JL, Zothankima B, Pachuau L, Kumar NS. Clinical features and first degree relative breast cancer, their correlation with histological tumor grade: a 5-year retrospective case study of breast cancer in Mizoram, India. Environ Sci Pollut Res Int 2020; 27:1991-2000. [PMID: 31768959 DOI: 10.1007/s11356-019-06944-8] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/01/2019] [Indexed: 06/10/2023]
Abstract
The aim was to assess the association of histological tumor grade with other clinical features and epidemiological factors of women with invasive breast carcinoma. A retrospective study of 103 Mizo breast cancer patients visiting hospitals was made in Aizawl, Mizoram, Northeast India. With a prior consent, information on epidemiological factors and family history in relation to cancer was obtained. Clinical reports were obtained from their medical records. The frequency of distribution was calculated for age at diagnosis and tumor characteristics. Statistical analysis for different variables was done using a chi-square test. p < 0.05 was considered significant. The histological tumor grades in our studies were found to be associated with lymph node invasion (p < 0.021), different subtype of hormone receptor such as ER status (p < 0.004), ER/PR status (p < 0.007), HER2/neu status (p < 0.014), and ER/PR/HER2 status (p < 0.025). A patient with a family history of breast cancer in their 1st degree relative is also seen to have association in determining the tumor grade (p < 0.003). Reproductive history, lifestyle and dietary habits, tobacco, and alcohol consumption were found to have no influence on breast cancer tumor grade. Our results showing significant correlation between status of lymph node, ER, PR, and HER2/neu oncoprotein and family history with 1st degree relative breast cancer are the first time report to target and focus on the possible role of biomarkers for diagnosis among the Mizo tribal breast cancer patients.
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Affiliation(s)
- Doris Zodinpuii
- Department of Biotechnology, Mizoram University, Tanhril, Aizawl, Mizoram, 796009, India
| | | | - Bawitlung Zothankima
- Department of Radiation Oncology, Mizoram State Cancer Institute, Zemabawk, Aizawl, Mizoram, India
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Hasbay B, Aka Bolat F, Aytaç HÖ, Aslan H, Purbager A. Metaplastic Carcinoma of the Breast: Analysis of 38 Cases from a Single Institute. Turk Patoloji Derg 2020; 36:23-30. [PMID: 31769499 PMCID: PMC10512683 DOI: 10.5146/tjpath.2019.01472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/29/2019] [Accepted: 10/16/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the pathological and radiological features, hormone profiles, surgery and treatment methods of metaplastic breast carcinoma cases diagnosed at our center in the light of current literature. MATERIAL AND METHOD A total of 38 metaplastic breast cancer cases diagnosed between 2006-2018 at our center were included in the study. The patients were evaluated in terms of age, tumor size, localization, histological grade, hormone profiles (ER, PR, Her2-neu), American Joint Committee on Cancer (AJCC) Tumor, Lymph node status, Metastases (TNM) stage, progression, survival, radiological features, types of surgery and therapy modalities (chemotherapy and / or radiotherapy). RESULTS The age of the patients ranged between 32 and 95 years. Pathological evaluation of cases showed that 14 were pure epithelial (IC-NST + squamous cell carcinoma) and 24 were metaplastic carcinomas with mesenchymal differentiation. Ductal carcinoma in situ (DCIS) was accompanying an invasive component in twenty cases. Seventeen patients had lymph node metastasis. Twelve patients developed distant metastasis. Thirty patients were triple negative for hormone receptors. The mean follow-up period of the patients was 34 months. The estimated life expectancy was 116 months. All of the patients received chemotherapy and 28 patients received adjuvant radiotherapy. There was no correlation between tumor size and lymph node or distant metastasis in our series. Our findings are consistent with the literature. CONCLUSION Metaplastic breast carcinoma is a rare entity among breast carcinomas. Metaplastic carcinomas of the breast draw attention with the differences in their clinical course and the radiological and pathological heterogeneity.
