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Schandiz H, Park D, Kaiser YL, Lyngra M, Talleraas IS, Geisler J, Sauer T. Subtypes of high-grade breast ductal carcinoma in situ (DCIS): incidence and potential clinical impact. Breast Cancer Res Treat 2023:10.1007/s10549-023-07016-9. [PMID: 37453021 PMCID: PMC10361903 DOI: 10.1007/s10549-023-07016-9] [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: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate and classify the molecular subtypes of high-grade ductal carcinoma in situ (DCIS) and identify possible high-risk subtypes. The heterogenicity of DCIS with variable clinical and histopathological presentations has been recognized. Nevertheless, only histopathological grading and diameter are currently implemented in clinical decision-making following the diagnosis of DCIS. The molecular subtypes of DCIS and their IHC surrogate markers have not been defined in conventional treatment guidelines and recommendations. We applied the definitions of molecular subtypes according to the IHC surrogate markers defined for IBC and subclassified high-grade DCIS, accordingly. METHODS Histopathological specimens were collected, revised, and regraded from 494 patients diagnosed with DCIS between 1996 and 2018. Other in situ and papillary lesions observed in breast biopsies were excluded from this study. 357 high-grade DCIS cases were submitted to IHC analysis. The markers investigated were ER, PR, HER2, and Ki67. RESULTS 45 cases were classified as grade 1, 19 as grade 2, and 430 as grade 3. Sixty patients with high-grade DCIS had an additional invasive component in the surgical specimen. Thirty-three patients were diagnosed with recurrent DCIS or invasive cancer (minimum one year after their primary DCIS diagnosis). The proportions of luminal A and luminal B HER2-negative subtypes varied depending on whether 2011 or 2013 St. Gallen Consensus Conference guidelines were adopted. Luminal A was the most prevalent subtype, according to both classifications. The luminal B HER2-positive subtype was found in 22.1% of cases, HER2-enriched subtype in 21.8%, and TPN subtype in 5.6%. There were strong indications that HER2-enriched subtype was significantly more frequent among DCIS with invasive component (p = 0.0169). CONCLUSIONS High-grade DCIS exhibits all the molecular subtypes previously identified in IBC, but with a somewhat different distribution in our cohort. HER2-enriched subtype is substantially related to the presence of an invasive component in DCIS; consequently, it is regarded as a high-risk entity.
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Affiliation(s)
- Hossein Schandiz
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway.
| | - Daehoon Park
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Yan Liu Kaiser
- Department of Clinical Molecular Biology (EpiGen), Akershus University Hospital (AHUS), Lørenskog, Norway
| | - Marianne Lyngra
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
| | | | - Jürgen Geisler
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus AHUS, Oslo, Norway
| | - Torill Sauer
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Campus AHUS, Oslo, Norway
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Hammersen F, Fischer D, Pursche T, Strobel AM, Katalinic A, Labohm L, Waldmann A. Young Adult German Breast Cancer Patients Participating in a Three-Week Inpatient Mother–Child Rehab Program Have High Needs for Supportive Care. Cancers (Basel) 2023; 15:cancers15061770. [PMID: 36980656 PMCID: PMC10046589 DOI: 10.3390/cancers15061770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
A known cut-off problem hampers the interpretation of quality of life (QOL) scores. The purpose of this study was to apply a novel approach for the EORTC QLQ-C30 instrument to identify the proportion of breast cancer (BC) patients in need of supportive care. Changes in QOL during the COVID-19 pandemic were evaluated, as well as changes over time (after treatment termination and up to 4 years later). Data were obtained from a cohort study on young adult BC patients with minor children participating in a mother–child rehab program. Cross-sectional QOL data were collected from 2015 to 2021 (baseline). Follow-up data were available for up to 4 years after diagnosis for a subgroup. The baseline cohort included 853 women (mean age 35 years). More than 50% had a need for supportive care. In the subgroup with follow-up, this proportion remained at a high level up to several years after diagnosis. During the COVID-19 pandemic, changes regarding the proportion with this need were not as high as expected—with the exception of changes on the QLQ-C30 scale ‘role functioning’ (+15%). Even several years after diagnosis, every second BC patient with minor children had a need for supportive care, which is much higher than previously found. Healthcare staff should be aware of this potential need and should address this issue.
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Affiliation(s)
- Friederike Hammersen
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (A.K.); (L.L.)
- Correspondence: (F.H.); (A.W.)
| | - Dorothea Fischer
- Department of Obstetrics and Gynecology, Ernst von Bergmann Clinic, Charlottenstraße 72, 14467 Potsdam, Germany;
| | - Telja Pursche
- Department of Gynecology and Obstetrics, Hospital Dueren gem. GmbH, Roonstraße 30, 52351 Dueren, Germany;
| | - Angelika M. Strobel
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (A.K.); (L.L.)
- Institute for Cancer Epidemiology e.V., University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Louisa Labohm
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (A.K.); (L.L.)
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (A.K.); (L.L.)
- Correspondence: (F.H.); (A.W.)
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3
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Hatse S, Serena M, Vulsteke C, Punie K, Neven P, Smeets A, Laenen A, Wildiers H. Impact of baseline telomere length on survival and chemotherapy related toxicity in breast cancer patients receiving (neo)adjuvant anthracycline containing chemotherapy. Transl Oncol 2022; 26:101551. [PMID: 36219936 PMCID: PMC9558049 DOI: 10.1016/j.tranon.2022.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study is to assess baseline mean leukocyte telomere length (TL) as a potential predictive factor for chemotherapy toxicity and a prognostic marker for long-term outcome in early breast cancer (BC) patients. METHODS 445 BC patients were selected, diagnosed between 2007 and 2010 with early BC and treated with (neo)adjuvant fluorouracil, epirubicin and cyclophosphamide (FEC) or with FEC and Docetaxel (FEC-D). RT-qPCR was performed on germline DNA samples collected at diagnosis before any treatment, to measure mean leukocyte TL. Uni- and multivariable logistic regression or Cox proportional hazard regression analyses were carried out to assess correlation between baseline TL and toxicity parameters (derived from the medical chart) or longer-term outcome. RESULTS Baseline TL correlated with age as expected (p = 0.005), but not with febrile neutropenia (n = 97), left ventricular ejection fraction >10% decrease (n = 17) nor other toxicity endpoints measured (all p > 0.05). TL was neither associated with overall survival, breast cancer specific survival or distant disease-free survival (all p > 0.05). CONCLUSIONS Baseline TL is not associated with chemotherapy-related toxicity nor long-term outcome in BC patients.
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Affiliation(s)
- Sigrid Hatse
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Marta Serena
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Christof Vulsteke
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Kevin Punie
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Hans Wildiers
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
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Timmermans L, De Brabander I, Van Damme N, Bleyen L, Martens P, Van Herck K, Thierens H, Bacher K, Depypere H. Tumour characteristics of screen-detected and interval cancers in the Flemish Breast Cancer Screening Programme: A mammographic breast density study. Maturitas 2022; 158:55-60. [DOI: 10.1016/j.maturitas.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/29/2021] [Accepted: 12/12/2021] [Indexed: 12/25/2022]
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5
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Phan NN, Huang CC, Tseng LM, Chuang EY. Predicting Breast Cancer Gene Expression Signature by Applying Deep Convolutional Neural Networks From Unannotated Pathological Images. Front Oncol 2021; 11:769447. [PMID: 34926274 PMCID: PMC8673486 DOI: 10.3389/fonc.2021.769447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/29/2021] [Indexed: 01/16/2023] Open
Abstract
We proposed a highly versatile two-step transfer learning pipeline for predicting the gene signature defining the intrinsic breast cancer subtypes using unannotated pathological images. Deciphering breast cancer molecular subtypes by deep learning approaches could provide a convenient and efficient method for the diagnosis of breast cancer patients. It could reduce costs associated with transcriptional profiling and subtyping discrepancy between IHC assays and mRNA expression. Four pretrained models such as VGG16, ResNet50, ResNet101, and Xception were trained with our in-house pathological images from breast cancer patient with recurrent status in the first transfer learning step and TCGA-BRCA dataset for the second transfer learning step. Furthermore, we also trained ResNet101 model with weight from ImageNet for comparison to the aforementioned models. The two-step deep learning models showed promising classification results of the four breast cancer intrinsic subtypes with accuracy ranging from 0.68 (ResNet50) to 0.78 (ResNet101) in both validation and testing sets. Additionally, the overall accuracy of slide-wise prediction showed even higher average accuracy of 0.913 with ResNet101 model. The micro- and macro-average area under the curve (AUC) for these models ranged from 0.88 (ResNet50) to 0.94 (ResNet101), whereas ResNet101_imgnet weighted with ImageNet archived an AUC of 0.92. We also show the deep learning model prediction performance is significantly improved relatively to the common Genefu tool for breast cancer classification. Our study demonstrated the capability of deep learning models to classify breast cancer intrinsic subtypes without the region of interest annotation, which will facilitate the clinical applicability of the proposed models.
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Affiliation(s)
- Nam Nhut Phan
- Bioinformatics Program, Taiwan International Graduate Program, Institute of Information Science, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Bioinformatics and Biostatistics Core, Centre of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Cheng Huang
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ling-Ming Tseng
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Eric Y. Chuang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- Bioinformatics and Biostatistics Core, Centre of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
- Master Program for Biomedical Engineering, China Medical University, Taichung, Taiwan
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6
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van Walle L, Punie K, Van Eycken E, de Azambuja E, Wildiers H, Duhoux FP, Vuylsteke P, Barbeaux A, Van Damme N, Verhoeven D. Assessment of potential process quality indicators for systemic treatment of breast cancer in Belgium: a population-based study. ESMO Open 2021; 6:100207. [PMID: 34273808 PMCID: PMC8319479 DOI: 10.1016/j.esmoop.2021.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Quality indicators (QIs) for the management of breast cancer (BC) have been published in Europe and internationally. In Belgium, a task force was established to select measurable process indicators of systemic treatment for BC, focusing on appropriateness of delivered care. The objective of this study was to evaluate the results of the selected QIs, both nationally and among individual centres. PATIENTS AND METHODS Female Belgian residents with unilateral primary invasive BC diagnosed between 2010 and 2014 were selected from the Belgian Cancer Registry database. The national number enabled linkage with the national reimbursement database, which contains information on all reimbursed medical procedures. A total of 12 process indicators were measured on the population and hospital level. Intercentre variability was assessed by median results and interquartile ranges. RESULTS A total of 48 872 patients were included in the study. QIs concerning specific BC subtypes only applied to patients diagnosed in 2014 (n = 9855). Clinical stage (cStage) I patients (n = 17 116) were staged with positron emission tomography/computed tomography. Among patients who were pT1aN0 human epidermal growth factor receptor 2 (HER2) positive (n = 47), 25.5% (n = 12) received adjuvant trastuzumab. Among patients with de novo metastatic luminal A/B-like HER2-negative BC (n = 295), 17.3% (n = 51) received upfront chemotherapy. (Neo)adjuvant chemotherapy was administered in 52.4% (n = 12 592) of operated women with cStage I-III, in 37.0% (n = 1270) of operated women with cStage I-III luminal A/B-like HER2-negative BC, and in 19.1% of operated women with cStage I luminal A/B-like HER2-negative BC. In the population of operated patients with cStage I-III, of those younger than 70 years that started adjuvant endocrine therapy (n = 3591), 81.7% (n = 2932) continued treatment for ≥4.5 years. Among patients in cStage I-III older than 70 years (n = 8544), 19.0% (n = 1622) received (neo)adjuvant chemotherapy, whereas among patients with cStage I-III luminal A/B-like HER2-negative BC (n = 1388), 13.0% (n = 181) received (neo)adjuvant chemotherapy. In patients with cStage I-II luminal A/B-like HER2-negative BC older than 70 years (n = 1477), 11.6% (n = 171) were not operated and received upfront endocrine treatment. CONCLUSION Well-considered QIs using population-based data can evaluate quality of care and expose disparities among treatment centres. Their use in daily practice should be implemented in all centres treating BC.
