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Banerjee S, Mahajan I, Ghose A, Boussios S, Chakraborty S. A rare case of metaplastic breast carcinoma from India: Towards precision oncology. Cancer Rep (Hoboken) 2024; 7:e1997. [PMID: 38421154 PMCID: PMC10903326 DOI: 10.1002/cnr2.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/13/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Metaplastic Breast Cancer (MpBC) is an exceedingly rare entity, accounting for less than 1% of all malignant breast tumours. Predominantly triple-negative, they are notorious for their chemoresistance, high rates of recurrence and decreased disease-free survival (DFS). All this contributes significantly to BC mortality and results in poor prognostic implications. Limited evidence has led to a lacuna of specific treatment guidelines for this entity and hence remains an uncharted territory for clinicians. CASE We report a case of a 46 year old premenopausal female with left-sided metaplastic triple negative T3N2aM0 BC with mesenchymal differentiation (high grade) whom we treated with neoadjuvant chemotherapy, primary surgery in the form of extreme oncoplasty and adjuvant radiotherapy by Telecobalt machine. Contrary to the expected aggressive course of the disease and poor prognosis of treatment, the patient is presently in remission without progression for over 2 years of follow up. CONCLUSION Limited experience in management of this pathological entity warrants the need for more research on it, with a special focus on targeted therapy. Discussing possibilities of a tailored approach, rather than a one-size-fits-all approach may aid in paving the path for the future of MpBC treatment.
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Affiliation(s)
- Soirindhri Banerjee
- Department of Radiation OncologyInstitute of Post Graduate Medical Education & Research and SSKM HospitalKolkataIndia
| | - Ishika Mahajan
- Department of Haematology and OncologyLincoln County Hospital, United Lincolnshire Hospitals TrustLincolnUK
| | - Aruni Ghose
- Department of Medical OncologyBarts Cancer Centre, St. Bartholomew's Hospital, Barts Health NHS TrustLondonUK
- Department of Medical OncologyMount Vernon Cancer Centre, East and North Hertfordshire NHS TrustLondonUK
- Department of Medical OncologyMedway NHS Foundation TrustKentUK
- United Kingdom and Ireland Global Cancer NetworkLondonUK
- Immuno‐Oncology Clinical NetworkKentUK
| | - Stergios Boussios
- Department of Medical OncologyMedway NHS Foundation TrustKentUK
- Faculty of Life Sciences and MedicineSchool of Cancer and Pharmaceutical Sciences, King's College LondonLondonUK
- Kent and Medway Medical SchoolUniversity of KentCanterburyUK
- AELIA OrganisationThessalonikiGreece
| | - Shivam Chakraborty
- Depatment of PathologyInstitute of Post Graduate Medical Education & Research and SSKM HospitalKolkataIndia
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Ismail Y, Zakaria AS, Allam R, Götte M, Ibrahim SA, Hassan H. Compartmental Syndecan-1 (CD138) expression as a novel prognostic marker in triple-negative metaplastic breast cancer. Pathol Res Pract 2024; 253:154994. [PMID: 38071886 DOI: 10.1016/j.prp.2023.154994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Metaplastic breast cancer (MpBC) is rare, aggressive, and mostly triple-negative (TN) subtype of BC. We aimed to investigate the potential prognostic significance of Syndecan-1 (SDC1/CD138) expression in this unique tumor. METHODS Archived charts of 50 TNBC patients [21 MpBC and 29 invasive ductal carcinoma (IDC)] were retrospectively evaluated. Corresponding paraffin blocks were used for immunohistochemical (IHC) staining of SDC1. Compartmental (epithelial membranous, stromal, and cytoplasmic) staining scores were expressed in quartiles (Q) and correlated with disease-free survival (DFS) and overall survival (OS). RESULTS The median follow-up period was 54.6 months (range: 2.2-112.7). MpBC patients showed significantly worse DFS and OS than IDC (p = 0.007 and 0.004, respectively). MpBC demonstrated significantly higher Q4 stromal and membranous SDC1 compared to IDC (p = 0.016 and 0.021, respectively), whereas IDC exhibited significantly higher cytoplasmic Q4 SDC1 than MpBC (p = 0.015). Stromal Q4 SDC1 expression was found to be an independent factor associated with MpBC relative to IDC (OR: 6.7, 95% CI: 1.24-36.90; p = 0.028). Stromal Q4 SDC1 expression was also an independent prognostic parameter for worse DFS and OS compared to Q1-3 in the whole cohort (HR: 4.2, 95% CI: 1.6-10.5; p = 0.003 and HR: 5.8; 95% CI: 2.2-15.3; p < 0.001, respectively). In MpBC, cytoplasmic Q1-3 SDC1 expression was an independent prognostic indicator for worse OS compared with their IDC counterparts (HR: 2.837, 95% CI: 1.048-7.682; p = 0.04). CONCLUSION This study suggests, for the first time, that differential expression and localization of SDC1 may contribute to the pathogenesis and prognosis of TN-MpBC. Therefore, targeting SDC1 (CD138) could emerge as a novel therapeutic approach for this devastating disease.