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Affiliation(s)
- Bermal Hasbay
- Department of Pathology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Filiz Aka Bolat
- Department of Pathology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Hüseyin Özgür Aytaç
- Department of General Surgery, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Hülya Aslan
- Department of Radiology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Ayşin Purbager
- Department of Radiology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
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Anupa G, Sharma JB, Roy KK, Sengupta J, Ghosh D. An assessment of the multifactorial profile of steroid-metabolizing enzymes and steroid receptors in the eutopic endometrium during moderate to severe ovarian endometriosis. Reprod Biol Endocrinol 2019; 17:111. [PMID: 31878927 PMCID: PMC6933937 DOI: 10.1186/s12958-019-0553-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/04/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies of expression profiles of major endometrial effectors of steroid physiology in endometriosis have yielded markedly conflicting conclusions, presumably because the relative effects of type of endometriosis, fertility history and menstrual cycle phases on the measured variables were not considered. In the present study, endometrial mRNA and protein levels of several effectors of steroid biosynthesis and action in patients with stage III-IV ovarian endometriosis (OE) with known fertility and menstrual cycle histories were compared with the levels in control endometrium to test this concept. METHODS Endometrial samples were collected from patients without endometriosis (n = 32) or OE stages III-IV (n = 52) with known fertility and cycle histories. qRT-PCR and immunoblotting experiments were performed to measure levels of NR5A1, STAR, CYP19A1, HSD17Bs, ESRs and PGR transcripts and proteins, respectively. Tissue concentrations of steroids (P4, T, E1 and E2) were measured using ELISAs. RESULTS The levels of expression of aromatase and ERβ were lower (P < 0.0001) and 17β-HSD1 (P < 0.0001) and PRA (P < 0.01) were higher in OE endometrium. Lower aromatase levels and higher 17β-HSD1 levels were detected in fertile (aromatase: P < 0.05; 17β-HSD1: P < 0.0001) and infertile (aromatase: P < 0.0001; 17β-HSD1: P < 0.0001) OE endometrium than in the matched control tissues. Both proliferative (PP) and secretory (SP) phase OE samples expressed aromatase (P < 0.0001) and ERβ (PP: P < 0.001; SP: P < 0.01) at lower levels and 17β-HSD1 (P < 0.0001) and PRA (PP: P < 0.01; SP: P < 0.0001) at higher levels than matched controls. Higher 17β-HSD1 (P < 0.01) and E2 (P < 0.05) levels and a lower (P < 0.01) PRB/PRA ratio was observed in infertile secretory phase OE endometrium than in control. CONCLUSIONS We report that dysregulated expression of 17β-HSD1 and PGR resulting in hyperestrogenism and progesterone resistance during the secretory phase of the menstrual cycle, rather than an anomaly in aromatase expression, was the hallmark of eutopic endometrium from infertile OE patients. Furthermore, the results provide proof of concept that the fertility and menstrual cycle histories exerted relatively different effects on steroid physiology in the endometrium from OE patients compared with the control subjects.
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Affiliation(s)
- G. Anupa
- 0000 0004 1767 6103grid.413618.9Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
- 0000 0004 1767 6103grid.413618.9Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- 0000 0004 1767 6103grid.413618.9Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Kallol K. Roy
- 0000 0004 1767 6103grid.413618.9Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jayasree Sengupta
- 0000 0004 1767 6103grid.413618.9Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Debabrata Ghosh
- 0000 0004 1767 6103grid.413618.9Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Song J, Lai X, Zhang Y, Zheng X, Su J. Preoperative platelet morphology parameters as prognostic predictors for endometrial malignant carcinoma stage and progesterone receptor. Medicine (Baltimore) 2019; 98:e17818. [PMID: 31764773 PMCID: PMC6882632 DOI: 10.1097/md.0000000000017818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
To investigate preoperative platelet morphology parameters and other whole blood cells in patients of malignant endometrial carcinoma compared with benign disease.Retrospective analysis was performed through collecting patients' hematological parameters before performing total abdominal/vaginal hysterectomy and standard radical surgery due to benign and malignant endometrial disease between 2006 and 2017. Parameters required included white blood cell (WBC), hemoglobin, platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), and platelet thrombocytocrit (PCT). And neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. For malignant carcinoma, Ki-67 percentage and progesterone receptor (PR) status were further collected.A total of 288 patients were included with 145 benign cases and 143 malignant cases. Patients of confirmed endometrial carcinoma showed a significant lower value of PDW (55.21 ± 4.72 vs 49.54 ± 5.89, P < .001), meanwhile significant higher values of MPV (7.12 ± 1.56 vs 8.89 ± 1.67, P < .001) and PCT (24.18 ± 6.89 vs 27.93 ± 8.93, P = .003). Further analysis of endometrial carcinoma patients showed that no significant difference in platelet parameters was found between patients with stage I to II and stage III to IV (P > .05), while increased value in PDW and reduced value in MPV was found in PR negative compared with positive patients.Preoperative platelet morphology parameters seemed to be used as one kind of predictive factors to discriminate malignant and benign endometrial disease. Limited by present study design, further prospective studies are required to support this finding.