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Affiliation(s)
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - E de Azambuja
- Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - H Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - F P Duhoux
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - P Vuylsteke
- Department of Medical Oncology, CHU UCL Namur, Site Ste Elisabeth, Namur, Belgium; University of Botswana, Botswana, Belgium
| | - A Barbeaux
- Department of Medical Oncology, CHR Verviers East Belgium, Verviers, Belgium
| | | | - D Verhoeven
- Department of Medical Oncology, AZ Klina, Brasschaat, Belgium; University of Antwerp, Antwerp, Belgium
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7
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Hammersen F, Pursche T, Fischer D, Katalinic A, Waldmann A. Psychosocial and family-centered support among breast cancer patients with dependent children. Psychooncology 2020; 30:361-368. [PMID: 33137218 DOI: 10.1002/pon.5585] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the psychosocial situation of breast cancer (BC) patients with dependent children, with regard to who used family-centered psychosocial support (PS) services, reasons against using it, as well as existing, unmet needs, and current PS need. METHODS Data were collected via survey and patient files during an inpatient rehabilitation program for mothers with BC, who were accompanied by a child <12 years. Descriptive statistics and tests for statistical significance were used. RESULTS Out of the total of 561 patients, 23.0% had used family-centered PS services before. Common reasons against it were enough support, no anticipated need and organizational issues. Patients stated a high number of unmet needs. The most urgent ones related to their children. About 59.3% of mothers stated a current PS need (PSN) and 33.3% a need for their children. Little social support and a worse maternal HRQOL, but not time since diagnosis, were related to a higher PSN in mothers and children (bivariate association). CONCLUSION Among BC patients with dependent children, clinicians need to take the whole family and their support needs into account. They should know about the existing organizational barriers, which need to be overcome with the help of tailored offers. Patients with low HRQOL, little social support and single-mothers (with regard to children's PSN) need special attention as these can be indicators of high PSN.
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Affiliation(s)
- Friederike Hammersen
- Institute for Social Medicine and Epidemiology, University of Luebeck, Lübeck, Germany
| | - Telja Pursche
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Lübeck, Germany.,Department of Gynaecology and Obstetrics, Hospital Dueren gem. GmbH, Düren, Germany
| | - Dorothea Fischer
- Department of Obstetrics and Gynecology, Ernst von Bergmann Clinic, Potsdam, Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Luebeck, Lübeck, Germany.,Institute for Cancer Epidemiology e.V, University of Luebeck, Lübeck, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Luebeck, Lübeck, Germany
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8
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Assessment of stromal tumor infiltrating lymphocytes and immunohistochemical features in invasive micropapillary breast carcinoma with long-term outcomes. Breast Cancer Res Treat 2020; 184:985-998. [PMID: 32920743 DOI: 10.1007/s10549-020-05913-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/01/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE We studied the long-term outcomes of invasive micropapillary carcinoma (IMPCs) of the breast in relation to stromal tumor infiltrating lymphocytes (sTILs), prognostic biomarkers and clinicopathological features. METHODS Stage I-III IMPCs treated with upfront surgery at our institution (January 2000 and December 2016) were included. Central pathology review was performed and sTILs (including zonal distribution and hot spot analysis) and tumor-associated plasma cells (TAPC) were evaluated. Expression of P53, BCL2, FOXP3, and WT1, which are variably linked to breast cancer prognosis, was measured by immunohistochemistry using tissue microarrays. Time-to-event endpoints were distant recurrence free interval (DRFI) and breast cancer-specific survival (BCSS). RESULTS We included 111 patients of whom 59% were pure IMPCs. Standard clinicopathological features were comparable between pure and non-pure IMPCs. Overall, the mean sTILs level was 20% with higher proportion of sTILs present at the invasive front. There were no significant differences between pure- and non-pure IMPCs in sTILs levels, nor in the spatial distribution of the hot spot regions or in the distribution of TAPC. Higher sTILs correlated with worse DRFI (HR = 1.55; p = 0.0172) and BCSS (HR = 2.10; p < 0.001). CONCLUSIONS Clinicopathological features, geographical distribution of sTILs and TAPC are similar between pure and non-pure IMPCs. Despite a high proportion of grade 3 tumors and lymph node involvement, we observed a low rate of distant recurrences and breast cancer-related death in this cohort of stage I-III IMPCs treated with primary surgery. Caution in interpretation of the observed prognostic correlations is required given the very low number of events, warranting validation in other cohorts.
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Pizzato M, Carioli G, Rosso S, Zanetti R, La Vecchia C. The impact of selected risk factors among breast cancer molecular subtypes: a case-only study. Breast Cancer Res Treat 2020; 184:213-220. [PMID: 32851454 DOI: 10.1007/s10549-020-05820-1] [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: 02/05/2020] [Accepted: 07/20/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE Breast cancer (BC) risk factors have been differentially associated with BC subtypes, but quantification is still undefined. Therefore, we compared selected risk factors with BC subtypes, using a case-case approach. METHODS We retrieved 1321 invasive female BCs from the Piedmont Cancer Registry. Through record linkage of clinical records, we obtained data on estrogen (Er) and progesterone (Pr) receptors, Ki67 and HER2+ status, BC family history, breast imaging reporting and data system (BI-RADS) density, reproductive risk factors and education. We defined BC subtypes as follows : luminal A (Er+ and/or Pr+ , HER2- , low Ki67), luminal BH- (Er+ and/or Pr + , HER2- , Ki67 high), luminal BH+ (Er+ and/or Pr + , HER2+), HER2+ (Er - , Pr - , HER2+), ) and triple negative (Er - , Pr - , HER2-). Using a multinomial regression model, we estimated the odds ratios (ORs) for selected BC risk factors considering luminal A as reference. RESULTS For triple negative, the OR for BC family history was 1.83 (95% confidence interval (CI) 1.13-2.97). Compared to BI-RADS 1, for triple negative, the OR for BI-RADS 2 was 0.56 (95% CI 0.27-1.14) and for BI-RADS 3-4 was 0.37 (95% CI 0.15-0.88); for luminal BH +, the OR for BI-RADS 2 was 2.36 (95% CI 1.08-5.11). For triple negative, the OR for high education was 1.78 (95% CI 1.03-3.07), and for late menarche, the OR was 1.69 (95% CI 1.02-2.81). For luminal BH + , the OR for parous women was 0.56 (95% CI 0.34-0.92). CONCLUSIONS This study supported BC etiologic heterogeneity across subtypes, particularly for triple negative.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Augusto Vanzetti 5, 20133, Milano, Milan, Italy
| | - Greta Carioli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Augusto Vanzetti 5, 20133, Milano, Milan, Italy.
| | - Stefano Rosso
- Piedmont Cancer Registry, Città della Salute e della Scienza di Torino, A.O.U, Turin, Italy
| | - Roberto Zanetti
- Piedmont Cancer Registry, Città della Salute e della Scienza di Torino, A.O.U, Turin, Italy.,Fondo Elena Moroni for Oncology
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Augusto Vanzetti 5, 20133, Milano, Milan, Italy
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10
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Finn RS, Cristofanilli M, Ettl J, Gelmon KA, Colleoni M, Giorgetti C, Gauthier E, Liu Y, Lu DR, Zhang Z, Bartlett CH, Slamon DJ, Turner NC, Rugo HS. Treatment effect of palbociclib plus endocrine therapy by prognostic and intrinsic subtype and biomarker analysis in patients with bone-only disease: a joint analysis of PALOMA-2 and PALOMA-3 clinical trials. Breast Cancer Res Treat 2020; 184:23-35. [PMID: 32783178 PMCID: PMC7568717 DOI: 10.1007/s10549-020-05782-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/30/2020] [Indexed: 01/11/2023]
Abstract
Purpose This analysis evaluated the relationship between treatment-free interval (TFI, in PALOMA-2)/disease-free interval (DFI, in PALOMA-3) and progression-free survival (PFS) and overall survival (OS, in PALOMA-3), treatment effect in patients with bone-only disease, and whether intrinsic subtype affects PFS in patients receiving palbociclib. Methods Data were from phase 3, randomized PALOMA-2 and PALOMA-3 clinical studies of hormone receptor‒positive/human epidermal growth factor receptor 2‒negative (HR+ /HER2−) advanced breast cancer (ABC) patients receiving endocrine therapy plus palbociclib or placebo. Subpopulation treatment effect pattern plot (STEPP) analysis evaluated the association between DFI and PFS and OS. PFS by luminal subtype and cyclin-dependent kinase (CDK) 4/6 or endocrine pathway gene expression levels were evaluated in patients with bone-only disease; median PFS and OS were estimated by the Kaplan–Meier method. Results Median durations of TFI were 37.1 and 30.9 months (PALOMA-2) and DFI were 49.2 and 52.0 months (PALOMA-3) in the palbociclib and placebo groups, respectively. Among the PALOMA-2 biomarker population (n = 454), 23% had bone-only disease; median PFS was longer with palbociclib versus placebo (31.3 vs 11.2 months; hazard ratio, 0.41; 95% CI 0.25‒0.69). The interaction effect of bone-only versus visceral disease subgroups on median PFS with palbociclib was not significant (P = 0.262). Among the PALOMA-3 biomarker population (n = 302), 27% had bone-only disease. STEPP analyses showed that palbociclib PFS benefit was not affected by DFI, and that palbociclib OS effect may be smaller in patients with short DFIs. Among patients who provided metastatic tumor tissues (n = 142), regardless of luminal A (hazard ratio, 0.23; 95% CI 0.11‒0.47; P = 0.0000158) or luminal B (hazard ratio, 0.26; 95% CI 0.12‒0.56; P = 0.000269) subtype, palbociclib improved PFS versus placebo. Conclusions These findings support palbociclib plus endocrine therapy as standard of care for HR+ /HER2− ABC patients, regardless of baseline TFI/DFI or intrinsic molecular subtype, including patients with bone-only disease. Trial registration Pfizer (clinicaltrials.gov:NCT01740427, NCT01942135).