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Affiliation(s)
- Yahia Ismail
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Al-Shimaa Zakaria
- Pathology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Rasha Allam
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
| | - Martin Götte
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster 48149 Germany
| | | | - Hebatallah Hassan
- Department of Zoology, Faculty of Science, Cairo University, Giza 12613, Egypt.
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Bagbudar S, Karanlık H, Cabioglu N, Bayram A, Tükenmez M, Aydıner A, Yavuz E, Onder S. Evaluation of immune density, PD-L1, and CXCR4 expressions in metaplastic breast carcinoma to predict potential immunotherapy benefit. Med Oncol 2023; 41:18. [PMID: 38102446 DOI: 10.1007/s12032-023-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023]
Abstract
Metaplastic breast carcinoma (MBC) -rare but fatal subtype of invasive breast carcinomas- provides limited benefit from conventional triple-negative breast carcinoma chemotherapy. We aimed to determine the immune density of this tumor and to evaluate of programmed death-ligand 1 (PD-L1) and chemokine receptor type 4 (CXCR4) expressions to determine whether it would benefit from immunotherapy. Clinicopathological characteristics of 85 patients diagnosed as MBC between 1997 and 2017 were retrospectively assessed. We evaluated the immunohistochemical expression of PD-L1 and CXCR4, and the extent of tumour infiltrating lymphocytes (TILs), with survival data. TILs groups were statistically significantly associated with lymph node status, histological subtype, squamous component, local recurrence and/or systemic metastasis, and disease-related deaths (p < 0.05). PD-L1 positivity in immune cells (ICs) has a statistically significant relationship with the presence of squamous component (p = 0.011) and HER2 positivity (p = 0.031). PD-L1 positivity in tumor cells (TCs) was found to be significantly more frequent in high-TILs density (p = 0.003). PD-L1 combined positive score was significantly associated with the tumors containing high-TILs density (p = 0.012) and squamous component (p = 0.035). Disease-free and disease-specific survival rates were found to be longer for the cases displaying PD-L1 positivity in ICs; and also PD-L1 positivity in ICs was found to be an independent prognostic factor. When the expression of CXCR4 was compared with clinicopathological and survival parameters, no statistically significant association was found (p > 0.05). Based on the results of this retrospective study, PD-L1 and TILs appear to be prognostic. This study provides rationale for further studies to determine whether a subset of patients with metaplastic breast cancer could derive a meaningful benefit from immune-targeting therapies.
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Affiliation(s)
- Sidar Bagbudar
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Çapa, Fatih, 34390, Istanbul, Turkey.
| | - Hasan Karanlık
- Department of Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysel Bayram
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Çapa, Fatih, 34390, Istanbul, Turkey
| | - Mustafa Tükenmez
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Adnan Aydıner
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Ekrem Yavuz
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Çapa, Fatih, 34390, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Çapa, Fatih, 34390, Istanbul, Turkey
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Yang X, Tang T, Zhou T. Clinicopathological characteristics and prognosis of metaplastic breast cancer versus triple-negative invasive ductal carcinoma: a retrospective analysis. World J Surg Oncol 2023; 21:364. [PMID: 37996840 PMCID: PMC10668344 DOI: 10.1186/s12957-023-03261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Metaplastic breast cancer(MBC) is a specific pathological type of invasive breast cancer. There are few studies related to MBC due to its rarity. This study aimed to analyse the differences in clinicopathological characteristics and prognosis between Metaplastic breast cancer and triple-negative invasive ductal carcinoma (TN-IDC). METHODS We retrospectively compared the clinicopathological characteristics of patients diagnosed with MBC and TN-IDC at the Fourth Hospital of Hebei Medical University between 2011 and 2020 in a 1:2 ratio. The log-rank test was used to compare the two groups' disease-free survival (DFS) and overall survival (OS). For MBCs, we performed univariate and multivariate analyses using the Cox proportional hazards model to determine the characteristics that impacted OS and DFS. RESULTS A total of 81 patients with MBC and 162 patients with TN-IDC were included in this study. At initial diagnosis, MBC patients had larger tumour diameters(P = 0.03) and fewer positive lymph nodes (P = 0.04). Patients with MBC were more likely to have organ metastases after surgery (P = 0.03). Despite receiving the same treatment, MBC patients had worse DFS (HR = 1.66, 95%CI 0.90-3.08, P = 0.11) and OS (HR = 1.98, 95% CI 1.03-3.81, P = 0.04), and OS was statistically significant. Positive lymph nodes at initial diagnosis were associated with worse DFS (HR = 3.98, 95%CI 1.05-15.12, P = 0.04) and OS (HR = 3.70, 95%CI 1.03-13.34, P = 0.04) for patients with MBC. The efficacy of platinum-based agents is insensitive for MBC patients receiving chemotherapy. In addition, patients treated with preoperative chemotherapy had worse DFS compared to patients treated with postoperative chemotherapy (HR = 3.51, 95%CI 1.05-11.75, P = 0.04). CONCLUSIONS The clinicopathological characteristics and prognosis of MBC and TN-IDC differ in many ways. Further studies are required to determine suitable treatment guidelines for patients with MBC.