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Wang Y, Yang SH, Hsu PW, Chien SY, Wang CQ, Su CM, Dong XF, Zhao YM, Tang CH. Impact of WNT1-inducible signaling pathway protein-1 (WISP-1) genetic polymorphisms and clinical aspects of breast cancer. Medicine (Baltimore) 2019; 98:e17854. [PMID: 31689877 PMCID: PMC6946553 DOI: 10.1097/md.0000000000017854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the most common diagnosed malignancy in women. This study genotyped blood samples from 236 Han Chinese women with breast cancer and 128 healthy controls for single nucleotide polymorphisms (SNPs) rs2977537, rs2929970, rs2929973, rs2977530, and rs62514004, to determine whether these WNT1-inducible signaling pathway protein 1 (WISP-1) genetic polymorphisms increase the risk of developing breast cancer. Compared with wild-type (AA) carriers, those carrying the WISP1 rs62514004 AG or AG + GG genetic variants had a greater risk of developing breast cancer. In an evaluation of the association between clinicopathological aspects and the WISP1 SNP rs62514004 in the breast cancer cohort, patients with the GG genotype were less likely than those with the AA genotype to develop stage III/IV disease. Patients carrying the WISP1 rs2929973 GG + TT variant were almost twice as likely as those carrying the GT genotype to have estrogen receptor (ER)- and progesterone receptor (PR)-positive tumors, while those with the WISP1 rs62514004 AG + GG genetic variants were around twice as likely as those with the AA genotype to have HER2-positive tumors. This study details risk associations between WISP1 SNPs and breast cancer susceptibility in women of Han Chinese ethnicity.
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Affiliation(s)
- Yan Wang
- Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Shi-Hui Yang
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Ping-Wen Hsu
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Szu-Yu Chien
- School of Medicine, China Medical University, Taichung, Taiwan
| | | | | | - Xiao-Fang Dong
- Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Yong-Ming Zhao
- Department of Surgical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Chih-Hsin Tang
- School of Medicine, China Medical University, Taichung, Taiwan
- Chinese Medicine Research Center, China Medical University
- Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan
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Mollon LE, Anderson EJ, Dean JL, Warholak TL, Aizer A, Platt EA, Tang DH, Davis LE. A Systematic Literature Review of the Prognostic and Predictive Value of PIK3CA Mutations in HR +/HER2 - Metastatic Breast Cancer. Clin Breast Cancer 2019; 20:e232-e243. [PMID: 32234362 DOI: 10.1016/j.clbc.2019.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 02/05/2019] [Revised: 08/05/2019] [Accepted: 08/26/2019] [Indexed: 11/18/2022]
Abstract
PIK3CA mutations may have prognostic value for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer, representing an important potential target for systemic therapy. Prognostic and predictive values associated with PIK3CA mutations are not well understood. A comprehensive search of PubMed/MEDLINE, EMBASE, Cochrane Central, and conference abstracts was performed for English-language articles published January 1993 through April 2019. Articles were categorized by treatment arms based on experimental and treatment drug classes. Information on progression-free survival (PFS), hazard ratios, overall survival, response rate, and clinical benefit rate was obtained. A total of 17 studies were included. Among those evaluating non-PI3Ki based therapies, 91% showed numerically shorter median PFS, ranging from 1.5 to 19.2 months and 1.8 to 29.6 months for the mutant versus non-mutant subgroups, respectively. Where reported (n = 13 studies), PFS was shorter between those arms offering endocrine monotherapy (range, 1.6-14.7 months) compared with a corresponding targeted therapy + endocrine monotherapy (range, 3.9-29.6 months). Of 5 PI3Ki-based arms comparing PFS, higher median PFS in PIK3CA mutant versus non-mutant cases was demonstrated. PFS was shorter for patients with PIK3CA mutant (range, 1.6-19.2 months) compared with PIK3CA wild-type (range, 1.8-29.6 months) in 10 (71%) of 14 treatment arms reporting PFS. Studies (n = 4) not reporting PFS reported response rate, but there were no clear directional trends. The presence of PIK3CA mutations may be associated with worse clinical outcomes in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer. Clinical outcomes such as PFS may be improved using a combination of PI3Ki-based therapies and endocrine therapies among this population. However, more research is warranted to fully elucidate this association.