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Affiliation(s)
- Richard S Finn
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd, Suite 200, Santa Monica, CA, USA.
| | - Massimo Cristofanilli
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, 710 N Fairbanks Ct, Suite 8-250A, Chicago, IL, USA
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str 22, 81675, Munich, Germany
| | - Karen A Gelmon
- British Columbia Cancer Agency, 675 West 10th Ave, Vancouver, BC, Canada
| | - Marco Colleoni
- IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | | | - Eric Gauthier
- Pfizer Inc, 525 Market Street, San Francisco, CA, USA
| | - Yuan Liu
- Pfizer Inc, 10646 Science Center Dr, La Jolla, San Diego, CA, USA
| | - Dongrui R Lu
- Pfizer Inc, 10646 Science Center Dr, La Jolla, San Diego, CA, USA
| | - Zhe Zhang
- Pfizer Inc, 10646 Science Center Dr, La Jolla, San Diego, CA, USA
| | | | - Dennis J Slamon
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, 2825 Santa Monica Blvd, Suite 200, Santa Monica, CA, USA
| | - Nicholas C Turner
- Royal Marsden Hospital and Institute of Cancer Research, Fulham Rd, London, SW3 6JJ, UK
| | - Hope S Rugo
- University of California San Francisco Comprehensive Center, 1600 Divisadero St, San Francisco, CA, USA
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11
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Pruessmann J, Pursche T, Hammersen F, Katalinic A, Fischer D, Waldmann A. Conditional Disease-Free and Overall Survival of 1,858 Young Women with Non-Metastatic Breast Cancer and with Participation in a Post-Therapeutic Rehab Programme according to Clinical Subtypes. Breast Care (Basel) 2020; 16:163-172. [PMID: 34012371 DOI: 10.1159/000507315] [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: 09/01/2019] [Accepted: 03/18/2020] [Indexed: 11/19/2022] Open
Abstract
Background Breast cancer in young women is associated with unfavourable tumour biology and is the main cause of death in this group. Conditional survival analysis estimates survival rates under the pre-condition of already having survived a certain time. Objectives To describe conditional disease-free and overall survival of female breast cancer patients according to clinical subtypes and age. Methods This study analyses information from 1,858 breast cancer patients aged between 21 and 54 years, who were taking part in a post-therapeutic rehab programme (time between diagnosis and rehab start: maximum 24, median 11 months). Mean follow-up time was 3.6 years. We describe biological, clinical and pathological features in regard to different age groups (<40 and ≥40 years) and report conditional 5-year survival rates for overall and disease-free survival, and Cox proportional hazard models. Results Very young and young patients differed in regard to hormone receptor negativity, tumour grade, lymphovascular invasion, and molecular subtypes. Young women bore triple-negative and HER2-like disease more frequently. Conditional 5-year overall survival did not differ substantially between women <40 and 40-54 years of age (95 vs. 96%). It was highest for women with cancer of the luminal A subtype (98%) and lowest for the triple-negative subtype (91%). Lymphangiosis was a significant predictor of death. Results for disease-free survival were comparable. Conclusions Conditional 5-year overall survival after non-metastatic breast cancer was as high as 95.5%, and disease-free survival was 85.2%. When controlling for time between diagnosis and rehab start, molecular subtypes influenced overall and disease-free survival prospects. When additionally controlling for clinical characteristics, this effect only remained stable for disease-free survival.
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Affiliation(s)
- Jonathan Pruessmann
- Institute for Social Medicine and Epidemiology, Lübeck University, Lübeck, Germany
| | - Telja Pursche
- Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Lübeck, Germany.,Department of Gynaecology and Obstetrics, Hospital Düren gem. GmbH, Düren, Germany
| | - Friederike Hammersen
- Institute for Social Medicine and Epidemiology, Lübeck University, Lübeck, Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, Lübeck University, Lübeck, Germany.,Cancer Registry Schleswig-Holstein, Lübeck, Germany
| | - Dorothea Fischer
- Department of Gynaecology and Obstetrics, Hospital Ernst von Bergmann, Potsdam, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, Lübeck University, Lübeck, Germany.,Hamburg Cancer Registry, Hamburg, Germany
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12
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Hammersen F, Pursche T, Fischer D, Katalinic A, Waldmann A. Use of Complementary and Alternative Medicine among Young Patients with Breast Cancer. Breast Care (Basel) 2020; 15:163-170. [PMID: 32398985 PMCID: PMC7204767 DOI: 10.1159/000501193] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) has received increasing attention in Western countries and is especially common among breast cancer (BC) patients. So far, its effectiveness has not been well studied, which is in part due to the contextuality of CAM along with a lack of information of why patients use it. OBJECTIVES Young BC patients constitute a special patient group regarding clinical characteristics, QOL, and their role in society. Since little is known about their CAM use, this study aimed at exploring it as well as their reasons for CAM use. METHODS Data on CAM and sociodemographics were collected via questionnaire in the context of a rehabilitation program for young mothers with BC. Initial BC diagnoses were between 2009 and 2014 (recruitment period 2012-2015). Clinical characteristics were derived from the patient files. Descriptive statistics were used to describe frequencies and statistically significant differences were tested. RESULTS Among the 827 patients, with an average age of 39.6 years, 62.5% had used CAM with regard to their cancer. CAM use was significantly higher in women with higher educational level, higher employment status, and statutory health insurance, respectively. The average monthly expenses on CAM were EUR 50. Every 5th woman used CAM without her physician's knowledge. The types most often used were dietary supplements with vitamins or minerals. The most frequent reasons for CAM use were to strengthen the immune system, support conventional medicine, and combat side effects. CONCLUSIONS CAM plays an important role for young BC patients with regard to prevalence and monthly expenses, and was used for a wide range of reasons. Certain subgroups with more frequent CAM use could be identified. Physicians should therefore proactively talk about CAM with their young BC patients, so that patients do not need to rely on information sources on CAM outside the medical system.
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Affiliation(s)
- Friederike Hammersen
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Telja Pursche
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Department of Gynecology and Obstetrics, Hospital Düren gem. GmbH, Düren, Germany
| | - Dorothea Fischer
- Department of Obstetrics and Gynecology, Hospital Ernst von Bergmann, Potsdam, Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Institute for Cancer Epidemiology e.V., University of Lübeck, Lübeck, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Hamburg Cancer Registry, Hamburg, Germany
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13
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Slembrouck L, Darrigues L, Laurent C, Mittempergher L, Delahaye LJ, Vanden Bempt I, Vander Borght S, Vliegen L, Sintubin P, Raynal V, Bohec M, Reyes C, Rapinat A, Helsmoortel C, Jongen L, Hoste G, Neven P, Wildiers H, Smeets A, Nevelsteen I, Punie K, Van Nieuwenhuysen E, Han S, Vincent Salomon A, Laas Faron E, Cynober T, Gentien D, Baulande S, Snel MH, Witteveen AT, Neijenhuis S, Glas AM, Reyal F, Floris G. Decentralization of Next-Generation RNA Sequencing-Based MammaPrint® and BluePrint® Kit at University Hospitals Leuven and Curie Institute Paris. Transl Oncol 2019; 12:1557-1565. [PMID: 31513983 PMCID: PMC6742807 DOI: 10.1016/j.tranon.2019.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022] Open
Abstract
A previously developed and centrally validated MammaPrint® (MP) and BluePrint® (BP) targeted RNA next-generation sequencing (NGS) kit was implemented and validated in two large academic European hospitals. Additionally, breast cancer molecular subtypes by MP and BP RNA sequencing were compared with immunohistochemistry (IHC). Patients with early breast cancer diagnosed at University Hospitals Leuven and Curie Institute Paris were prospectively included between September 2017 and January 2018. Formalin-fixed paraffin-embedded tissue sections were analyzed with MP and BP NGS technology at the beta sites and with both NGS and microarray technology at Agendia. Raw NGS data generated on Illumina MiSeq instruments at the beta sites were interpreted and compared with NGS and microarray data at Agendia. MP and BP NGS molecular subtypes were compared to surrogate IHC breast cancer subtypes. Equivalence of MP and BP indices was determined by Pearson's correlation coefficient. Acceptable limits were defined a priori, based on microarray data generated at Agendia between 2012 and 2016. The concordance, the Negative Percent Agreement and the Positive Percent Agreement were calculated based on the contingency tables and had to be equal to or higher than 90%. Out of 124 included samples, 48% were MP Low and 52% High Risk with microarray. Molecular subtypes were BP luminal, HER2 or basal in 82%, 8% and 10% respectively. Concordance between MP microarray at Agendia and MP NGS at the beta sites was 91.1%. Concordance of MP High and Low Risk classification between NGS at the beta sites and NGS at Agendia was 93.9%. Concordance of MP and BP molecular subtyping using NGS at the beta sites and microarray at Agendia was 89.5%. Concordance between MP and BP NGS subtyping, and IHC was 71.8% and 76.6%, for two IHC surrogate models. The MP/BP NGS kit was successfully validated in a decentralized setting.
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Affiliation(s)
- Laurence Slembrouck
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium.
| | - Lauren Darrigues
- Curie Institute, Department of Surgery, Paris Descartes University, F-75248, France
| | - Cecile Laurent
- Curie Institute, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Paris Descartes University, INSERM, U932 Immunity and Cancer, Paris, F-75248, France
| | - Lorenza Mittempergher
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Leonie Jmj Delahaye
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Isabelle Vanden Bempt
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Human Genetics, B-3000 Leuven, Belgium
| | - Sara Vander Borght
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Human Genetics, B-3000 Leuven, Belgium; KU Leuven - University Hospitals Leuven, Department of Pathology, B-3000 Leuven, Belgium
| | - Liesbet Vliegen
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Human Genetics, B-3000 Leuven, Belgium
| | - Petra Sintubin
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Human Genetics, B-3000 Leuven, Belgium
| | - Virginie Raynal
- Curie Institute, PSL Research University, Genomics of Excellence (ICGex) Platform, Paris, F-75248, France
| | - Mylene Bohec
- Curie Institute, PSL Research University, Genomics of Excellence (ICGex) Platform, Paris, F-75248, France
| | - Cécile Reyes
- Curie Institute, PSL Research University, Translational Research Department, Genomics Platform, Paris, F-75248, France
| | - Audrey Rapinat
- Curie Institute, PSL Research University, Translational Research Department, Genomics Platform, Paris, F-75248, France
| | - Céline Helsmoortel
- KU Leuven - University of Leuven, University Hospitals Leuven, Genomics Core, B-3000 Leuven, Belgium
| | - Lynn Jongen
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium
| | - Griet Hoste
- KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, B-3000 Leuven, Belgium
| | - Patrick Neven
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, B-3000 Leuven, Belgium
| | - Hans Wildiers
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, B-3000 Leuven, Belgium
| | - Ann Smeets
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Surgical Oncology, B-3000 Leuven, Belgium
| | - Ines Nevelsteen
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Surgical Oncology, B-3000 Leuven, Belgium
| | - Kevin Punie
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of General Medical Oncology, B-3000 Leuven, Belgium
| | - Els Van Nieuwenhuysen
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, B-3000 Leuven, Belgium
| | - Sileny Han
- KU Leuven - University of Leuven, Department of Oncology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, University Hospitals Leuven, Department of Gynaecology and Obstetrics, B-3000 Leuven, Belgium
| | | | - Enora Laas Faron
- Curie Institute, Department of Surgery, Paris Descartes University, F-75248, France
| | - Timothé Cynober
- Curie Institute, Administration and General Services, Paris, F-75248, France
| | - David Gentien
- Curie Institute, PSL Research University, Translational Research Department, Genomics Platform, Paris, F-75248, France
| | - Sylvain Baulande
- Curie Institute, PSL Research University, Genomics of Excellence (ICGex) Platform, Paris, F-75248, France
| | - Mireille Hj Snel
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Anke T Witteveen
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Sari Neijenhuis
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Annuska M Glas
- Agendia, Department of Research and Development, Medical Affairs, Amsterdam, The Netherlands
| | - Fabien Reyal
- Curie Institute, Department of Surgery, Paris Descartes University, F-75248, France; Curie Institute, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Paris Descartes University, INSERM, U932 Immunity and Cancer, Paris, F-75248, France
| | - Giuseppe Floris
- KU Leuven - University Hospitals Leuven, Department of Pathology, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research
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14
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Tumor characteristics and outcome by androgen receptor expression in triple-negative breast cancer patients treated with neo-adjuvant chemotherapy. Breast Cancer Res Treat 2019; 176:699-708. [DOI: 10.1007/s10549-019-05252-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 01/29/2023]
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15
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Talei A, Tahmasebi S, Akrami M, Zangouri V, Rezaianzadeh A, Arasteh P, Eghbali T, Hosseini S. The Shiraz Breast Cancer Registry (SBCR): study design and primary reports. Per Med 2018; 15:471-479. [PMID: 30375263 DOI: 10.2217/pme-2018-0047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM This is a description of the largest breast cancer (BC) registry in Iran, termed the Shiraz Breast Cancer Registry (SBCR). METHODS Data on baseline and clinical characteristics, socioeconomic status, imaging, physical examination, histopathology, treatment and prognosis have been recorded for each individual. RESULTS Overall, 5937 were included in the report. Mean age of first presentation was 49.05 ± 11.69 years. Mean tumor size was 2.78 ± 1.76 cm. Most patients had stage 2 (46.9%) and 3 (25.5%) BCs, respectively. Most common type of BC was invasive ductal carcinoma (83.3%), followed by medullary carcinoma (3.8%). Overall, 12.9% were triple negative (HER2-, ER- and PR-). CONCLUSION The study provides an overview on the status of BC's in Iran and a wide opportunity for future studies.
