1
|
Jung EJ, Kim JY, Kim JM, Lee HS, Kwag SJ, Park JH, Park T, Jeong SH, Jeong CY, Ju YT, Lee YJ, Hong SC. Positive estrogen receptor status is a poor prognostic factor in node-negative breast cancer: An observational study in Asian patients. Medicine (Baltimore) 2021; 100:e25000. [PMID: 33725973 PMCID: PMC7982180 DOI: 10.1097/md.0000000000025000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/10/2021] [Indexed: 01/05/2023] Open
Abstract
This study evaluated the outcomes and prognostic factors for breast cancer according to initial lymph node (LN) status. Among patients with LN-negative breast cancer, we also focused on the prognostic value of estrogen receptor (ER) status.Medical records were retrospectively reviewed for 715 patients who underwent curative surgery for breast cancer between January 2005 and December 2015 at a single Korean institution. We evaluated factors that were associated with metastasis-free survival (MFS) according to LN status.Among the 715 patients (age: 28-87 years), 458 patients (64.1%) did not have axillary LN metastasis. Relative to patients without LN metastasis, patients with LN metastasis had larger tumor sizes and higher histological grades. Among patients with no LN metastasis, ER positivity was associated with non-significantly poorer MFS than ER negativity (mean survival: 138.90 months vs. 146.99 months, p = .17), and patients with LN-negative ER-positive disease had MFS rates of 91.7% at 5 years and 74.5% at 10 years. Among patients with LN-negative ER-positive disease, a poor prognosis was significantly associated with larger tumor size (≥2 cm, P = .03) and older age (≥50 years, P = .03).These results indicate that the risk of metastasis increases over time for patients with LN-negative ER-positive breast cancer, and especially for older patients or patients with larger tumors.
Collapse
Affiliation(s)
- Eun Jung Jung
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jae-Myung Kim
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Han Shin Lee
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Soon-Chang Hong
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| |
Collapse
|
2
|
Wang Y, Yue W, Lang H, Ding X, Chen X, Chen H. Resuming Sensitivity of Tamoxifen-Resistant Breast Cancer Cells to Tamoxifen by Tetrandrine. Integr Cancer Ther 2021; 20:1534735421996822. [PMID: 33660534 PMCID: PMC8164553 DOI: 10.1177/1534735421996822] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Tamoxifen is one of the medicines for adjuvant endocrine therapy of
hormone-dependent breast cancer. However, development of resistance to
tamoxifen occurs inevitably during treatment. This study aimed to determine
whether sensitivity of tamoxifen-resistant breast cancer cells (TAM-R) could
be reinstated by tetrandrine (Tet). Methods: All experiments were conducted in TAM-R cells derived from the MCF-7 breast
cancer cell line by long-term tamoxifen exposure. Cell growth, apoptosis,
and autophagy were end-points that evaluated the effect of Tet (0.9 μg/ml,
1.8 μg/ml, and 3.75 μg/ml) alone or in combination with TAM (1 μM). Cell
apoptosis was determined by an ELISA assay and autophagy was determined by
fluorescent staining using the Enzo autophagy detection kit. Immunoblotting
was used to evaluate markers for apoptosis, autophagy, and related signal
pathway molecules. Results: Growth of TAM-R cells was significantly inhibited by Tet. Combination of Tet
with tamoxifen induced a greater inhibition on cell growth than tamoxifen
alone, which was predominantly due to enhancement of pro-apoptotic effect of
TAM by Tet. Autophagy was significantly inhibited in TAM-R cells treated
with Tet plus TAM as shown by increased autophagosomes and the levels of
LC3-II and p62. At 0.9 μg/ml, Tet increased the levels of both apoptosis and
autophagy markers. Among them increase in p53 levels was more dramatic. Conclusions: Tet as a monotherapy inhibits TAM-R cells. Tet potentiates the pro-apoptotic
effect of TAM via inhibition of autophagy.