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MESH Headings
- Antineoplastic Agents, Hormonal/pharmacology
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Chemotherapy, Adjuvant/methods
- Class I Phosphatidylinositol 3-Kinases/antagonists & inhibitors
- Class I Phosphatidylinositol 3-Kinases/genetics
- Drug Resistance, Neoplasm/genetics
- Female
- Humans
- Mastectomy
- Mutation
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/prevention & control
- Predictive Value of Tests
- Prognosis
- Progression-Free Survival
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Risk Assessment/methods
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Affiliation(s)
- Lea E Mollon
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ.
| | - Elizabeth J Anderson
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
| | - Joni L Dean
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
| | - Terri L Warholak
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
| | - Ayal Aizer
- Radiation Oncology, Harvard Medical School, Boston, MA
| | | | | | - Lisa E Davis
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
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Chung T, Aukerman W, Nannapaneni S, Urias DS, Shayesteh K. Exuberant Ductolobular Hyperplasia as the Primary Histological Finding in a Patient with Idiopathic Gigantomasita. Am Surg 2019; 85:e481-e482. [PMID: 31638546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Abstract
BACKGROUND/AIMS We conducted a retrospective analysis of the clinical activity of fulvestrant in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) previously treated with endocrine therapy and/or chemotherapy. METHODS We reviewed the medical records of all patients with MBC treated at Samsung Medical Center between January 2009 and August 2016. Patients received fulvestrant 250 mg intramuscularly every 28 days (from January 2009 to November 2010) or 500 mg intramuscularly every 28 days (from December 2010 to August 2016). Tumor responses were assessed every 8 weeks and at the end of treatment, as well as when disease progression was suspected. RESULTS A total of 84 patients were included in this study. A median of two previous endocrine treatments had been performed; 79% of the patients had received two or more endocrine treatments. Forty-five patients (54%) had been treated with chemotherapy for MBC before the fulvestrant treatment course. Visceral metastasis was found in 49 patients (58%). The estimated median progression-free survival and overall survival were 4.4 months (95% confidence interval [CI], 3.4 to 5.5) and 32.5 months (95% CI, 17.6 to 47.4), respectively. The disease control rate was 40.5% (95% CI, 30.5 to 51.5); partial response was observed in 16% of the patients and stable disease was observed in 25% of the patients. The most frequently reported adverse reactions were mild-to-moderate grade myalgia (10.5% of the patients), injection site pain (7%), and fatigue (7%). Fulvestrant was generally well tolerated. CONCLUSION Fulvestrant showed encouraging clinical activity and favorable feasibility in postmenopausal women with MBC who had been treated with multiple endocrine therapies and/or cytotoxic chemotherapies.
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Affiliation(s)
- Mi Hwa Heo
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Kyung Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hansang Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Yeon Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Hyuck Im
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Yeon Hee Park, M.D. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-1780 Fax: +82-2-3410-1754 E-mail:
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Sharghi KG, Ramey NA, Rush PS, Grider DJ. Endometriosis of the Eyelid, an Extraordinary Extra-abdominal Location Highlighting the Spectrum of Disease. Am J Dermatopathol 2019; 41:593-595. [PMID: 31335414 DOI: 10.1097/dad.0000000000001386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cutaneous endometriosis is an uncommon dermatologic disorder predominantly seen in young women. Most commonly, it presents within a region of a previous surgical scar, often in relation to a gynecologic procedure on the abdomen or in close proximity to the umbilicus. The typical clinical presentation is that of papules or nodules with monthly cyclical pain and size variation. Histologically, the lesions are composed of endometrial stroma and glands. The pathophysiology is not well understood but is believed to be due to metastasis or seeding of endometrial cells. When this uncommon disorder occurs outside of the most typical clinical setting, it may cause some diagnostic difficulty. In this report, we present the first known case of cutaneous endometriosis on the eyelid.
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Affiliation(s)
- Kevin G Sharghi
- Division of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | | | - Patrick S Rush
- Division of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Douglas J Grider
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA
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Musolino A, Michiara M, Bella MA, Naldi N, Zanelli P, Bortesi B, Capelletti M, Soldani L, Camisa R, Martella E, Franciosi V, Savi M, Neri TM, Ardizzoni A, Cascinu S. Molecular Profile and Clinical Variables in Brca1-Positive Breast Cancers. A Population-Based Study. Tumori 2019; 91:505-12. [PMID: 16457150 DOI: 10.1177/030089160509100611] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To evaluate the clinical features of breast cancer patients with genetic susceptibility to this disease and to investigate the contribution of BRCA1 germline mutations to the phenotype of these tumors. Patients and Methods We reviewed the clinical and pathological records of 102 women with suspected inherited susceptibility to breast cancer consecutively seen at the Genetic Oncology Service of Parma, Italy. Sixty-two patients with a high probability of harboring a germline, cancer-predisposing mutation were tested for BRCA1 mutations. Exon 11 was screened using the protein truncation test and detected mutations were confirmed by direct sequencing (DS). All other exons were analyzed by DS. Results Among the 62 patients with a completed mutation analysis, 48 (77.4%) had wild-type BRCA1, six (9.6%) had variants of unclear significance, eight (13%) had deleterious mutations. BRCA1-associated breast cancers (BABC) were significantly less likely to be diagnosed at stage I than breast cancers in women without mutations (12.5% vs 51%; P = 0.045), more likely to have a high proliferation rate (100% vs 24%, P<0.001), and more likely to be histological grade 3 (100% vs 14%, P<0.001), estrogen and progesterone receptor negative (87.5% vs 13%, P<0.001; 75% vs 23%, P = 0.004), and p53 positive (87.5% vs 30%, P = 0.023). All tumors with BRCA1 mutations were HER-2/neu negative compared with 57% of the non-BRCA1 tumors ( P = 0.04). There were no significant differences between BABC and non-BABC in 20-year relapse-free survival, 20-year event-free survival, and 20-year overall survival. Conclusion In this population-based study, BABC seems to present with adverse molecular features when compared with non-BABC, although the prognosis appears to be similar.