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Affiliation(s)
- Abdolrasoul Talei
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Tahmasebi
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Surgical Oncology Division, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tannaz Eghbali
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Hosseini
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Van Asten K, Slembrouck L, Olbrecht S, Jongen L, Brouckaert O, Wildiers H, Floris G, Van Limbergen E, Weltens C, Smeets A, Paridaens R, Giobbie-Hurder A, Regan MM, Viale G, Thürlimann B, Vergote I, Christodoulou E, Van Calster B, Neven P. Prognostic Value of the Progesterone Receptor by Subtype in Patients with Estrogen Receptor-Positive, HER-2 Negative Breast Cancer. Oncologist 2018; 24:165-171. [PMID: 30171067 DOI: 10.1634/theoncologist.2018-0176] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In estrogen receptor-positive (ER+), human epidermal growth factor receptor 2 (HER-2) negative breast cancers, the progesterone receptor (PR) is an independent prognostic marker. Little is known about the prognostic value of PR by tumor grade. We assessed this in two independent datasets. PATIENTS AND METHODS Women with primary operable, invasive ER+ HER-2 negative breast cancer diagnosed between 2000 and 2012, treated at University Hospitals Leuven, were included. We assessed the association of PR status and subtype (grade 1-2 vs. grade 3) with distant recurrence-free interval (DRFI) and breast cancer-specific survival. The interaction between PR status and subtype was investigated, and associations of PR status by subtype were calculated. The BIG 1-98 data set was used for validation. RESULTS In total, 4,228 patients from Leuven and 5,419 from BIG 1-98 were analyzed. In the Leuven cohort, the adjusted hazard ratio (HR) of PR-positive versus PR-negative tumors for DRFI was 0.66 (95% confidence interval [CI], 0.50-0.89). For the interaction with subtype (p = .34), the HR of PR status was 0.79 (95% CI, 0.61-1.01) in luminal A-like and 0.59 (95% CI, 0.46-0.76) in luminal B-like tumors. In luminal A-like tumors, observed 5-year cumulative incidences of distant recurrence were 4.1% for PR-negative and 2.8% for PR-positive tumors, and in luminal B-like 18.7% and 9.2%, respectively. In the BIG 1-98 cohort, similar results were observed; for the interaction with subtype (p = .12), the adjusted HR of PR status for DRFI was 0.88 (95% CI, 0.57-1.35) in luminal A-like and 0.58 (95% CI, 0.43-0.77) in luminal B-like tumors. Observed 5-year cumulative incidences were similar. CONCLUSION PR positivity may be more protective against metastatic relapse in luminal B-like versus luminal A-like breast cancer, but no strong conclusions can be made. In absolute risk, results suggest an absent PR is clinically more important in high compared with low proliferative ER+ HER-2 negative tumors. IMPLICATIONS FOR PRACTICE An absent progesterone receptor (PR) predicts a worse outcome in women treated for an estrogen receptor-positive, human epidermal growth factor receptor 2 negative breast cancer. As low proliferative tumors lacking PR are now also classified high risk, the prognostic value of PR across risk groups was studied. Despite a negative test for interaction of the prognostic value of PR by tumor grade, the magnitude of an absent PR on breast cancer relapse is much larger in high than in low proliferative breast cancers.
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Affiliation(s)
- Kathleen Van Asten
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | | | - Siel Olbrecht
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Lynn Jongen
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Olivier Brouckaert
- Department of Gynecology and Obstetrics, Senology, Jan Yperman Hospital, Ypres, Belgium
| | - Hans Wildiers
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Giuseppe Floris
- Laboratory of Translational Cell & Tissue Research, Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Erik Van Limbergen
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Radiotherapy Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Caroline Weltens
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Radiotherapy Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Robert Paridaens
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anita Giobbie-Hurder
- Department of Biostatistics and Computational Biology, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meredith M Regan
- Department of Biostatistics and Computational Biology, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Giuseppe Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy
| | - Beat Thürlimann
- Breast Center St. Gallen, Cantonal Hospital, St. Gallen, Switzerland
- International Breast Cancer Study Group, Bern, Switzerland
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Ignace Vergote
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Evangelia Christodoulou
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
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17
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Low levels of intra-tumoural T cells in breast cancer identify clinically frail patients with shorter disease-specific survival. J Geriatr Oncol 2018; 9:606-612. [PMID: 29685380 DOI: 10.1016/j.jgo.2018.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/18/2017] [Accepted: 03/31/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The global health status of older patients with cancer influences their clinical course, but little is known regarding the influence of the immune system on the global health of older patients with cancer. The goal of this study was to assess the relationships between patient fitness/frailty status and survival, and the local tumour immune environment of older patients with breast cancer. MATERIALS AND METHODS In a cohort of 58 older patients with breast cancer (over 70 years of age), fluorescence microscopy was used to investigate whether levels of intra-tumoural T cells (CD3+) and granulocytic cells (CD15+) could predict clinical outcome, and/or whether they correlated with patient physical and mental performance as evaluated by comprehensive geriatric assessment. RESULTS We observed that patients with higher levels of intra-tumoural T cells were fitter according to a number of clinical health measures including G8 (p = 0.006), Karnofsky Index (p = 0.0372), and Leuven Oncology Frailty Score (LOFS) (p = 0.0187). In contrast, high relative levels of granulocytic cells were found in patients with poorer clinical health (LOFS, p = 0.0474). Furthermore, high levels of T cells but not granulocytic cells were associated with longer breast cancer-specific survival (p = 0.0444). CONCLUSIONS This is the first study to show that low relative levels of intra-tumoural T cells are associated with inferior patient fitness. In contrast to T cells, we observed that intra-tumoural granulocytic cells displayed an inverse relationship with patient performance. Further research is needed to determine whether boosting the level of intra-tumoural T cells in older non-fit patients can result in improved outcome.
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18
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Ye L, Guo L, He Z, Wang X, Lin C, Zhang X, Wu S, Bao Y, Yang Q, Song L, Lin H. Upregulation of E2F8 promotes cell proliferation and tumorigenicity in breast cancer by modulating G1/S phase transition. Oncotarget 2018; 7:23757-71. [PMID: 26992224 PMCID: PMC5029661 DOI: 10.18632/oncotarget.8121] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/25/2016] [Indexed: 01/04/2023] Open
Abstract
E2F transcription factors are involved in cell cycle regulation and synthesis of DNA in mammalian cells, and simultaneously play important roles in the development and progression of cancer when dysregulated. E2F8, a novel identified E2F family member, was found to be associated with the progression of several human cancers; however, the biological role and clinical significance of E2F8 in breast cancer remain to be further elucidated. Herein, we report that E2F8 is robustly elevated in breast cancer cell lines and clinical breast cancer tissue samples, respectively. The high expression level of E2F8 significantly correlates with clinical progression (P = 0.001), poor patient survival (P < 0.001) and a high Ki67 staining index (P = 0.008) in 187 human breast cancer specimens. Furthermore, we find that overexpressing E2F8 promotes, whereas silencing E2F8 suppresses, the proliferation and tumorigenicity of breast cancer cells both in vitro and in vivo. We further demonstrate that E2F8 transcriptionally upregulates CCNE1 and CCNE2 via directly interacting with their respective gene promoter, which accelerates the transition of G1 to S phase of breast cancer cells. Taken together, these findings uncover a novel biologic role and regulatory mechanism of E2F8 responsible for the progression of breast cancer, indicating E2F8 may represent a novel prognostic biomarker and therapeutic target against breast cancer.
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Affiliation(s)
- Liping Ye
- Department of Experimental Research, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Ling Guo
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Zhenyu He
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Xi Wang
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Chuyong Lin
- Department of Experimental Research, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Xin Zhang
- Department of Experimental Research, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Shu Wu
- Department of Experimental Research, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Yong Bao
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Qi Yang
- Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Libing Song
- Department of Experimental Research, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Huanxin Lin
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
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19
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Brouckaert O, Van Asten K, Laenen A, Soubry A, Smeets A, Nevelstreen I, Vergote I, Wildiers H, Paridaens R, Van Limbergen E, Weltens C, Moerman P, Floris G, Neven P. Body mass index, age at breast cancer diagnosis, and breast cancer subtype: a cross-sectional study. Breast Cancer Res Treat 2017; 168:189-196. [PMID: 29159760 DOI: 10.1007/s10549-017-4579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Evidence suggests that premenopausal obesity decreases and postmenopausal obesity increases breast cancer risk. Because it is not well known whether this is subtype dependent, we studied the association between body mass index (BMI) and age at breast cancer diagnosis, or the probability of being diagnosed with a specific breast cancer phenotype, by menopausal status. METHODS All patients with non-metastatic operable breast cancer from the University Hospital Leuven diagnosed between January 1, 2000 and December 31, 2013 were included (n = 7020) in this cross-sectional study. Linear models and logistic regression were used for statistical analysis. Allowing correction for age-related BMI-increase, we used the age-adjusted BMI score which equals the difference between a patient's BMI score and the population-average BMI score corresponding to the patient's age category. RESULTS The quadratic relationship between the age-adjusted BMI and age at breast cancer diagnosis (p = 0.0207) interacted with menopausal status (p < 0.0001); increased age at breast cancer diagnosis was observed with above-average BMI scores in postmenopausal women, and with below-average BMI scores in premenopausal women. BMI was linearly related to the probabilities of Luminal B and HER2-like breast cancer phenotypes, but only in postmenopausal women. The relative changes in probabilities between both these subtypes mirrored each other. CONCLUSION BMI associates differently before and after menopause with age at breast cancer diagnosis and with the probability that breast cancer belongs to a certain phenotype. The opposite effect of increasing BMI on relative frequencies of Luminal B and HER2-like breast cancers suggests a common origin.