Collapse
Affiliation(s)
- Yuntao Wang
- Beijing Yuyuan Dian of Xingzhitang TCM Clinic, Beijing, China
| | - Wei Yue
- University of Virginia Health System, Charlottesville, VA, USA
| | - Haiyan Lang
- Dongfang Hospital affiliated to Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Xiaoqing Ding
- Dongfang Hospital affiliated to Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Xinyi Chen
- Dongzhimen Hospital affiliated to Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Haiyan Chen
- Dongfang Hospital affiliated to Beijing University of Traditional Chinese Medicine, Beijing, China
| |
Collapse
|
3
|
Body Composition Analysis of 10 Years versus 5 Years of Adjuvant Endocrine Therapy in Patients with Nonmetastatic Breast Cancer. JOURNAL OF ONCOLOGY 2021; 2021:6659680. [PMID: 33510788 PMCID: PMC7826243 DOI: 10.1155/2021/6659680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 01/07/2023]
Abstract
Objective Our study aims to investigate the association of extended adjuvant endocrine therapy with disease-free survival (DFS), muscle mass, muscle strength, and visceral adipose tissue in patients with nonmetastatic breast cancer and the effect of extended endocrine therapy on body composition. Patients and Methods. Patients (N = 90) with nonmetastatic breast cancer aged between 60 and 65 years old were prospectively recruited in this study, compromising a cohort of subjects rece iving 5 years or 10 years of adjuvant endocrine therapy. Patients' DFS was compared between these two groups. Patients' body composition including muscle and fat using CT scans, muscle strength, and gait speed was evaluated in these two groups. Results Dietary behavior was recorded with the food frequency questionnaire (FFQ). Patients' age, body weight, and body mass index (BMI) did not differ between the two groups. An extended adjuvant endocrine therapy into 10 years could translate into DFS benefit (123.8 vs. 102.2 months, P=0.038). Patients receiving 10 years of adjuvant endocrine therapy had less skeletal muscle and more visceral fat compared with patients receiving 5 years of adjuvant endocrine therapy. The skeletal muscle index was 50.3 ± 1.6 cm2/m2 versus 46.5 ± 1.3 cm2/m2 in the 10 years or 5 years of adjuvant endocrine therapy group (P=0.042). The visceral fat was 28.9 ± 2.9 cm2/m2 versus 55.0 ± 3.2 cm2/m2 in the 10 years or 5 years of adjuvant endocrine therapy group (P=0.011). The muscle strength, gait speed, and FFQ results in the two groups not reaching statistical difference. Conclusion In conclusion, breast cancer patients with 10 years of adjuvant endocrine therapy had DFS benefit, but with more muscle loss and adipose tissue deposits compared to patients receiving 5 years of adjuvant endocrine therapy.
Collapse
|
4
|
Rangel-Méndez JA, Rubi-Castellanos R, Ascencio-Montiel IDJ, Moo-Puc RE. CYP2D6 does not impact on breast cancer-free survival in Southeast Mexican patients under tamoxifen treatment. Per Med 2020; 17:261-270. [DOI: 10.2217/pme-2019-0135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim: We conducted a retrospective analysis in 71 Mexican Mestizo patients to evaluate the breast cancer-free survival (BCFS) among the inferred genetic phenotypes (GP) of CYP2D6. Patients & methods: CYP2D6 was genotyped through Taqman-probe analysis; GP were inferred according to international guidelines. The BCFS was estimated through Kaplan–Meier method and analyzed with a log-rank test; hazard ratios were calculated with 95% CI and p < 0.05. Results: The BCFS did not differ among CYP2D6 GP (p = 0.45) and recurrence risk was similar between gNM + gUM and gPM + gIM groups (hazard ratio: 1.54, 95% CI: 0.37–6.38; p = 0.55). Conclusion: The findings do not support any impact of CYP2D6 on BCFS. Evaluation of other genetic/nongenetic biomarkers is needed in Mexican Mestizo patients under tamoxifen treatment.
Collapse
Affiliation(s)
- Jorge-Aarón Rangel-Méndez
- Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional ‘Ignacio García Téllez’, Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, 97150 Mérida, Yucatán, México
| | - Rodrigo Rubi-Castellanos
- Centro de Investigaciones Regionales ‘Dr Hideyo Noguchi’ Calle 96 S/N, Avenida Jacinto Canek y calle 47, Paseo de las Fuentes, 97225 Mérida, Yucatán, México
| | - Iván de Jesús Ascencio-Montiel
- División Vigilancia Epidemiológica de Enfermedades No Transmisibles, Instituto Mexicano del Seguro Social, Mier y Pesado 120, Col. Del Valle, Benito Juárez, 03100 Ciudad de México, México
| | - Rosa Esther Moo-Puc
- Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional ‘Ignacio García Téllez’, Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, 97150 Mérida, Yucatán, México
| |
Collapse
|
5
|
Coelho S, Rego IB, Dionísio MR, Cavaco-Silva J, Semedo PM, Pavão F, Leite RB, Costa L. 360 Health Analysis (H360) - A Proposal for an Integrated Vision of Breast Cancer in Portugal. Eur J Breast Health 2020; 16:91-98. [PMID: 32285029 PMCID: PMC7138355 DOI: 10.5152/ejbh.2020.5144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/22/2019] [Indexed: 12/31/2022]
Abstract
H360 aims to provide a comprehensive picture of breast cancer management in Portugal by retrieving real-world data from 10 Portuguese hospitals and deriving a snapshot from the medical interpretation of evidence-based data to patient perspective on the quality and effectiveness of medical care provided. This article reviews evidence on breast cancer clinical practice and quality of care and disease management in Portugal. A review of evidence on breast cancer clinical practice and quality of care over the last 10 years was performed in PubMed using the query "Organization and Administration"[Mesh] AND "breast cancer"[All Fields] NOT "Review" [ptyp]. National cancer initiatives relevant for quality of care and national and international guidelines and consensus were analyzed. Retrieved results showed that breast cancer incidence is still increasing, including in Portugal. Studies investigating disease outcomes seek to derive improvements to clinical practice and better financial resource allocation. Setting performance measures (KPIs) in institutions treating cancer is not a reality in Portugal yet, but has potential to leverage the quality of clinical performance. A multidisciplinary approach within one health structure is also desirable. More investment in clinical (including academic) research is key to optimize the quality of care. Implementation of clinical practice guidelines (largely based on ESMO guidelines in Portugal) is crucial to improve patient outcomes. Not less importantly, quality of life is a treatment goal on its own in breast cancer care. Breast cancer remains a health challenge and a multidimensional, 360-degree appraisal, beyond the exclusively clinical perspective, may provide new insights towards an optimal patient-centered approach.