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Affiliation(s)
- Antonino Musolino
- Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy.
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Cantini L, Pistelli M, Merloni F, Fontana A, Bertolini I, De Angelis C, Bastianelli L, Della Mora A, Santinelli A, Savini A, Maccaroni E, Diodati L, Falcone A, Berardi R. Body Mass Index and Hormone Receptor Status Influence Recurrence Risk in HER2-Positive Early Breast Cancer Patients. Clin Breast Cancer 2019; 20:e89-e98. [PMID: 31378534 DOI: 10.1016/j.clbc.2019.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/27/2019] [Revised: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A reliable risk stratification on the basis of tumor biology and host factors of HER2-positive (HER2+) early breast cancer (eBC) patients is needed. The aim of our study was to assess the prognostic role of body mass index (BMI) and hormone receptor (HR) expression in this setting. PATIENTS AND METHODS We retrospectively evaluated 238 women with stage I to III HER2+ breast cancer who completed adjuvant chemotherapy (CHT) and 1 year of treatment with trastuzumab. The end point was 3-year distant disease-free survival (3yDDFS). Survival analysis was evaluated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional-hazards model adjusting for HR status, BMI, tumor staging, size, nodal status, and type of adjuvant CHT. Association among categorical variables was assessed using χ2 test. RESULTS The early recurrence rate after 3 years resulted as 4.2% (40% HR+ patients and 60% HR- patients). Neither HR status nor BMI alone showed an association with 3yDDFS in multivariate analysis. However, the hazard ratios for patients with HR- tumors who had also BMI ≥25 (3yDDFS 86.9%; 95% confidence interval [CI], 75.0%-97.7%) were amplified compared with patients with HR+ tumors and with BMI <25 (3yDDFS 98%; 95% CI, 94.8%-100.0%) and other subgroups (P = .003). This observation was confirmed in multivariate analysis (hazard ratio, 1.79; 95% CI, 1.04-3.07; P = .03). CONCLUSION Our real-life data highlight a different risk of eBC recurrence after grouping patients according to HR status and BMI. These results might help clinicians to identify correct treatment strategies. Patients who are HR- and have BMI ≥25 might benefit from escalation approaches, whereas those who are HR+ and have BMI <25 might be eligible for a shorter duration of adjuvant treatment with anti-HER2 agents.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Body Mass Index
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Chemotherapy, Adjuvant/statistics & numerical data
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Prognosis
- Receptor, ErbB-2/analysis
- Receptor, ErbB-2/antagonists & inhibitors
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/analysis
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/analysis
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Risk Assessment/methods
- Time Factors
- Trastuzumab/therapeutic use
- Young Adult
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Affiliation(s)
- Luca Cantini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Mirco Pistelli
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Filippo Merloni
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Andrea Fontana
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Ilaria Bertolini
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Lucia Bastianelli
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Arianna Della Mora
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Alfredo Santinelli
- Anatomia Patologica e Citologia, AO Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Agnese Savini
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Elena Maccaroni
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - Lucrezia Diodati
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- Oncology Unit II, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, AOU Ospedali Riuniti, Ancona, Italy.