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Affiliation(s)
- O Brouckaert
- Department of Obstetrics and Gynaecology, Jan Yperman Hospital, briekestraat 12, 8900, Ypres, Belgium.
| | - K Van Asten
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - A Laenen
- Department of Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Kasteel park Arenberg 10, 3001 LEUVEN, Louvain, Belgium
| | - A Soubry
- Epidemiology Research Group, Department of Public Health and Primary Care, Faculty of Medicine, Katholieke Universiteit Leuven, Kapucyijnenvoer 35 blok d, box 7001, 3000, Louvain, Belgium
| | - A Smeets
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - I Nevelstreen
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - I Vergote
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - H Wildiers
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - R Paridaens
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - E Van Limbergen
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - C Weltens
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - P Moerman
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - G Floris
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - P Neven
- Multidisciplinary Breast Centre Leuven, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium
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20
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Re-excision rates after breast conserving surgery following the 2014 SSO-ASTRO guidelines. Am J Surg 2017; 214:1104-1109. [PMID: 28974314 DOI: 10.1016/j.amjsurg.2017.08.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/11/2017] [Accepted: 08/27/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND In 2014, SSO-ASTRO published guidelines which recommended "no ink on tumor" as adequate margins for patients undergoing breast conservation for invasive breast cancer. In 2016, new SSO-ASTRO-ASCO guidelines recommended 2 mm margins for DCIS. We evaluated whether these guidelines affected re-excision rates at our institution. METHODS Patients treated with breast conservation surgery from January 1, 2010-March 1, 2016 were identified. Re-excision rates, tumor characteristics, and presence of residual disease were recorded. The 2016 guidelines were retrospectively applied to the same cohort and expected re-excision rates calculated. RESULTS Re-excision rates did not significantly decline before and after 2014 guideline adoption (11.9% before, 10.9% after; p = 0.65) or when the 2016 guidelines were retrospectively applied (8.4%; p = 0.10). CONCLUSIONS The 2014 and 2016 guidelines had minimal impact on our re-excision rates, as most re-excisions were done for DCIS and 2016 guidelines supported our prior institutional practices of 2 mm margins for these patients.
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21
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Landercasper J, Bennie B, Parsons BM, Dietrich LL, Greenberg CC, Wilke LG, Linebarger JH. Fewer Reoperations After Lumpectomy for Breast Cancer with Neoadjuvant Rather than Adjuvant Chemotherapy: A Report from the National Cancer Database. Ann Surg Oncol 2017; 24:1507-1515. [PMID: 28062931 PMCID: PMC5413581 DOI: 10.1245/s10434-016-5760-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reoperations occur frequently after initial lumpectomy for breast cancer. The authors hypothesized that the receipt of neoadjuvant chemotherapy (NAC) is associated with fewer reoperations. METHODS The association between timing of chemotherapy and reoperation rates (ROR) after lumpectomy was investigated for patients with stages 1-3 breast cancer in the National Cancer Database (NCDB) from 2010 to 2013 by multivariable logistic regression modeling. Then propensity score-matching was performed. RESULTS The unadjusted ROR for 71,627 stages 1-3 patients was 11.4% for those who had NAC compared with 20.3% for those who had postoperative chemotherapy (p < 0.001) (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.49-0.57; p < 0.001). The ORs for the reoperations performed for patients with stages 1, 2, and 3 cancers who received NAC were respectively 0.65 (95% CI 0.56-0.75), 0.50 (95% CI 0.45-0.56), and 0.27 (95% CI 0.19-0.38) The p values for all were lower than 0.001. CONCLUSION For a population of patients receiving chemotherapy, the receipt of chemotherapy before instead of after surgery was associated with fewer reoperations after initial lumpectomy for breast cancer.
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Affiliation(s)
- Jeffrey Landercasper
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA. .,Norma J. Vinger Center for Breast Care, Gundersen Health System, La Crosse, WI, USA.
| | - Barbara Bennie
- Department of Mathematics and Statistics, University of Wisconsin La Crosse, La Crosse, WI, USA
| | - Benjamin M Parsons
- Department of Medical Oncology, Gundersen Health System, La Crosse, WI, USA
| | - Leah L Dietrich
- Department of Medical Oncology, Gundersen Health System, La Crosse, WI, USA
| | - Caprice C Greenberg
- Department of Surgery, University of Wisconsin Madison, 600 Highland Avenue, Madison, WI, USA
| | - Lee G Wilke
- Department of Surgery, University of Wisconsin Madison, 600 Highland Avenue, Madison, WI, USA
| | - Jared H Linebarger
- Norma J. Vinger Center for Breast Care, Gundersen Health System, La Crosse, WI, USA.,Department of Surgery, Gundersen Health System, La Crosse, WI, USA
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22
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Minemura H, Takagi K, Sato A, Takahashi H, Miki Y, Shibahara Y, Watanabe M, Ishida T, Sasano H, Suzuki T. CITED2 in breast carcinoma as a potent prognostic predictor associated with proliferation, migration and chemoresistance. Cancer Sci 2016; 107:1898-1908. [PMID: 27627783 PMCID: PMC5198946 DOI: 10.1111/cas.13081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/26/2016] [Accepted: 09/09/2016] [Indexed: 12/20/2022] Open
Abstract
CITED2 (Cbp/p300‐interacting transactivator, with Glu/Asp‐rich carboxy‐terminal domain, 2) is a member of the CITED family and is involved in various cellular functions during development and differentiation. Mounting evidence suggests the importance of CITED in the progression of human malignancies, but the significance of CITED2 protein has not yet been examined in breast carcinoma. Therefore, in the present study, we examined the clinical significance and the biological functions of CITED2 in breast carcinoma by immunohistochemistry and in vitro study. CITED2 immunoreactivity was detected in breast carcinoma tissues, and it was significantly higher compared to those in morphologically normal mammary glands. CITED2 immunoreactivity was significantly associated with stage, pathological T factor, lymph node metastasis, histological grade, HER2 and Ki‐67, and inversely correlated with estrogen receptor. Moreover, the immunohistochemical CITED2 status was significantly associated with increased incidence of recurrence and breast cancer‐specific death of the breast cancer patients, and multivariate analyses demonstrated CITED2 status as an independent worse prognostic factor for disease‐free and breast cancer‐specific survival. Subsequent in vitro experiments showed that CITED2 expression significantly increased proliferation activity and migration property in MCF‐7and S KBR‐3 breast carcinoma cells. Moreover, CITED2 caused chemoresistance to epirubicin and 5‐fluorouracil, but not paclitaxel, in these cells, and it inhibited p53 accumulation after 5‐fluorouracil treatment in MCF‐7 cells. These results suggest that CITED2 plays important roles in the progression and chemoresistance of breast carcinoma and that CITED2 status is a potent prognostic factor in breast cancer patients.
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Affiliation(s)
- Hiroyuki Minemura
- Department of Pathology and Histotechnology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyoshi Takagi
- Department of Pathology and Histotechnology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ai Sato
- Department of Pathology and Histotechnology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hikaru Takahashi
- Department of Pathology and Histotechnology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Miki
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukiko Shibahara
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, Sendai, Japan
| | - Takanori Ishida
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hironobu Sasano
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Pathology, Tohoku University Hospital, Sendai, Japan
| | - Takashi Suzuki
- Department of Pathology and Histotechnology, Tohoku University Graduate School of Medicine, Sendai, Japan
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23
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Hennigs A, Riedel F, Gondos A, Sinn P, Schirmacher P, Marmé F, Jäger D, Kauczor HU, Stieber A, Lindel K, Debus J, Golatta M, Schütz F, Sohn C, Heil J, Schneeweiss A. Prognosis of breast cancer molecular subtypes in routine clinical care: A large prospective cohort study. BMC Cancer 2016; 16:734. [PMID: 27634735 DOI: 10.1186/s12885-016-2766-313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 09/06/2016] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND In Germany, most breast cancer patients are treated in specialized breast cancer units (BCU), which are certified, and routinely monitored. Herein, we evaluate up-to-date oncological outcome of breast cancer (BC) molecular subtypes in routine clinical care of a specialized BCU. METHODS The study was a prospectively single-center cohort study of 4102 female cases with primary, unilateral, non-metastatic breast cancer treated between 01 January 2003 and 31 December 2012. The five routinely used molecular subtypes (Luminal A-like, Luminal B/HER2 negative-like, Luminal B/HER2 positive-like, HER2-type, Triple negative) were analyzed. The median follow-up time of the whole cohort was 55 months. We calculated estimates for local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS), and relative overall survival (ROS). RESULTS Luminal A-like tumors were the most frequent (44.7 %) and showed the best outcome with LCR of 99.1 % (95 % CI 98.5; 99.7), OS of 95.1 % (95 % CI 93.7; 96.5), and ROS of 100.0 % (95 % CI 98.5; 101.5). Triple negative tumors (12.3 %) presented the poorest outcome with LCR of 89.6 % (95 % CI 85.8; 93.4), OS of 78.5 % (95 % CI 73.8; 83.3), and ROS of 80.1 % (95 % CI 73.8; 83.2). CONCLUSIONS Patients with a favorable subtype can expect an OS above 95 % and an LCR of almost 100 % over 5 years. On the other hand the outcome of patients with HER2 and Triple negative subtypes remains poor, thus necessitating more intensified research and care.
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Affiliation(s)
- André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Adam Gondos
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Peter Sinn
- Department of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Peter Schirmacher
- Department of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Frederik Marmé
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Dirk Jäger
- National Center for Tumor Diseases (NCT), University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Radiology Department, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Anne Stieber
- Radiology Department, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Katja Lindel
- Radiology Department, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Radiology Department, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Florian Schütz
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Andreas Schneeweiss
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
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24
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Hennigs A, Riedel F, Gondos A, Sinn P, Schirmacher P, Marmé F, Jäger D, Kauczor HU, Stieber A, Lindel K, Debus J, Golatta M, Schütz F, Sohn C, Heil J, Schneeweiss A. Prognosis of breast cancer molecular subtypes in routine clinical care: A large prospective cohort study. BMC Cancer 2016; 16:734. [PMID: 27634735 PMCID: PMC5024419 DOI: 10.1186/s12885-016-2766-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 09/06/2016] [Indexed: 01/22/2023] Open
Abstract
Background In Germany, most breast cancer patients are treated in specialized breast cancer units (BCU), which are certified, and routinely monitored. Herein, we evaluate up-to-date oncological outcome of breast cancer (BC) molecular subtypes in routine clinical care of a specialized BCU. Methods The study was a prospectively single-center cohort study of 4102 female cases with primary, unilateral, non-metastatic breast cancer treated between 01 January 2003 and 31 December 2012. The five routinely used molecular subtypes (Luminal A-like, Luminal B/HER2 negative-like, Luminal B/HER2 positive-like, HER2-type, Triple negative) were analyzed. The median follow-up time of the whole cohort was 55 months. We calculated estimates for local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS), and relative overall survival (ROS). Results Luminal A-like tumors were the most frequent (44.7 %) and showed the best outcome with LCR of 99.1 % (95 % CI 98.5; 99.7), OS of 95.1 % (95 % CI 93.7; 96.5), and ROS of 100.0 % (95 % CI 98.5; 101.5). Triple negative tumors (12.3 %) presented the poorest outcome with LCR of 89.6 % (95 % CI 85.8; 93.4), OS of 78.5 % (95 % CI 73.8; 83.3), and ROS of 80.1 % (95 % CI 73.8; 83.2). Conclusions Patients with a favorable subtype can expect an OS above 95 % and an LCR of almost 100 % over 5 years. On the other hand the outcome of patients with HER2 and Triple negative subtypes remains poor, thus necessitating more intensified research and care. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2766-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Adam Gondos
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Peter Sinn
- Department of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Peter Schirmacher
- Department of Pathology, University of Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Frederik Marmé
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Dirk Jäger
- National Center for Tumor Diseases (NCT), University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Radiology Department, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Anne Stieber
- Radiology Department, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Katja Lindel
- Radiology Department, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Radiology Department, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Florian Schütz
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Andreas Schneeweiss
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
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25
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Rudolph M, Anzeneder T, Schulz A, Beckmann G, Byrne AT, Jeffers M, Pena C, Politz O, Köchert K, Vonk R, Reischl J. AKT1 (E17K) mutation profiling in breast cancer: prevalence, concurrent oncogenic alterations, and blood-based detection. BMC Cancer 2016; 16:622. [PMID: 27515171 PMCID: PMC4982009 DOI: 10.1186/s12885-016-2626-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 07/26/2016] [Indexed: 12/30/2022] Open
Abstract
Background The single hotspot mutation AKT1 [G49A:E17K] has been described in several cancers, with the highest incidence observed in breast cancer. However, its precise role in disease etiology remains unknown. Methods We analyzed more than 600 breast cancer tumor samples and circulating tumor DNA for AKT1E17K and alterations in other cancer-associated genes using Beads, Emulsions, Amplification, and Magnetics digital polymerase chain reaction technology and targeted exome sequencing. Results Overall AKT1E17K mutation prevalence was 6.3 % and not correlated with age or menopausal stage. AKT1E17K mutation frequency tended to be lower in patients with grade 3 disease (1.9 %) compared with those with grade 1 (11.1 %) or grade 2 (6 %) disease. In two cohorts of patients with advanced metastatic disease, 98.0 % (n = 50) and 97.1 % (n = 35) concordance was obtained between tissue and blood samples for the AKT1E17K mutation, and mutation capture rates of 66.7 % (2/3) and 85.7 % (6/7) in blood versus tissue samples were observed. Although AKT1-mutant tumor specimens were often found to harbor concurrent alterations in other driver genes, a subset of specimens harboring AKT1E17K as the only known driver alteration was also identified. Initial follow-up survival data suggest that AKT1E17K could be associated with increased mortality. These findings warrant additional long-term follow-up. Conclusions The data suggest that AKT1E17K is the most likely disease driver in certain breast cancer patients. Blood-based mutation detection is achievable in advanced-stage disease. These findings underpin the need for a further enhanced-precision medicine paradigm in the treatment of breast cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2626-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marion Rudolph
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany.