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Affiliation(s)
- Xiaolu Yang
- Hebei Medical University, Shijiazhuang, China
- Department of Breast Cancer Center, The Fourth Hospital of Hebei Medical University, No. 12, Jian-Kang Road, Shijiazhuang, 050011, China
| | - Tiantian Tang
- Department of Breast Cancer Center, The Fourth Hospital of Hebei Medical University, No. 12, Jian-Kang Road, Shijiazhuang, 050011, China
| | - Tao Zhou
- Department of Breast Cancer Center, The Fourth Hospital of Hebei Medical University, No. 12, Jian-Kang Road, Shijiazhuang, 050011, China.
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Chartier S, Brochard C, Martinat C, Coussy F, Feron JG, Kirova Y, Cottu P, Marchiò C, Vincent-Salomon A. TROP2, androgen receptor, and PD-L1 status in histological subtypes of high-grade metaplastic breast carcinomas. Histopathology 2023; 82:664-671. [PMID: 36527253 DOI: 10.1111/his.14852] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
AIMS High-grade metaplastic breast carcinoma (HG-MBC) is a rare subtype of invasive breast carcinoma, mostly triple-negative. Metaplastic carcinomas are less responsive to neoadjuvant chemotherapy and are associated with a worse outcome than invasive carcinomas of no special type. METHODS Clinicopathological characteristics and immunophenotype were retrospectively assessed in a series of 65 patients diagnosed with HG-MBC between 2005 and 2017 at the Curie Institute (antibody panel: oestrogen receptor [ER], progesterone receptor [PR], androgen receptor [AR], human epidermal growth factor receptor 2 [HER2], programmed death ligand-1 [PD-L1], and trophoblast cell surface antigen 2 [TROP2]). RESULTS The median age at diagnosis was 59.5 years. Six (9%) patients had metastatic disease at diagnosis. Among the nonmetastatic patients receiving neoadjuvant therapy, 26% (5/19) achieved pathological complete response. Most tumours were pT1/pT2 (77%) and 12% were pN+. Histological subtypes (mixed, squamous, mesenchymal, and spindle cell) were 40%, 35.5%, 15.5%, and 9%, respectively. Tumour-infiltrating lymphocytes were low or moderate except when squamous differentiation was present. Most tumours were triple-negative (92%). AR and TROP2 were positive in 34% and 85% of the cases, respectively. PD-L1 was positive in tumour cells in 18% (cutoff: 1% of positive tumour cells) of the cases and in tumour-infiltrating immune cells in 40% (cutoff: 1% of tumour area) of the cases. Notably, spindle cell and mesenchymal metaplastic breast carcinomas were mostly PDL1-negative. Lastly, 21 (32.3%) cases were HER2-low, all being HER2 1+, with no HER2 2+. CONCLUSION Metaplastic breast carcinoma could benefit from tailored therapeutic strategies adapted to the phenotypic specificities of histological subtypes.