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Asavasupreechar T, Saito R, Edwards DP, Sasano H, Boonyaratanakornkit V. Progesterone receptor isoform B expression in pulmonary neuroendocrine cells decreases cell proliferation. J Steroid Biochem Mol Biol 2019; 190:212-223. [PMID: 30926428 PMCID: PMC9968952 DOI: 10.1016/j.jsbmb.2019.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 11/22/2022]
Abstract
The progesterone receptor (PR) has been reported to play important roles in lung development and function, such as alveolarization, alveolar fluid clearance (AFC) and upper airway dilator muscle activity. In the lung, pulmonary neuroendocrine cells (PNECs) are important in the etiology and progression of lung neuroendocrine tumors (NETs). Women with lung NETs had significantly better survival rates than men, suggesting that sex steroids and their receptors, such as the PR, could be involved in the progression of lung NETs. The PR exists as two major isoforms, PRA and PRB. How the expression of different PR isoforms affects proliferation and the development of lung NETs is not well understood. To determine the role of the PR isoforms in PNECs, we constructed H727 lung NET cell models expressing PRB, PRA, Green Fluorescence Protein (GFP) (control). The expression of PRB significantly inhibited H727 cell proliferation better than that of PRA in the absence of progestin. The expression of the unrelated protein, GFP, had little to no effect on H727 cell proliferation. To better understand the role of the PR isoform in PNECs, we examined PR isoform expression in PNECs in lung tissues. A monoclonal antibody specific to the N-terminus of PRB (250H11 mAb) was developed to specifically recognize PRB, while a monoclonal antibody specific to a common N-terminus epitope present in both PRA and PRB (1294 mAb) was used to detect both PRA and PRB. Using these PR and PRB-specific antibodies, we demonstrated that PR (PRA&PRB) and PRB were expressed in the PNECs of the normal fetal and adult lung, with significantly higher PR expression in the fetal lung. Interestingly, PRB expression in the normal lung was associated with lower cell proliferation than PR expression, suggesting a distinct role of PRB in the PNECs. A better understanding of the molecular mechanism of PR and PR isoform signaling in lung NET cells may help in developing novel therapeutic strategies that will benefit lung NET patients in the future.
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Affiliation(s)
- Teeranut Asavasupreechar
- Graduate Program in Clinical Biochemistry and Molecular Medicine, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ryoko Saito
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Dean P Edwards
- Departments of Molecular & Cellular Biology and Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Viroj Boonyaratanakornkit
- Graduate Program in Clinical Biochemistry and Molecular Medicine, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand; Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand; Age-Related Inflammation and Degeneration Research Unit, Chulalongkorn University, Bangkok, Thailand.
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Sangaramoorthy M, Hines LM, Torres-Mejía G, Phipps AI, Baumgartner KB, Wu AH, Koo J, Ingles SA, Slattery ML, John EM. A Pooled Analysis of Breastfeeding and Breast Cancer Risk by Hormone Receptor Status in Parous Hispanic Women. Epidemiology 2019; 30:449-457. [PMID: 30964816 PMCID: PMC6472273 DOI: 10.1097/ede.0000000000000981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Data on breastfeeding and breast cancer risk are sparse and inconsistent for Hispanic women. METHODS Pooling data for nearly 6,000 parous Hispanic women from four population-based studies conducted between 1995 and 2007 in the United States and Mexico, we examined the association of breastfeeding with risk of breast cancer overall and subtypes defined by estrogen receptor (ER) and progesterone receptor (PR) status, and the joint effects of breastfeeding, parity, and age at first birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression. RESULTS Among parous Hispanic women, older age at first birth was associated with increased breast cancer risk, whereas parity was associated with reduced risk. These associations were found for hormone receptor positive (HR+) breast cancer only and limited to premenopausal women. Age at first birth and parity were not associated with risk of ER- and PR- breast cancer. Increasing duration of breastfeeding was associated with decreasing breast cancer risk (≥25 vs. 0 months: OR = 0.73; 95% CI = 0.60, 0.89; Ptrend = 0.03), with no heterogeneity by menopausal status or subtype. At each parity level, breastfeeding further reduced HR+ breast cancer risk. Additionally, breastfeeding attenuated the increase in risk of HR+ breast cancer associated with older age at first birth. CONCLUSIONS Our findings suggest that breastfeeding is associated with reduced risk of both HR+ and ER- and PR- breast cancer among Hispanic women, as reported for other populations, and may attenuate the increased risk in women with a first pregnancy at older ages.