| | | | - Anke Schulz
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Georg Beckmann
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Annette T Byrne
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,At the time of manuscript preparation, the author was on a Science Foundation Ireland-funded industry secondment, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | | | - Carol Pena
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Oliver Politz
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Karl Köchert
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Richardus Vonk
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Joachim Reischl
- Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany.,AstraZeneca R&D, Personalized Healthcare and Biomarkers, Gothenburg, Sweden
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26
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Kurebayashi J, Miyoshi Y, Ishikawa T, Saji S, Sugie T, Suzuki T, Takahashi S, Nozaki M, Yamashita H, Tokuda Y, Nakamura S. Clinicopathological characteristics of breast cancer and trends in the management of breast cancer patients in Japan: Based on the Breast Cancer Registry of the Japanese Breast Cancer Society between 2004 and 2011. Breast Cancer 2015; 22:235-44. [PMID: 25758809 DOI: 10.1007/s12282-015-0599-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/25/2015] [Indexed: 01/15/2023]
Abstract
PURPOSES We conducted a study to analyze the clinicopathological characteristics of breast cancer in Japan registered to the Japanese Breast Cancer Registry of the Japanese Breast Cancer Society (JBCS). Trends in the management of breast cancer patients in Japan were also analyzed. PATIENTS AND METHODS More than 250,000 breast cancer patients were registered to the JBCS registry between 2004 and 2011. Demographic and clinicopathological factors in newly diagnosed primary breast cancer patients were registered to the JBCS through the Web-based system from affiliated institutes nationwide. RESULTS Two distinct peaks were observed, in patients in their late 40s and early 60s, in the population-adjusted age distribution of breast cancer patients. An increased rate of screen-detected breast cancer may contribute to an earlier detection of breast cancer and increased rate of non-invasive ductal carcinoma. The positive rate of either ER or PgR appears to have increased in recent years. The annual rates of patients treated with breast-conserving surgery increased until 2006, but these increases stopped in 2007 and thereafter plateaued at approximately 60 %. The annual rates of patients treated with sentinel lymph node dissection alone have steadily increased. The annual rates of patients treated with preoperative trastuzumab plus chemotherapy have also increased, as well as those treated with postoperative aromatase inhibitors. The annual rates of patients treated with postoperative anthracycline-containing regimens have decreased, whereas those treated with postoperative taxane-containing regimens have increased. The postoperative use of trastuzumab has markedly increased since 2007. CONCLUSION Although this study was based on the registry database, several unique clinicopathological characteristics of breast cancer in Japan have been unveiled. Our results suggest that recent trends in the management of breast cancer patients in Japan were strongly followed by clinical evidence that originated from a number of clinical trials worldwide.
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Affiliation(s)
- Junichi Kurebayashi
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan,
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27
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Campone M, Yang H, Faust E, Kageleiry A, Signorovitch JE, Zhang J, Gao H. Cost of adverse events during treatment with everolimus plus exemestane or single-agent chemotherapy in patients with advanced breast cancer in Western Europe. J Med Econ 2014; 17:837-45. [PMID: 25164472 DOI: 10.3111/13696998.2014.959589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Treatment options for recurrent or progressive hormone receptor-positive (HR+) advanced breast cancer include chemotherapy and everolimus plus exemestane (EVE + EXE). This study estimates the costs of managing adverse events (AEs) during EVE + EXE therapy and single-agent chemotherapy in Western Europe. METHODS An economic model was developed to estimate the per patient cost of managing grade 3/4 AEs for patients who were treated with EVE + EXE or chemotherapies. AE rates for patients receiving EVE + EXE were collected from the phase III BOLERO-2 trial. AE rates for single-agent chemotherapy, capecitabine, docetaxel, or doxorubicin were collected from published clinical trial data. AEs with at least 2% prevalence for any of the treatments were included in the model. A literature search was conducted to obtain costs of managing each AE, which were then averaged across Western European countries (when available). Per patient costs for managing AEs among patients receiving different therapies were reported in 2012 euros (€). RESULTS The EVE + EXE combination had the lowest average per patient cost of managing AEs (€730) compared to all chemotherapies during the first year of treatment (doxorubicin: €1230; capecitabine: €1721; docetaxel: €2390). The most costly adverse event among all patients treated with EVE + EXE was anemia (on average €152 per patient). The most costly adverse event among all patients treated with capecitabine, docetaxel, or doxorubicin was lymphocytopenia (€861 per patient), neutropenia (€821 per patient), and leukopenia (€382 per patient), respectively. CONCLUSIONS The current model estimates that AE management during the treatment of HR+ advanced breast cancer will cost one-half to one-third less for EVE + EXE patients than for chemotherapy patients. The consideration of AE costs could have important implications in the context of healthcare spending for advanced breast cancer treatment.
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Affiliation(s)
- Mario Campone
- Centre René Gauducheau, Service Oncologie Médicale , Nantes Saint-Herblain , France
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Jia WJ, Jia HX, Feng HY, Yang YP, Chen K, Su FX. HER2-enriched tumors have the highest risk of local recurrence in Chinese patients treated with breast conservation therapy. Asian Pac J Cancer Prev 2014; 15:315-20. [PMID: 24528048 DOI: 10.7314/apjcp.2014.15.1.315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the recurrence pattern and characteristics of patients based on the 2013 St. Gallen surrogate molecular subtypes after breast-conserving surgery (BCS) in Chinese women. METHODS This retrospective analysis included 709 consecutive breast cancer patients undergoing BCS from 1999-2010 at our institution. Five different surrogate subtypes were created using combined expression of the estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2. Locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) rates were calculated. RESULTS The 5-year LRRFS, DMFS, and DFS rates were 90.5%, 88.2%, and 81.5%, respectively. Multivariate analysis revealed that young age, node-positive disease, and HER2 enrichment were independent prognostic factors in LRRFS patients. There was also an independent prognostic role of lymph node-positive disease in DMFS and DFS patients. Patients with luminal A tumors had the most favorable prognosis, with LRRFS, DMFS, and DFS rates of 93.2%, 91.5%, and 87.5% at 5 years, respectively. Conversely, HER-2-enriched tumors exhibited the highest rate of recurrence (27.5%) and locoregional recurrence (11.4%). CONCLUSION Surrogate subtypes present with significant differences in RFS, DMFS, and LRRFS. Luminal A tumors have the best prognosis, whereas HER2-enriched tumors have the poorest.
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Affiliation(s)
- Wei-Juan Jia
- Department of breast cancer, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, China E-mail :
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Vulsteke C, Pfeil AM, Schwenkglenks M, Pettengell R, Szucs TD, Lambrechts D, Peeters M, van Dam P, Dieudonné AS, Hatse S, Neven P, Paridaens R, Wildiers H. Impact of genetic variability and treatment-related factors on outcome in early breast cancer patients receiving (neo-) adjuvant chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide, and docetaxel. Breast Cancer Res Treat 2014; 147:557-70. [PMID: 25168315 DOI: 10.1007/s10549-014-3105-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/16/2014] [Indexed: 01/26/2023]
Abstract
To assess the impact of patient-related factors, including genetic variability in genes involved in the metabolism of chemotherapeutic agents, on breast cancer-specific survival (BCSS) and recurrence-free interval (RFI). We selected early breast cancer patients treated between 2000 and 2010 with 4-6 cycles of (neo-)adjuvant 5-fluorouracil, epirubicin, and cyclophosphamide (FEC) or 3 cycles FEC followed by 3 cycles docetaxel. Tumor stage/subtype; febrile neutropenia and patient-related factors such as selected single nucleotide polymorphisms and baseline laboratory parameters were evaluated. Multivariable Cox regression was performed. Of 991 patients with a mean follow-up of 5.2 years, 152 (15.3 %) patients relapsed and 63 (6.4 %) patients died. Advanced stage and more aggressive subtype were associated with poorer BCSS and RFI in multivariable analysis (p < 0.0001). Associations with worse BCSS in multivariable analysis were: homozygous carriers of the rs1057910 variant C-allele in CYP2C9 (hazard ratio [HR] 30.4; 95 % confidence interval [CI] 6.1-151.5; p < 0.001) and higher white blood cell count (WBC) (HR 1.2; 95 % CI 1.0-1.3; p = 0.014). The GT genotype of the ABCB1 variant rs2032582 was associated with better BCSS (HR 0.5; 95 % CI 0.3-0.9, p = 0.021). Following associations with worse RFI were observed: higher WBC (HR 1.1; 95 % CI 1.0-1.2; p = 0.026), homozygous carriers of the rs1057910 variant C-allele in CYP2C9 (HR 10.9; 95 % CI 2.5-47.9; p = 0.002), CT genotype of the CYBA variant rs4673 (HR 1.8; 95 % CI 1.2-2.7; p = 0.006), and G-allele homozygosity for the UGT2B7 variant rs3924194 (HR 3.4; 95 % CI 1.2-9.7, p = 0.023). Patient-related factors including genetic variability and baseline white blood cell count, impacted on outcome in early breast cancer.
