1
|
Mooghal M, Khan MAA, Samar MR, Shaikh H, Valimohammad AT, Idrees R, Abdul Rashid Y, Sattar AK. Association Between Ki-67 Proliferative Index and Oncotype-Dx Recurrence Score in Hormone Receptor-Positive, HER2-Negative Early Breast Cancers. A Systematic Review of the Literature. Breast Cancer (Auckl) 2024; 18:11782234241255211. [PMID: 38779417 PMCID: PMC11110513 DOI: 10.1177/11782234241255211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Background Oncotype-Dx (ODx) is a 21-gene assay used as a prognostic and predictive tool for hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative, node-negative, or 1 to 3 lymph node-positive early breast cancers (EBCs). The cost of the test, which is not available in low-middle income countries (LMICs), is not within the means of most individuals. The Ki-67 index is a marker of tumor proliferation that is cost-effective and easily performed and has been substituted in many cases to obtain prognostic information. Objective We aimed to identify the correlation between the ODx recurrence score (RS) and the Ki-67 index in HR-positive EBCs and to determine whether Ki-67, like the ODx, can help facilitate clinical decision-making. Design Systematic review correlating Ki-67 index and ODx in HR-positive and HER2-negative EBCs as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources and methods We searched different databases between January 2010 and May 2023 and included retrospective/prospective cohorts, clinical trials, case-control, and cross-sectional studies involving HR-positive and HER2-negative EBCs correlating the Ki-67 index and ODx RS categories. Results Of the 18 studies included, 16 indicated a positive or weakly positive correlation between ODx and the Ki-67 index. The combined P value of the included studies is <0.05 (P = .000), which shows a statistical significance between the 2. Our review also discusses the potential of machine learning and artificial intelligence (AI) in Ki-67 assessment, offering a cost-effective and reproducible alternative. Conclusion Even although there are limitations, studies indicate a favorable association between ODx and the Ki-67 index in specific situations. This implies that Ki-67 can offer important predictive details, especially regarding the likelihood of relapse in HR-positive EBC. This is particularly significant in LMICs where financial constraints often hinder the availability of costly diagnostic tests.
Collapse
Affiliation(s)
- Mehwish Mooghal
- Section of Breast Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | | | - Mirza Rameez Samar
- Section of Medical Oncology, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Hafsa Shaikh
- Section of Breast Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Azmina Tajdin Valimohammad
- Section of Medical Oncology, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Romana Idrees
- Department of Pathology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Yasmin Abdul Rashid
- Section of Medical Oncology, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Abida K Sattar
- Section of Breast Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
2
|
Lin LH, Wesseling-Rozendaal Y, Vasudevaraja V, Shen G, Black M, van Strijp D, Neerken S, van de Wiel PA, Jour G, Cotzia P, Darvishian F, Snuderl M. Increased PI3K pathway activity is associated with recurrent breast cancer in patients with low and intermediate 21-gene recurrence score. J Clin Pathol 2024:jcp-2023-209344. [PMID: 38383139 DOI: 10.1136/jcp-2023-209344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
AIMS We investigated key signalling pathways' activity and mutational status of early-stage breast carcinomas with low and intermediate 21-gene recurrence score (RS) to identify molecular features that may predict recurrence. METHODS This is a retrospective case-control study of 18 patients with recurrent breast carcinoma with low and intermediate 21-gene RS (<25) and control group of 15 non-recurrent breast cancer patients. DNA and mRNA were extracted from tumour tissue. mRNA expression of genes involved in oestrogen receptor (ER), androgen receptor (AR), PI3K and MAPK signalling pathways was measured by real-time quantitative reverse transcription-qPCR (OncoSIGNal G4 test, InnoSIGN). Tumour mutational landscape was assessed by targeted DNA sequencing (Oncomine Precision Assay). RESULTS There were no statistical differences between the groups' demographic and clinicopathological characteristics. PI3K pathway showed significantly higher activity in cases compared with controls (p=0.0014). Receiver operating characteristic curve analysis showed an area under the curve of 0.79 for PI3K pathway activity in the prediction of recurrent disease in low and intermediate 21-gene RS breast cancer. There was no difference in ER, AR and MAPK pathway activity. PIK3CA alterations were the most common driver mutations, but no difference was found between the groups (p=0.46) and no association with PI3K pathway activity (p=0.86). Higher Ki67 gene expression was associated with recurrences (p=0.042) CONCLUSION: Increased PI3K pathway activity, independent of PIK3CA mutations, may play a role in the recurrence of early-stage breast cancer with low and intermediate 21-gene RS. Pathway analysis can help to identify high-risk patients in this setting.
Collapse
Affiliation(s)
- Lawrence Hsu Lin
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| | | | - Varshini Vasudevaraja
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| | - Guomiao Shen
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| | - Margaret Black
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| | | | | | | | - George Jour
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| | - Paolo Cotzia
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| | - Farbod Darvishian
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| | - Matija Snuderl
- Department of Pathology, New York University Langone Health and Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
3
|
Chen M, Chen W, Liu D, Chen W, Shen K, Wu J, Zhu L. Prognostic values of clinical and molecular features in HER2 low-breast cancer with hormonal receptor overexpression: features of HER2-low breast cancer. Breast Cancer 2022; 29:844-853. [PMID: 35729304 PMCID: PMC9385837 DOI: 10.1007/s12282-022-01364-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 12/24/2022]
Abstract
Background Human epidermal growth factor receptor 2 (HER2) low breast cancer was considered as a distinct subtype different from HER2-zero breast cancer. Our study aimed to investigate the prognostic values of clinicopathological features and recurrence score (RS) in HER2-low and HER2-zero hormone receptor (HR)-positive breast cancer patients. Methods A total of 2099 HR + primary female breast cancer patients diagnosed between Jan 2009 and Jan 2019 were collected. Tumors with immunohistochemistry 1 + /2 + and negative in situ hybridization results were defined as HER2-low. We compared the clinical and genetical features of HER2-low (n = 1732) and HER2-zero (n = 367) breast cancer and their prognostic values. Results Estrogen receptor (ER) high expression (> 90%) was more common in HER2-low breast cancer than HER2-zero breast cancer (78.2% vs 58.6%, p < 0.01). Five-year disease-free survival (DFS) was similar between HER2-zero and HER2-low subgroups (92.3% vs 93.3%, p = 0.83). The predictive value of RS was only significant in HER2-zero patients (p = 0.03). The proliferation-related genes performed well in predicting DFS in HER2-zero patients, but not in HER2-low patients (p for interaction < 0.01). The higher HER2 module score was correlated with worse DFS only in HER2-low patients (p = 0.04). Conclusion We observed similar survival outcomes between HER2-low and HER2-zero HR + patients. HER2-low patients had a higher proportion of ER high expressed tumors than HER2-zero patients did. RS and its proliferation module might be less clinically meaningful to HER2-low patients. Supplementary Information The online version contains supplementary material available at 10.1007/s12282-022-01364-y.
Collapse
Affiliation(s)
- Mengdi Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Huangpu District, Shanghai, 200025, China.,Department of Thyroid and Breast Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Weilin Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Huangpu District, Shanghai, 200025, China.,Department of Thyroid and Breast Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Deyue Liu
- Department of Thyroid and Breast Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Weiguo Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Huangpu District, Shanghai, 200025, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Huangpu District, Shanghai, 200025, China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Huangpu District, Shanghai, 200025, China.
| | - Li Zhu
- Department of Thyroid and Breast Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Hongkou District, Shanghai, 200080, China.
| |
Collapse
|