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Affiliation(s)
| | - Lisa M. Hines
- Department of Biology, University of Colorado at Colorado Springs, Colorado Springs, CO 80918
| | - Gabriela Torres-Mejía
- Instituto Nacional de Salud Puública, Population Health Research Center, Cuernavaca Morelos,
Mexico
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, WA 98195
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
98109
| | - Kathy B. Baumgartner
- Department of Epidemiology and Population Health, School of Public Health & Information Sciences, James
Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202
| | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center,
University of Southern California, Los Angeles, CA 90089
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, CA 94538
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94304
| | - Sue A. Ingles
- Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center,
University of Southern California, Los Angeles, CA 90089
| | | | - Esther M. John
- Cancer Prevention Institute of California, Fremont, CA 94538
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94304
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA
94304
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Castelnovo LF, Magnaghi V, Thomas P. Expression of membrane progesterone receptors (mPRs) in rat peripheral glial cell membranes and their potential role in the modulation of cell migration and protein expression. Steroids 2019; 142:6-13. [PMID: 28962850 DOI: 10.1016/j.steroids.2017.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 09/14/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
The role played by progestogens in modulating Schwann cell pathophysiology is well established. Progestogens exert their effects in these cells through both classical genomic and non-genomic mechanisms, the latter mediated by the GABA-A receptor. However, there is evidence that other receptors may be involved. Membrane progesterone receptors (mPRs) are novel 7-transmembrane receptors coupled to G proteins that have been characterized in different tissues and cells, including the central nervous system (CNS). The mPRs were shown to mediate some of progestogens' neuroprotective effects in the CNS, and to be upregulated in glial cells after traumatic brain injury. Based on this evidence, this paper investigated the possible involvement of mPRs in mediating progestogen actions in S42 Schwann cells. All five mPR isoforms and progesterone receptor membrane component 1 (PGRMC1) were detected in Schwann cells, and were present on the cell membrane. Progesterone and the mPR-specific agonist, Org-OD-02-0 (02) bound to these membranes, indicating the presence of functional mPRs. The mPR agonist 02 rapidly increased cell migration in an in vitro assay, suggesting a putative role of mPRs in the nerve regeneration process. Treatment with pertussis toxin and 8-Br-cAMP blocked 02-induced cell migration, suggesting this progestogen action is mediated by activation of an inhibitory G protein, leading to a decrease in intracellular cAMP levels. In contrast, long-term mPR activation led to increased expression levels of myelin associated glycoprotein (MAG). Taken together, these findings show that mPRs are present and active in Schwann cells and have a role in modulating their physiological processes.
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Affiliation(s)
- Luca F Castelnovo
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via G. Balzaretti 9, 20133 Milan, Italy; Marine Science Institute, The University of Texas at Austin, 750 Channel View Drive, Port Aransas TX 78373, United States.
| | - Valerio Magnaghi
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via G. Balzaretti 9, 20133 Milan, Italy
| | - Peter Thomas
- Marine Science Institute, The University of Texas at Austin, 750 Channel View Drive, Port Aransas TX 78373, United States
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Flores VA, Vanhie A, Dang T, Taylor HS. Progesterone Receptor Status Predicts Response to Progestin Therapy in Endometriosis. J Clin Endocrinol Metab 2018; 103:4561-4568. [PMID: 30357380 PMCID: PMC6226602 DOI: 10.1210/jc.2018-01227] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022]
Abstract
Context Progestin-based therapy is the first-line treatment for managing endometriosis-associated pain. However, response to progestins is currently variable and unpredictable. Predictive markers for response to progestin-based therapy would allow for a personalized approach to endometriosis treatment. Objective We hypothesize that progesterone receptor (PR) levels in endometriotic lesions determine response to progestin-based therapy. Design Retrospective cohort study. Setting Academic center. Patients Fifty-two subjects with histologically confirmed endometriosis and a previous documented response to hormonal therapy were included. Interventions Immunohistochemistry was performed on sections of endometriotic lesions using a rabbit polyclonal IgG for detection of PR-A/B. Main Outcome Measures The Histo (H)-score was used for quantifying PR status. Response to progestin-based therapies was determined from review of the electronic medical record. Results H-score was higher in responders compared with nonresponders. Subjects were categorized into three groups: high (H-score > 80, n = 7), medium (H-score 6 to 80, n = 28), and low (H-score ≤ 5, n = 17) PR status. The threshold of PR > 80 was associated with a 100% positive predictive value. The threshold of PR < 5 was associated with a 94% negative predictive value. Conclusion PR status is strongly associated with response to progestin-based therapy. Receptor status in endometriosis could be used to tailor hormonal-based regimens after surgery, and negate trialing progestin-based therapy to determine resistance. Ascertainment of PR status may allow for a novel, targeted, precision-based approach to treating endometriosis.