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Affiliation(s)
- C Vulsteke
- Integrated Cancer Center Ghent, AZ Maria Middelares, Ghent, Belgium,
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30
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Pfeil AM, Vulsteke C, Paridaens R, Dieudonné AS, Pettengell R, Hatse S, Neven P, Lambrechts D, Szucs TD, Schwenkglenks M, Wildiers H. Multivariable regression analysis of febrile neutropenia occurrence in early breast cancer patients receiving chemotherapy assessing patient-related, chemotherapy-related and genetic risk factors. BMC Cancer 2014; 14:201. [PMID: 24641830 PMCID: PMC3994907 DOI: 10.1186/1471-2407-14-201] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 03/11/2014] [Indexed: 12/29/2022] Open
Abstract
Background Febrile neutropenia (FN) is common in breast cancer patients undergoing chemotherapy. Risk factors for FN have been reported, but risk models that include genetic variability have yet to be described. This study aimed to evaluate the predictive value of patient-related, chemotherapy-related, and genetic risk factors. Methods Data from consecutive breast cancer patients receiving chemotherapy with 4–6 cycles of fluorouracil, epirubicin, and cyclophosphamide (FEC) or three cycles of FEC and docetaxel were retrospectively recorded. Multivariable logistic regression was carried out to assess risk of FN during FEC chemotherapy cycles. Results Overall, 166 (16.7%) out of 994 patients developed FN. Significant risk factors for FN in any cycle and the first cycle were lower platelet count (OR = 0.78 [0.65; 0.93]) and haemoglobin (OR = 0.81 [0.67; 0.98]) and homozygous carriers of the rs4148350 variant T-allele (OR = 6.7 [1.04; 43.17]) in MRP1. Other significant factors for FN in any cycle were higher alanine aminotransferase (OR = 1.02 [1.01; 1.03]), carriers of the rs246221 variant C-allele (OR = 2.0 [1.03; 3.86]) in MRP1 and the rs351855 variant C-allele (OR = 2.48 [1.13; 5.44]) in FGFR4. Lower height (OR = 0.62 [0.41; 0.92]) increased risk of FN in the first cycle. Conclusions Both established clinical risk factors and genetic factors predicted FN in breast cancer patients. Prediction was improved by adding genetic information but overall remained limited. Internal validity was satisfactory. Further independent validation is required to confirm these findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.
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Chen C, Yuan JP, Wei W, Tu Y, Yao F, Yang XQ, Sun JZ, Sun SR, Li Y. Subtype classification for prediction of prognosis of breast cancer from a biomarker panel: correlations and indications. Int J Nanomedicine 2014; 9:1039-48. [PMID: 24591826 PMCID: PMC3937188 DOI: 10.2147/ijn.s58270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Hormone receptors, including the estrogen receptor and progesterone receptor, human epidermal growth factor receptor 2 (HER2), and other biomarkers like Ki67, epidermal growth factor receptor (EGFR, also known as HER1), the androgen receptor, and p53, are key molecules in breast cancer. This study evaluated the relationship between HER2 and hormone receptors and explored the additional prognostic value of Ki67, EGFR, the androgen receptor, and p53. Methods Quantitative determination of HER2 and EGFR was performed in 240 invasive breast cancer tissue microarray specimens using quantum dot (QD)-based nanotechnology. We identified two subtypes of HER2, ie, high total HER2 load (HTH2) and low total HER2 load (LTH2), and three subtypes of hormone receptor, ie, high hormone receptor (HHR), low hormone receptor (LHR), and no hormone receptor (NHR). Therefore, breast cancer patients could be divided into five subtypes according to HER2 and hormone receptor status. Ki67, p53, and the androgen receptor were determined by traditional immunohistochemistry techniques. The relationship between hormone receptors and HER2 was investigated and the additional value of Ki67, EGFR, the androgen receptor, and p53 for prediction of 5-year disease-free survival was assessed. Results In all patients, quantitative determination showed a statistically significant (P<0.001) negative correlation between HER2 and the hormone receptors and a significant positive correlation (P<0.001) between the estrogen receptor and the progesterone receptor (r=0.588), but a significant negative correlation (P<0.001, r=−0.618) with the HHR subtype. There were significant differences between the estrogen receptor, progesterone receptor, and HER2 subtypes with regard to total HER2 load and hormone receptor subtypes. The rates of androgen receptor and p53 positivity were 46.3% and 57.0%, respectively. Other than the androgen receptor, differences in expression of Ki67, EGFR, and p53 did not achieve statistical significance (P>0.05) between the five subtypes. EGFR and Ki67 had prognostic significance for 5-year disease-free survival in univariate analysis, but the androgen receptor and p53 did not. Multivariate analysis identified that EGFR expression had predictive significance for 5-year disease-free survival in hormone-receptor positive patients and in those with the lymph node-positive breast cancer subtype. Conclusion Hormone receptor expression was indeed one of the molecular profiles in the subtypes identified by quantitative HER2 and vice versa. EGFR status may provide discriminative prognostic information in addition to HER2 and hormone receptor status, and should be integrated into routine practice to help formulate more specific prediction of the prognosis and appropriate individualized treatment.
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Affiliation(s)
- Chuang Chen
- Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, People's Republic of China
| | - Jing-Ping Yuan
- Department of Oncology, Zhongnan Hospital of Wuhan University and Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, People's Republic of China ; Department of Pathology, The Central Hospital of Wuhan, Wuhan, People's Republic of China
| | - Wen Wei
- Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, People's Republic of China
| | - Yi Tu
- Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, People's Republic of China
| | - Feng Yao
- Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, People's Republic of China
| | - Xue-Qin Yang
- Medical School of Jingchu University of Technology, Jingmen, People's Republic of China
| | - Jin-Zhong Sun
- Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, People's Republic of China
| | - Sheng-Rong Sun
- Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, People's Republic of China
| | - Yan Li
- Department of Oncology, Zhongnan Hospital of Wuhan University and Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, People's Republic of China
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Brouckaert O, Laenen A, Smeets A, Christiaens MR, Vergote I, Wildiers H, Moerman P, Floris G, Neven P. Prognostic implications of lobular breast cancer histology: new insights from a single hospital cross-sectional study and SEER data. Breast 2014; 23:371-7. [PMID: 24530094 DOI: 10.1016/j.breast.2014.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 09/12/2013] [Accepted: 01/19/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Invasive lobular breast cancer (ILC) is generally believed to have an increased risk for late relapse compared to invasive ductal breast cancer (IDC). However, the study most often referred to is a chemotherapy trial that mainly included node positive patients. We hypothesize that nodal status may influence the hazard of relapse since time of diagnosis differently in invasive ductal carcinoma (IDC) and ILC. METHODS Primary operable breast cancer patients from our institution diagnosed between 2000 and 2009 were studied. Multivariable analysis and subgroup analyses were performed to assess whether ILC carries a different prognosis compared to IDC. SEER data were used for external validation. RESULTS In lymph node negative patients, ILC carries a better prognosis regarding distant metastasis free interval (DMFI) (HR 3.242 (1.380-7.614), p = 0.0069) with a trend towards improved breast cancer specific survival (BCSS), over the entire study frame (UZ Leuven data). In lymph node positive patients, both DMFI (HR 0.466 (0.309-0.703), p = 0.0003) and BCSS (HR 0.441 (0.247-0.788), p = 0.0057) are significantly worse for ILC, especially after longer follow-up (>4-5 years) (UZ Leuven data). Similar results were found in the SEER cohort. Results remained identical when excluding screen detected cases (data not shown). CONCLUSION The prognostic impact of lobular histology not only depends on time since diagnosis but also on nodal status. The general believe that ILC have compromised late-term outcome compared to IDC seems untrue for the majority ( = node negative) of ILCs.
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Affiliation(s)
- O Brouckaert
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven, Belgium.
| | - A Laenen
- Department of Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium.
| | - A Smeets
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven, Belgium.
| | - M R Christiaens
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven, Belgium.
| | - I Vergote
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven, Belgium.
| | - H Wildiers
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven, Belgium.
| | - P Moerman
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven, Belgium.
| | - G Floris
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven, Belgium.
| | - P Neven
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven, Belgium.
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Falck AK, Fernö M, Bendahl PO, Rydén L. St Gallen molecular subtypes in primary breast cancer and matched lymph node metastases--aspects on distribution and prognosis for patients with luminal A tumours: results from a prospective randomised trial. BMC Cancer 2013; 13:558. [PMID: 24274821 PMCID: PMC4222553 DOI: 10.1186/1471-2407-13-558] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/21/2013] [Indexed: 02/07/2023] Open
Abstract
Background The St Gallen surrogate molecular subtype definitions classify the oestrogen (ER) positive breast cancer into the luminal A and luminal B subtypes according to proliferation rate and/or expression of human epidermal growth factor receptor 2 (HER2) with differences in prognosis and chemo-responsiveness. Primary tumours and lymph node metastases might represent different malignant clones, but in the clinical setting only the biomarker profile of the primary tumour is used for selection of adjuvant systemic treatment. The present study aimed to classify primary breast tumours and matched lymph node metastases into luminal A, luminal B, HER2-positive and triple-negative subtypes and compare the distributions. Methods Eighty-five patients with available tumour tissue from both locations were classified. The distribution of molecular subtypes in primary tumours and corresponding lymph node metastases were compared, and related to 5-year distant disease-free survival (DDFS). Results The St Gallen molecular subtypes were discordant between primary tumours and matched lymph node metastases in 11% of the patients (p = 0.06). The luminal A subtype in the primary tumour shifted to a subtype with a worse prognostic profile in the lymph node metastases in 7 of 45 cases (16%) whereas no shift in the opposite direction was observed (0/38) (p = 0.02). All subtypes had an increased hazard for developing distant metastasis during the first 5 years after diagnosis in both primary breast tumours and matched lymph node metastases, compared with the luminal A subtype. Conclusion The classification according to the St Gallen molecular subtypes in primary tumours and matched lymph node metastases, implicates a shift to a more aggressive subtype in synchronous lymph node metastases compared to the primary breast tumour. The selection of systemic adjuvant therapy might benefit from taking the molecular subtypes in the metastatic node into account.
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Affiliation(s)
- Anna-Karin Falck
- Department of Surgery, Clinical Sciences, Lund University, Lund SE-22185, Sweden.
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Sato-Tadano A, Suzuki T, Amari M, Takagi K, Miki Y, Tamaki K, Watanabe M, Ishida T, Sasano H, Ohuchi N. Hexokinase II in breast carcinoma: a potent prognostic factor associated with hypoxia-inducible factor-1α and Ki-67. Cancer Sci 2013; 104:1380-8. [PMID: 23869589 DOI: 10.1111/cas.12238] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 01/20/2023] Open
Abstract
Hypoxia-inducible factor-1α (HIF-1α) mediates adaptive responses to changes under tissue hypoxia in carcinoma cells by controlling the expression of various target genes. Previous studies have demonstrated that HIF-1α is associated with adverse clinical outcome in breast carcinoma patients, but details of HIF-1α's role have remained largely unknown. Therefore, in this study, we examined the expression profiles of HIF-1α-induced genes in 10 breast carcinoma cases using microarray data. As a result, we demonstrated that the status of hexokinase II (HKII) was associated with carcinoma recurrence in patients with these genes. The enzyme HKII is involved in the first, and rate-limiting, step of glycolysis, but its clinical significance has not yet been examined in breast carcinoma. Therefore, we immunolocalized HKII in 118 breast carcinomas, and HKII immunoreactivity was detected in 44% of the cases. It is significantly associated with histological grade, Ki-67 labeling index and HIF-1α immunoreactivity. Also, HKII status is significantly associated with increased risk of recurrence and adverse clinical outcome in breast cancer patients. Subsequent multivariate analysis demonstrated that HKII status was an independent prognostic factor for disease-free survival of patients. These results all suggest that HKII is induced by HIF-1α and plays important roles in the proliferation and/or progression of breast carcinoma possibly through increased glycolytic activity. The status of HKII is therefore considered a potent prognostic factor in human breast cancer patients.