Collapse
Affiliation(s)
- Sara Coelho
- Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, Portugal
| | - Inês Brandão Rego
- Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | | | | | | | - Francisco Pavão
- Universidade Católica Portuguesa, Institute of Health Sciences, Lisbon, Portugal
| | - Ricardo Baptista Leite
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands
| | - Luís Costa
- Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Luis Costa Lab, Lisbon, Portugal
| |
Collapse
|
6
|
Li L, Chang B, Jiang X, Fan X, Li Y, Li T, Wu S, Zhang J, Kariminia S, Li Q. Clinical outcomes comparison of 10 years versus 5 years of adjuvant endocrine therapy in patients with early breast cancer. BMC Cancer 2018; 18:977. [PMID: 30314452 PMCID: PMC6186070 DOI: 10.1186/s12885-018-4878-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/01/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Adjuvant endocrine therapy undoubtedly prolongs the time to recurrence for patients with hormone-positive early breast cancer. Extended endocrine therapy to 10 years or longer has been expected to bring a greater clinical advantage. However, the related research conclusions are controversial. METHODS Tamoxifen (TAM), Aromatase Inhibitor (AI), Exemestane, letrozole (LET) and anastrozole were used as key words in the literature search. After the patients completed 5 years of adjuvant endocrine treatment, they were allocated to continue endocrine treatment for 5 years or receive placebo/observation for 5 years. Disease-free survival (DFS) and overall survival (OS) were the end points. Systematic assessment was performed using Stata 12.0. RESULTS Twelve trials including 30,848 cases were involved. The overall analysis demonstrated that extended endocrine therapy to 10 years significantly prolonged DFS compared with 5 years of endocrine therapy [hazard ratio (HR) = 0.84, 95% CI: 0.73-0.97]. Subgroup analysis showed that DFS was significant prolonged with TAM 5y - AI 5y treatment versus TAM 5y treatment and with (AI and/or TAM) 5y - LET 5y treatment versus (AI and/or TAM) 5y treatment [(HR = 0.61, 95% CI: 0.50-0.76) and (HR = 0.81, 95% CI: 0.71-0.93), respectively]. However, no significant difference was found in the DFS with TAM 5y - TAM 5y treatment versus TAM 5y treatment (HR = 0.97, 95% CI: 0.81-1.17). Overall and subgroup analysis did not demonstrate an OS benefit of therapy extended to 10 years. A DFS benefit of extended endocrine therapy to 10 years was verified in the lymph node-positive subgroup, postmenopausal subgroup and ER+ and/or PR+ subgroup (HR = 058, 95% CI: 0.45-0.75; HR = 0.70, 95% CI: 0.58-0.80; HR = 0.80, 95% CI: 0.67-0.96). CONCLUSIONS An extended 10 years of endocrine treatment yields a DFS benefit for patients with early breast cancer; (AI and/or TAM) 5y - AI 5y treatment is the optimal choice. ER+ and/or PR+, postmenopausal and lymph node-positive patients are the most suitable groups.
Collapse
Affiliation(s)
- Li Li
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Bingmei Chang
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.,Department of Biochemistry and Molecular Biology, Basic Medical College, Shanxi Medical University, Taiyuan, 030001, China
| | - Xiaoyue Jiang
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Xueke Fan
- Gastroenterology Department, JinCheng People's Hospital, Shanxi, 048000, China
| | - Yingrui Li
- Biochemistry and Molecular Biology, Basic Medicine College, Shanxi Medical University, Taiyuan, 050001, China
| | - Teng Li
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Shanshan Wu
- Statistical Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jun Zhang
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, 77030, USA
| | - Seyed Kariminia
- Molecular and Cellular Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, 77030, USA
| | - Qin Li
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| |
Collapse
|