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Affiliation(s)
- Suzanne Chartier
- Department of Pathology, Hôpital Bicêtre, APHP, Université Paris Saclay, Le Kremlin-Bicêtre, France.,Department of Pathology, Institut Curie, Paris, France
| | | | | | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | - Youlia Kirova
- Department of Radiotherapy, Institut Curie, Paris, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Caterina Marchiò
- Department of Medical Sciences, University of Turin, Italy.,Pathology Unit, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy
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Voutilainen S, Heikkilä P, Bartkova J, Nevanlinna H, Blomqvist C, Bartek J, Mattson J. Markers associated with genomic instability, immunogenicity and immune therapy responsiveness in Metaplastic carcinoma of the breast: Expression of γH2AX, pRPA2, P53, PD-L1 and tumor infiltrating lymphocytes in 76 cases. BMC Cancer 2022; 22:1298. [PMID: 36503417 PMCID: PMC9743555 DOI: 10.1186/s12885-022-10408-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Metaplastic breast cancer (MpBC) is an aggressive subtype of breast carcinoma that is often resistant to conventional chemotherapy. Therefore, novel treatment strategies are urgently needed. Immune check point inhibitors have shown activity in programmed death-ligand 1 (PD-L1) - positive metastatic triple negative breast carcinoma (TNBC), which raises the possibility that immunotherapy may also be effective in MpBC as most of the MpBCs are triple negative. The aim of the present study was to assess genomic instability and immunogenicity in tumor specimens of patients with MpBC. METHODS A total of 76 patients diagnosed with MpBC over a 15-year period were included in the study. We performed immunohistochemical analyses for tumor cell PD-L1, immune cell PD-L1 and p53 on tissue microarrays (TMAs), analyzed stromal and intratumoral tumor infiltrating lymphocytes (TILs) from hematoxylin and eosin-stained (H&E) slides and scored gamma-H2AX (γH2AX) and phosphorylated-RPA2 (pRPA2) from whole tissue sections. We correlated marker expression with clinicopathologic features and clinical outcome. RESULTS All tumors expressed γH2AX and pRPA2 with median expressions of 43% and 44%. P53- (68%), tumor cell PD-L1- (59%) and immune cell PD-L1-positivity (62%) were common in MpBCs. Median stromal TIL and intratumoral TIL counts were 5% and 0. The spindle and squamous cell carcinomas expressed the highest levels of PD-L1 and TILs, and carcinoma with mesenchymal differentiation the lowest. CONCLUSIONS MpBC appears to be an immunogenic cancer with high genomic instability and frequent PD-L1-positivity, implying that check point inhibitors might be effective in MpBC. Expression levels of PD-L1 and TILs varied across different histologic subtypes, suggesting that immunotherapy might be less effective in carcinoma with mesenchymal differentiation.
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Affiliation(s)
- S. Voutilainen
- grid.15485.3d0000 0000 9950 5666Helsinki University Hospital Comprehensive Cancer Centre, Paciuksenkatu 3, PO BOX 180, 00290 Helsinki, Finland
| | - P. Heikkilä
- grid.15485.3d0000 0000 9950 5666Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - J. Bartkova
- grid.417390.80000 0001 2175 6024Danish Cancer Society Research Center, Copenhagen, Denmark ,grid.4714.60000 0004 1937 0626Division of Genome Biology, Department of Medical Biochemistry and Biophysics, Science for Life Laboratory, Karolinska Institute, Stockholm, Sweden
| | - H. Nevanlinna
- grid.7737.40000 0004 0410 2071Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - C. Blomqvist
- grid.15485.3d0000 0000 9950 5666Helsinki University Hospital Comprehensive Cancer Centre, Paciuksenkatu 3, PO BOX 180, 00290 Helsinki, Finland
| | - J. Bartek
- grid.417390.80000 0001 2175 6024Danish Cancer Society Research Center, Copenhagen, Denmark ,grid.4714.60000 0004 1937 0626Division of Genome Biology, Department of Medical Biochemistry and Biophysics, Science for Life Laboratory, Karolinska Institute, Stockholm, Sweden
| | - J. Mattson
- grid.15485.3d0000 0000 9950 5666Helsinki University Hospital Comprehensive Cancer Centre, Paciuksenkatu 3, PO BOX 180, 00290 Helsinki, Finland
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Yang X, Tang T, Zhou T. Prognosis and clinicopathological characteristics of metaplastic breast cancer: A meta-analysis. Medicine (Baltimore) 2022; 101:e32226. [PMID: 36626445 PMCID: PMC9750705 DOI: 10.1097/md.0000000000032226] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To compare the clinicopathological characteristics and prognosis of metaplastic breast cancer (MBC) and triple-negative breast cancer (TNBC). METHODS A meta-analysis was performed on relevant cohort or case-control studies retrieved by a literature search of the PubMed, EMBASE, Ovid, and Web of Science databases. Hazard ratio (HR) was used to evaluate disease-free survival (DFS) and overall survival (OS), and the odds ratio (OR) and corresponding 95% confidence interval (CI) was used to evaluate clinicopathological characteristics, including age, tumor diameter, lymph node metastasis status, distant metastasis status, TNM staging, and histological grade. RESULTS Nine studies were included in the meta-analysis. Compared with TNBC patients, the HRs for 5-year DFS and 5-year OS of those with MBC were 1.64 (95% confidence interval [CI] 1.36 - 1.98; P < .001) and 1.52 (95% CI 1.27 - 1.81; P < .001), respectively. The OR for age ≥ 50 years, tumor diameter ≤ 5 cm, lymph node-negative, distant metastasis, TNM stage III and IV, and histological grade 3 was 1.63 (95% CI 1.45-1.84), 0.29 (95% CI 0.14-0.58), 1.46 (95% CI 1.13-1.88), 1.59 (95% CI 0.89-2.81), 1.49 (95% CI 0.80-2.77), and 2.25 (95% CI 0.85-5.97), respectively. CONCLUSION Patients with MBC had worse prognosis than those with TNBC. Furthermore, regarding clinicopathological characteristics, patients with MBC mostly presented at ≥ 50 years of age, with tumor diameter > 5 cm, and negative lymph nodes at first diagnosis. Moreover, there were no statistically significant differences in the occurrence of distant metastasis, TNM stages III and IV, or histological grade 3. MBC treatment was not assessed in this study. Data from randomized controlled trials are needed to guide the treatment of patients with MBC.