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Affiliation(s)
- Akiko Sato-Tadano
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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35
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Relative and disease-free survival for breast cancer in relation to subtype: a population-based study. J Cancer Res Clin Oncol 2013; 139:1569-77. [DOI: 10.1007/s00432-013-1478-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
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Lips EH, Mulder L, de Ronde
JJ, Mandjes IAM, Koolen BB, Wessels LFA, Rodenhuis S, Wesseling J. Breast cancer subtyping by immunohistochemistry and histological grade outperforms breast cancer intrinsic subtypes in predicting neoadjuvant chemotherapy response. Breast Cancer Res Treat 2013; 140:63-71. [PMID: 23828499 PMCID: PMC3706735 DOI: 10.1007/s10549-013-2620-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/21/2013] [Indexed: 12/17/2022]
Abstract
Intrinsic subtypes are widely accepted for the classification of breast cancer. Lacking gene expression data, surrogate classifications based on immunohistochemistry (IHC) have been proposed. A recent St. Gallen consensus meeting recommends to use this "surrogate intrinsic subtypes" for predicting adjuvant chemotherapy resistance, implying that "Surrogate Luminal A" breast cancers should only receive endocrine therapy. In this study we assessed both gene expression based intrinsic subtypes as well as surrogate intrinsic subtypes regarding their power to predict neoadjuvant chemotherapy benefit. Single institution data of 560 breast cancer patients were reviewed. Gene expression data was available for 247 patients. Subtypes were determined on the basis of IHC, Ki67, histological grade, endocrine responsiveness, and gene expression, and were correlated with chemotherapy response and recurrence-free survival. In ER+/HER2- tumors, a high histological grade was the best predictor for chemotherapy benefit, both in terms of pCR (p = 0.004) and recurrence-free survival (p = 0.002). The gene expression based and surrogate intrinsic subtype based on Ki67 had no predictive or prognostic value in ER+/HER2- tumors. Histological grade, ER, PR, and HER2 were the best predictive factors for chemotherapy response in breast cancer. We propose to continue the conventional use of these markers.
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Affiliation(s)
- E. H. Lips
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - L. Mulder
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - J. J. de Ronde
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Bioinformatics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - I. A. M. Mandjes
- Data Center, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B. B. Koolen
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L. F. A. Wessels
- Department of Bioinformatics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S. Rodenhuis
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J. Wesseling
- Department of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Brouckaert O, Schoneveld A, Truyers C, Kellen E, Van Ongeval C, Vergote I, Moerman P, Floris G, Wildiers H, Christiaens MR, Van Limbergen E, Neven P. Breast cancer phenotype, nodal status and palpability may be useful in the detection of overdiagnosed screening-detected breast cancers. Ann Oncol 2013; 24:1847-1852. [PMID: 23680691 DOI: 10.1093/annonc/mdt179] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Breast cancer remains the leading cause of female cancer death despite improvements in treatment and screening. Screening is often criticized for leading to overdiagnosis and overtreatment. However, few have attempted to identify overdiagnosed cases. PATIENTS AND METHODS A large, consecutive series of patients treated for primary operable, screening-detected, breast cancer (n = 1610). Details from pathology and clinical reports, treatment and follow-up were available from our prospectively managed database. Univariate and multivariate Cox proportional models were used to study the prognostic variables in screening-detected breast cancers for distant metastatic and breast cancer-specific survival. RESULTS We included 1610 patients. The mean/median follow-up was 6.0/6.0 years. Univariate analysis: tumor size, palpability, breast cancer phenotype and nodal status were predictors of distant metastasis and breast cancer-specific death. Multivariate analysis: palpability, breast cancer phenotype and nodal status remained independent prognostic variables. Palpability differed by breast cancer phenotype. CONCLUSION Screening-detected breast cancer is associated with excellent outcome. Palpability, nodal status and breast cancer phenotype are independent prognostic variables that may select patients at increased risk for distant metastatic relapse and breast cancer-specific death. Overdiagnosed cases reside most likely in the nonpalpable node negative subgroup with a Luminal A phenotype.
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Affiliation(s)
- O Brouckaert
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
| | - A Schoneveld
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
| | | | - E Kellen
- Centre for cancer prevention, University Hospital Leuven, Leuven, Belgium
| | - C Van Ongeval
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
| | - I Vergote
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
| | - P Moerman
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
| | - G Floris
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
| | - H Wildiers
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
| | - M R Christiaens
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
| | - E Van Limbergen
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
| | - P Neven
- Multidisciplinary Breast Center, University Hospital Leuven, Leuven
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Falck AK, Bendahl PO, Chebil G, Olsson H, Fernö M, Rydén L. Biomarker expression and St Gallen molecular subtype classification in primary tumours, synchronous lymph node metastases and asynchronous relapses in primary breast cancer patients with 10 years' follow-up. Breast Cancer Res Treat 2013; 140:93-104. [PMID: 23807420 DOI: 10.1007/s10549-013-2617-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/19/2013] [Indexed: 01/12/2023]
Abstract
Molecular profiles of asynchronous breast cancer metastases are of clinical relevance to individual patients' treatment, whereas the role of profiles in synchronous lymph node metastases is not defined. The present study aimed to assess individual biomarkers and molecular subtypes according to the St Gallen classification in primary breast tumours, synchronous lymph node metastases and asynchronous relapses and relate the results to 10-year breast cancer mortality (BCM). Tissue microarrays were constructed from archived tissue blocks of primary tumours (N = 524), synchronous lymph node metastases (N = 147) and asynchronous relapses (N = 36). The samples were evaluated by two independent pathologists according to oestrogen receptor (ER), progesterone receptor (PR), Ki67 and human epidermal growth factor receptor 2 (HER2) by immunohistochemistry and in situ hybridisation. The expression of biomarkers and molecular subtypes in the primary tumour was compared with that in the synchronous lymph node metastases and relapses, and related to 10-year BCM. Discordances were found between primary tumours and relapses (ER: p = 0.006, PR: p = 0.04, Ki67: p = 0.02, HER2: p = 0.02, St Gallen subtypes: p = 0.07) but not between primary tumours and metastatic lymph node. Prognostic information was gained by the molecular subtype classification in primary tumours and nodal metastases; triple negative subtype had the highest BCM compared with the luminal A subtype (primary tumours: HR 4.0; 95 % CI 2.0-8.2, p < 0.001, lymph node metastases: HR 3.5; 95 % CI 1.3-9.7, p = 0.02). When a shift in subtype inherence between primary tumour and metastatic lymph node was identified, the prognosis seemed to follow the subtype of the lymph node. Molecular profiles are not stable throughout tumour progression in breast cancer. Prognostic information for individual patients appears to be available from the analysis of biomarker expression in synchronous metastatic lymph nodes. The study supports biomarker analysis also in asynchronous relapses.
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Affiliation(s)
- Anna-Karin Falck
- Division of Surgery, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
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Brouckaert O, Laenen A, Wildiers H, Floris G, Moerman P, Van Limbergen E, Vergote I, Billen J, Christiaens MR, Neven P. The prognostic role of preoperative and (early) postoperatively change in CA15.3 serum levels in a single hospital cohort of primary operable breast cancers. Breast 2013; 22:254-62. [PMID: 23566558 DOI: 10.1016/j.breast.2013.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/24/2013] [Indexed: 01/11/2023] Open
Abstract
Measuring CA15.3 serum levels in the early breast cancer setting is not recommended by current ASCO guidelines. In this large single center study, we assess the prognostic value of preoperative (n = 3746), postoperative (n = 4049) and change in (n = 3252) CA15.3, also across different breast cancer phenotypes. Preoperative, postoperative and change in CA15.3 were all significant (p = 0.0348, p < 0.0001, p < 0.0001 respectively in multivariate analysis) predictors of distant metastasis free survival. For breast cancer specific survival, only postoperative and change in CA15.3 were significant predictors (p < 0.0001 both). Multivariate prognostic models did not improve by incorporating information on preoperative CA15.3, but did improve when introducing information on postoperative CA15.3 for distant metastasis (p = 0.0365) and on change in CA15.3 for breast cancer specific survival (p = 0.0291). Change in CA15.3 impacts on prognosis (distant metastasis) differently in different breast cancer phenotypes. A decrease in CA15.3 may be informative of improved prognosis in basal like and HER2 like breast cancer.
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Affiliation(s)
- O Brouckaert
- Multidisciplinary Breast Centre, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Affiliation(s)
- O Brouckaert
- Multidisciplinary Breast Centre, UZ Leuven, Leuven, Belgium.
| | - H Wildiers
- Multidisciplinary Breast Centre, UZ Leuven, Leuven, Belgium
| | - P Neven
- Multidisciplinary Breast Centre, UZ Leuven, Leuven, Belgium
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Ribelles N, Perez-Villa L, Jerez JM, Pajares B, Vicioso L, Jimenez B, de Luque V, Franco L, Gallego E, Marquez A, Alvarez M, Sanchez-Muñoz A, Perez-Rivas L, Alba E. Pattern of recurrence of early breast cancer is different according to intrinsic subtype and proliferation index. Breast Cancer Res 2013; 15:R98. [PMID: 24148581 PMCID: PMC3978680 DOI: 10.1186/bcr3559] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/07/2013] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Recurrence risk in breast cancer varies throughout the follow-up time. We examined if these changes are related to the level of expression of the proliferation pathway and intrinsic subtypes. METHODS Expression of estrogen and progesterone receptor, Ki-67, human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) was performed on tissue-microarrays constructed from a large and uniformly managed series of early breast cancer patients (N = 1,249). Subtype definitions by four biomarkers were as follows: luminal A (ER + and/or PR+, HER2−, Ki-67 <14), luminal B (ER + and/or PR+, HER2−, Ki-67 ≥14), HER2-enriched (any ER, any PR, HER2+, any Ki-67), triple-negative (ER−, PR−, HER2−, any Ki-67). Subtype definitions by six biomarkers were as follows: luminal A (ER + and/or PR+, HER2−, Ki-67 <14, any CK 5/6, any EGFR), luminal B (ER + and/or PR+, HER2−, Ki-67 ≥14, any CK 5/6, any EGFR), HER2-enriched (ER−, PR−, HER2+, any Ki-67, any CK 5/6, any EGFR), Luminal-HER2 (ER + and/or PR+, HER2+, any Ki-67, any CK 5/6, any EGFR), Basal-like (ER−, PR−, HER2−, any Ki-67, CK5/6+ and/or EGFR+), triple-negative nonbasal (ER−, PR−, HER2−, any Ki-67, CK 5/6−, EGFR−). Each four- or six-marker defined intrinsic subtype was divided in two groups, with Ki-67 <14% or with Ki-67 ≥14%. Recurrence hazard rate function was determined for each intrinsic subtype as a whole and according to Ki-67 value. RESULTS Luminal A displayed a slow risk increase, reaching its maximum after three years and then remained steady. Luminal B presented most of its relapses during the first five years. HER2-enriched tumors show a peak of recurrence nearly twenty months post-surgery, with a greater risk in Ki-67 ≥14%. However a second peak occurred at 72 months but the risk magnitude was greater in Ki-67 <14%. Triple negative tumors with low proliferation rate display a smooth risk curve, but with Ki-67 ≥14% show sharp peak at nearly 18 months. CONCLUSIONS Each intrinsic subtype has a particular pattern of relapses over time which change depending on the level of activation of the proliferation pathway assessed by Ki-67. These findings could have clinical implications both on adjuvant treatment trial design and on the recommendations concerning the surveillance of patients.
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Affiliation(s)
- Nuria Ribelles
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Lidia Perez-Villa
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Jose Manuel Jerez
- Department of Languages and Computer Science, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Bella Pajares
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Luis Vicioso
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Begoña Jimenez
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Vanessa de Luque
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Leonardo Franco
- Department of Languages and Computer Science, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Elena Gallego
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Antonia Marquez
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Martina Alvarez
- Department of Pathology, University of Malaga, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Alfonso Sanchez-Muñoz
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Luis Perez-Rivas
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
| | - Emilio Alba
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010 Málaga, Spain
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