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Affiliation(s)
- Valerie A Flores
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Arne Vanhie
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Tran Dang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
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Üreyen O, Çavdar DK, Adıbelli ZH, İlhan E. Axillary metastasis in clinically node-negative breast cancer. J Egypt Natl Canc Inst 2018; 30:159-163. [PMID: 30327215 DOI: 10.1016/j.jnci.2018.09.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/14/2018] [Accepted: 09/21/2018] [Indexed: 12/12/2022] Open
Abstract
AIM OF WORK This study investigates the factors related to metastasis detection in a sentinel lymph node biopsy (SLN) in patients without clinical axillary involvement. PATIENTS AND METHODS The medical records of patients who underwent an SLN biopsy after diagnosis with early-stage breast cancer were evaluated retrospectively. The study sample included 64 patients divided into two groups according to the histopathological examination of the SLN biopsy: Group I (positive for axillary metastasis) and Group II (negative for axillary metastasis). RESULTS The frequency of lymphovascular invasion was significantly higher in Group I (57%) than in Group II (13%) (p = 0.003). The progesterone receptor status (p = 0.036), tumor T-stage(p = 0,047), and Ki-67 index differed significantly (p = 0.045) between the two groups. While in univariate analysis, lymphovascular invasion, T-stage and KI-67 index were significant, in multivariate analysis only lymphovascular invasion was found to be significant. No significant differences were found in terms of estrogen receptor and HER2 considering tumor invasion type, histologic grade, vascular invasion, neural invasion, multifocality or bilaterality, hormone receptor status, menopause status, total number of lymph nodes, presence of non-sentinel lymph nodes and the number of SLNs in the groups (p > 0.05). CONCLUSIONS The results of this study indicate that lymphovascular invasion is associated with axillary metastasis, based on an SLN biopsy.
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Affiliation(s)
- Orhan Üreyen
- Health Sciences University, İzmir Bozyaka Training and Research Hospital, Department of General Surgery, Izmir, Turkey.
| | - Demet Kocatepe Çavdar
- Health Sciences University, İzmir Bozyaka Training and Research Hospital, Department of Medical Pathology, Izmir, Turkey
| | - Zehra Hilal Adıbelli
- Health Sciences University, İzmir Bozyaka Training and Research Hospital, Clinic of Radiology, Izmir, Turkey
| | - Enver İlhan
- Health Sciences University, İzmir Bozyaka Training and Research Hospital, Department of General Surgery, Izmir, Turkey
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Affiliation(s)
- G L Greene
- Ben May Institute, University of Chicago, Illinois
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Ronchi E, Granata G, Brivio M, Coradini D, Miodini P, Di Fronzo G. A Double-Labeling Assay for Simultaneous Estimation and Characterization of Estrogen and Progesterone Receptors using Radioiodinated Estradiol and Tritiated Org 2058. Tumori 2018; 72:251-7. [PMID: 3739005 DOI: 10.1177/030089168607200305] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Estrogen (ER) and progesterone receptors (PgR) appear to be a prerequisite to elicit a biologic response by a hormone-target organ. Current methodologies for analysis of these proteins (e.g., dextran-coated charcoal, DCC) in single-label assay (SLA) require relatively large amounts of tissue material, time and laboriousness. Therefore, we have developed for breast cancer tissue an improved dual-label assay (DLA) for simultaneous titration (by DCC) and/or characterization (by sedimentation properties) of ER and PgR on the same sample, using 125I-E2 and 3H-Org 2058 as tracers. The interaction of 125I-E2 with ER and plasma proteins in comparison to 3H-E2 was studied in terms of specificity, time course, affinity binding and sedimentation pattern. 125I-E2 bound the same molecular forms displayed by 3H-E2 (9 and 3S) but with lower titers (about 1.3-fold), irrespective of the technique used, and did not bind to sex hormone-binding globulin. Simultaneous detection of 125I and 3H was achieved by use of a gamma counter plus a beta counter sequentially. ER and PgR titrations with DCC in DLA were in good agreement with those obtained with SLA, in terms of titers and Ka values. An analogous result was obtained with sucrose density gradient (SDG) analysis. Both the DLA methods were highly reproducible (CV < 8.0 %). Between the rotors available for SDG, the vertical one was preferable because of the larger number of samples processed and of less purturbation of sedimenting receptor molecules. Furthermore, a biochemical application of the method is described. In conclusion, the DLA procedure, by simplifying ER and PgR estimation, makes it possible to study, even on small tumor biopsies, the molecular properties of these proteins in relation to the clinical response of the disease.
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Bracali G, Caracino AM, Rossodivita F, Bianchi C, Loli MG, Bracali M. Estrogen and Progesterone Receptors in Human Colorectal Tumour Cells (Study of 70 Cases). Int J Biol Markers 2018; 3:41-8. [PMID: 2854832 DOI: 10.1177/172460088800300108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Estrogen and progesterone receptors were studied in 70 cases of human colorectal cancer by a cytochemical technique. 28.5% of the cases were estrogen-receptor positive and 42.8% progesterone-receptor positive. There was no difference between the sexes for estrogen receptors but the women had more tumours with progesterone receptors than men. The presence of receptors is unrelated to the differentiation of the tumour. More colon tumours were positive than those of the sigma and rectum. The concentration of cells with receptors in positive cancer cases tended to be low or medium-low.
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Affiliation(s)
- G Bracali
- Department of Pathology, Pescara Hospital, Italy
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