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Affiliation(s)
- Xiaolu Yang
- Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tiantian Tang
- Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tao Zhou
- Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
- * Correspondence: Tao Zhou, Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, No. 12, Jian-Kang Road, Shijiazhuang 050011, China (e-mail: )
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Prognostic relevance of mixed histological subtypes in invasive breast carcinoma: a retrospective analysis. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04443-x. [DOI: 10.1007/s00432-022-04443-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
The prognostic and therapeutic power of special histological subtypes in breast cancer in pure form or in combination with other histological subtypes is still not established, and diagnostic guidelines are cautious regarding prognostic power based on the histological subtype alone. Therapy decisions are guided in most cases independently of the histological subtype and are directed by biomarkers and tumor stage. In this study, we analyzed a comprehensive large retrospective breast cancer cohort with a special focus on histological subtype (other than ductal non-special type or lobular carcinoma) and correlated pure or mixed histological forms with pathological tumor stage and overall disease-free survival.
Materials and methods
A total of 827 breast cancer cases with pure or mixed special histological types were retrospectively analyzed. Survival information was available in 645 of 827 cases.
Results
A total of 293 cases had pure forms, and 534 cases had mixed histological subtypes. The most common pure special types were mucinous (23.9%), micropapillary (21.2%), high-grade metaplastic (13%), male breast cancer (8.2%), cribriform (6.8%), metastases (6.1%), apocrine and papillary (each 5.46%), NST with medullary and clear cell pattern (up to 3.4%) and high-grade neuroendocrine carcinomas (2.7%). Mixed forms were most frequently encountered in NST carcinomas with micropapillary components (41.8%), followed by mucinous (9.93%) and cribriform (6.74%) mixed patterns. In univariate analysis, no pure form had prognostic relevance compared with any mixed form with the basic pure element. Pooling pure histological subtypes with tumor stage and age in a linear random-effects model, the cribriform subtype had the most favorable prognosis, while male breast cancer showed the poorest outcome (p < 0.001). All other frequent pure forms had intermediate prognostic power (p < 0.001).
Conclusion
Our results show that the analyzed special histological breast cancer subtypes (other than ductal and lobular carcinomas) do not carry prognostic information alone, either in pure form or in any combination with other subtypes. Prognostic groups including special subtypes, however, can strongly stratify breast cancer if tumor stage, age and biomarkers are included in the prognostic measurements.
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Corso G, D'Ecclesiis O, Magnoni F, Mazzotta E, Conforti F, Veronesi P, Sajjadi E, Venetis K, Fusco N, Gandini S. Metaplastic breast cancers and triple-negative breast cancers of no special type: are they prognostically different? A systematic review and meta-analysis. Eur J Cancer Prev 2022; 31:459-466. [PMID: 35088973 DOI: 10.1097/cej.0000000000000733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Metaplastic breast cancer (MBC) and triple-negative (TN) BC of no special type are often confounded with each other in terms of survival and prognosis. In this systematic study and meta-analysis, we evaluated the prognosis of each of these two different diagnoses. METHODS We conducted a systematic literature search and review using the MOOSE guidelines, through PUBMED database, the Ovid MEDLINE database, and the ISI Web of Science Citation Index Expanded (SCI Expanded). Overall survival (OS) and disease-free survival (DFS) were the main outcomes considered. RESULTS Our review eventually selected six independent studies, with a total of more than 59 519 patients. MBC was found to associate with worse OS compared to TNBC of no special type, with a significant 40% increased risk of death [summary hazard ratio (SHR) = 1.40, 95% confidence interval (CI): 1.30-1.50]. We found neither heterogeneity ( I2 = 0%) nor evidence of publication bias ( P = 0.82 and P = 0.49 by Begg's and Egger's test, respectively) between studies. No statistically significant difference was found between MBC and TNBC of no special type in terms of DFS (SHR = 1.17, 95% CI: 0.80-1.71). CONCLUSION This study demonstrates that TNBC of no special type and MBC have comparable DFS, although the latter presents a significantly worse prognosis in terms of OS. Despite DFS being similar in both subtypes, this did not result in significant OS benefits, with MBC score being the worse of the two diseases.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
| | - Oriana D'Ecclesiis
- Division of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan
| | - Erica Mazzotta
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan
| | - Fabio Conforti
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology (IEO), IRCCS, Milan
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
| | - Elham Sajjadi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
- Biobank for Translational Medicine (B4MED) Unit, Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Konstantinos Venetis
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
- Biobank for Translational Medicine (B4MED) Unit, Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan
- Biobank for Translational Medicine (B4MED) Unit, Division of Pathology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Sara Gandini
- Division of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan
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10
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Takada K, Kashiwagi S, Asano Y, Goto W, Morisaki T, Shibutani M, Tanaka H, Hirakawa K, Ohira M. Differences in tumor-infiltrating lymphocyte density and prognostic factors for breast cancer by patient age. World J Surg Oncol 2022; 20:38. [PMID: 35177074 PMCID: PMC8851811 DOI: 10.1186/s12957-022-02513-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Lymphocytes that surround cancer participate in tumor-related immune responses and are called tumor-infiltrating lymphocytes (TILs). Several recent reports suggest TILs index the tumor microenvironment and predict the therapeutic effect of chemotherapy. However, only few studies have studied the relationship between age and TILs. Aging reduces host immunity, and we predict that it may also affect TILs. Thus, we hypothesized that older breast cancer (BC) patients may have low TIL density than younger BC patients. Here, we retrospectively analyzed the differences in TILs by age and the therapeutic effects of preoperative chemotherapy (POC) in BC patients who were aged either less than 45 years or more than 60 years. Methods We retrospectively examined the data of 356 breast cancer patients who underwent POC, including 75 patients aged ≤ 45 years and 116 patients aged > 60 years. Using pre-treatment needle biopsy specimens, TIL density was compared for each age group by Student’s t-test. After analyzing different factors that affect TIL density, prognostic factors were also examined. Results Older patients with triple-negative BC had significantly lower TIL density than younger patients, while in human epidermal growth factor receptor 2 (HER2)-enriched BC, TIL density was significantly higher in the younger age group than that in the older age group. In addition, younger patients with HER2-rich breast cancer showed significantly higher complete pathological response rates than older patients with HER2-rich BC. In addition, significant differences in overall survival were observed among these patients with triple-negative BC. Conclusions Our study suggests that younger BC patients possess significantly higher TIL density than older patients. These differences may influence the therapeutic efficacy in highly immunogenic subtypes. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02513-5.
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Affiliation(s)
- Koji Takada
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shinichiro Kashiwagi
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yuka Asano
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Wataru Goto
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tamami Morisaki
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Tanaka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kosei Hirakawa
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.,Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.,Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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11
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Abada E, Kim S, Dozier K, Fehmi O, Jang H, Fehmi Z, Bandyopadhyay S. Estrogen receptor status has no prognostic relevance in metaplastic breast carcinoma. Cancer Treat Res Commun 2022; 33:100630. [PMID: 36058202 PMCID: PMC9742347 DOI: 10.1016/j.ctarc.2022.100630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Metaplastic breast carcinoma (MBC) is a rare histologic variant of breast cancer characterized by the presence of glandular and non-glandular components. The prognostic significance of estrogen receptor (ER) status has been scarcely studied in these tumors. We therefore investigated the prognostic relevance of ER status in MBC within our patient population. DESIGN We reviewed MBC cases (n = 125) between January 2000 and September 2019. Histologic slides were reviewed for variables including tumor morphology and hormonal status. Additional clinical information was obtained from the electronic medical records. RESULTS Of the 125 patients, 15 (12%) had ER positive tumors and 110 (88%) had ER negative tumors. Eleven (73%) ER positive tumors had ER positivity > 10% and 4 (27%) had ER positivity ≤ 10%. ER positive tumors had a smaller median tumor size of 2.5 cm, compared with ER negative tumors with median tumor size 3.05 cm, however this difference was not statistically significant (P = 0.82). There were no statistical differences between ER positive and ER negative tumors in terms of histologic grade (P = 0.34), histologic subtype (P = 0.65), clinical stage (P>0.99) or human epidermal growth factor receptor 2 (HER2) expression (P = 0.29). There was also no difference in overall survival (OS) between ER positive and ER negative metaplastic breast cancers (HR = 0.35, 95% CI, 0.003-2.67, P = 0.39). CONCLUSION Our experience suggests that ER positivity has no prognostic relevance in MBC. Regardless of ER expression status, there were no statistically significant differences in overall survival between ER positive and ER negative MBC.
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Affiliation(s)
- Evi Abada
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Street, Detroit, MI, 48201, USA,Corresponding author at: Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Street, Detroit Michigan, 48201, USA. (E. Abada)
| | - Seongho Kim
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Keion Dozier
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Street, Detroit, MI, 48201, USA
| | - Omar Fehmi
- Department of Biomolecular Science, University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | - Hyejeong Jang
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Ziad Fehmi
- Department of Biomolecular Science, University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Street, Detroit, MI, 48201, USA
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12
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Oner G, Önder S, Karatay H, Ak N, Tükenmez M, Müslümanoğlu M, İğci A, Dincçağ A, Özmen V, Aydiner A, Yavuz E, Cabioğlu N. Clinical impact of PD-L1 expression in triple-negative breast cancer patients with residual tumor burden after neoadjuvant chemotherapy. World J Surg Oncol 2021; 19:264. [PMID: 34474671 PMCID: PMC8414710 DOI: 10.1186/s12957-021-02361-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/05/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Studies on PD-L1 expression in breast cancer have gained importance in recent years, especially in triple-negative breast cancer (TNBC). Our aim was to analyze the differential expression of PD-L1 to explore its correlation with response to neoadjuvant chemotherapy (NACT) and patient survival. METHODS PD-L1 expression was evaluated immunohistochemically (Ventana SP263 clone kit) by staining tumor specimen. PD-L1 positivity was defined as membranous staining > 1%, > 5%, > 10%, and > 20% on either tumor cell (TC) and /or immune cell (IC). RESULTS Fifty patients with locally advanced TNBC, who had a partial response to NACT, were included in the study. PD-L1 staining was observed in TCs in 25 patients (50%) and in ICs in 23 patients (46%) when PD-L1 > 1% was considered positive. Patients with PD-L1 positivity on ICs were more likely to respond to chemotherapy as measured by "MD Anderson Cancer Center Residual Cancer Burden Index" (14/22, 63.6% vs. 10/27, 37%, p = 0.064). The 5-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 46.3% and 51.4%, respectively. A high (> 20%) tumoral PD-L1 positivity was associated with a better DFS and DSS. CONCLUSIONS Studies in the literature mostly focused on PD-L1 expression in inflammatory cells. However, our results suggest that patients with a high PD-L1 expression on TCs were more likely to have a better outcome. Since patients with residual tumor burden who express PD-L1 on TILs were more likely to respond to NACT, an immune checkpoint inhibitor therapy in addition to NACT would be an important option for TNBC with locally advanced disease.
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Affiliation(s)
- Gizem Oner
- grid.9601.e0000 0001 2166 6619Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey ,grid.411414.50000 0004 0626 3418Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium
| | - Semen Önder
- grid.9601.e0000 0001 2166 6619Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hüseyin Karatay
- grid.9601.e0000 0001 2166 6619Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Naziye Ak
- grid.9601.e0000 0001 2166 6619Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Mustafa Tükenmez
- grid.9601.e0000 0001 2166 6619Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahmut Müslümanoğlu
- grid.9601.e0000 0001 2166 6619Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Abdullah İğci
- grid.9601.e0000 0001 2166 6619Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Dincçağ
- grid.9601.e0000 0001 2166 6619Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vahit Özmen
- grid.9601.e0000 0001 2166 6619Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Adnan Aydiner
- grid.9601.e0000 0001 2166 6619Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Ekrem Yavuz
- grid.9601.e0000 0001 2166 6619Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioğlu
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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13
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González-Martínez S, Pérez-Mies B, Pizarro D, Caniego-Casas T, Cortés J, Palacios J. Epithelial Mesenchymal Transition and Immune Response in Metaplastic Breast Carcinoma. Int J Mol Sci 2021; 22:ijms22147398. [PMID: 34299016 PMCID: PMC8306902 DOI: 10.3390/ijms22147398] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
Metaplastic breast carcinoma (MBC) is a heterogeneous group of infrequent triple negative (TN) invasive carcinomas with poor prognosis. MBCs have a different clinical behavior from other types of triple negative breast cancer (TNBC), being more resistant to standard chemotherapy. MBCs are an example of tumors with activation of epithelial–mesenchymal transition (EMT). The mechanisms involved in EMT could be responsible for the increase in the infiltrative and metastatic capacity of MBCs and resistance to treatments. In addition, a relationship between EMT and the immune response has been seen in these tumors. In this sense, MBC differ from other TN tumors showing a lower number of tumor-infiltrating lymphocytes (TILS) and a higher percentage of tumor cells expressing programmed death-ligand 1 (PD-L1). A better understanding of the relationship between the immune system and EMT could provide new therapeutic approaches in MBC.
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Affiliation(s)
| | - Belén Pérez-Mies
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain;
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain; (D.P.); (T.C.-C.)
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
| | - David Pizarro
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain; (D.P.); (T.C.-C.)
| | - Tamara Caniego-Casas
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain; (D.P.); (T.C.-C.)
| | - Javier Cortés
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, 28670 Madrid, Spain
- International Breast Cancer Center (IBCC), Quironsalud Group, 08017 Barcelona, Spain
- Medica Scientia Innovation Research, 08007 Barcelona, Spain
- Medica Scientia Innovation Research, Ridgewood, NJ 07450, USA
- Vall d’Hebron Institute of Oncology, 08035 Barcelona, Spain
- Correspondence: (J.C.); (J.P.)
| | - José Palacios
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain;
- Institute Ramón y Cajal for Health Research (IRYCIS), 28034 Madrid, Spain; (D.P.); (T.C.-C.)
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain
- Correspondence: (J.C.); (J.P.)
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14
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McCart Reed AE, Kalaw EM, Lakhani SR. An Update on the Molecular Pathology of Metaplastic Breast Cancer. BREAST CANCER-TARGETS AND THERAPY 2021; 13:161-170. [PMID: 33664587 PMCID: PMC7924111 DOI: 10.2147/bctt.s296784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 12/13/2022]
Abstract
Metaplastic breast cancer (MpBC) is a fascinating morphologic sub-type of breast cancer, characterised by intra-tumoural heterogeneity. By definition, these tumors show regions of metaplasia that can present as spindle, squamous, chondroid or even osseous differentiation. MpBC are typically triple-negative, and are therefore not targetable with hormone therapy or anti-HER2 therapies, leaving only chemotherapeutics for management. MpBC are known for their aggressive course and poor response to chemotherapy. We review herein the pathology and molecular landscape of MpBC and discuss opportunities for targetted therapies as well as immunotherapies.
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Affiliation(s)
- Amy E McCart Reed
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Emarene M Kalaw
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Sunil R Lakhani
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Pathology Queensland, Brisbane, Queensland, Australia
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15
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Tadros AB, Sevilimedu V, Plitas G. Reply to: Metaplastic Breast Carcinoma and Other Triple-Negative Subtype Breast Cancers: Which is the Worst? Ann Surg Oncol 2021; 28:5440-5441. [PMID: 33566247 DOI: 10.1245/s10434-021-09679-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Audree B Tadros
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Varadan Sevilimedu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - George Plitas
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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16
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Ramirez-Valles EG, Rodríguez-Pulido A, Barraza-Salas M, Martínez-Velis I, Meneses-Morales I, Ayala-García VM, Alba-Fierro CA. A Quest for New Cancer Diagnosis, Prognosis and Prediction Biomarkers and Their Use in Biosensors Development. Technol Cancer Res Treat 2020; 19:1533033820957033. [PMID: 33107395 PMCID: PMC7607814 DOI: 10.1177/1533033820957033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Traditional techniques for cancer diagnosis, such as nuclear magnetic resonance, ultrasound and tissue analysis, require sophisticated devices and highly trained personnel, which are characterized by elevated operation costs. The use of biomarkers has emerged as an alternative for cancer diagnosis, prognosis and prediction because their measurement in tissues or fluids, such as blood, urine or saliva, is characterized by shorter processing times. However, the biomarkers used currently, and the techniques used for their measurement, including ELISA, western-blot, polymerase chain reaction (PCR) or immunohistochemistry, possess low sensitivity and specificity. Therefore, the search for new proteomic, genomic or immunological biomarkers and the development of new noninvasive, easier and cheaper techniques that meet the sensitivity and specificity criteria for the diagnosis, prognosis and prediction of this disease has become a relevant topic. The purpose of this review is to provide an overview about the search for new cancer biomarkers, including the strategies that must be followed to identify them, as well as presenting the latest advances in the development of biosensors that possess a high potential for cancer diagnosis, prognosis and prediction, mainly focusing on their relevance in lung, prostate and breast cancers.
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Affiliation(s)
- Eda G Ramirez-Valles
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Dgo, Mexico
| | | | - Marcelo Barraza-Salas
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Dgo, Mexico
| | - Isaac Martínez-Velis
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Dgo, Mexico
| | - Iván Meneses-Morales
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Dgo, Mexico
| | - Víctor M Ayala-García
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Dgo, Mexico
| | - Carlos A Alba-Fierro
- Facultad de Ciencias Químicas, Universidad Juárez del Estado de Durango, Dgo, Mexico
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17
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Corso G, Frassoni S, Girardi A, De Camilli E, Montagna E, Intra M, Bottiglieri L, Margherita De Scalzi A, Fanianos DM, Magnoni F, Invento A, Toesca A, Conforti F, Bagnardi V, Viale G, Colleoni MA, Veronesi P. Metaplastic breast cancer: Prognostic and therapeutic considerations. J Surg Oncol 2020; 123:61-70. [PMID: 33047318 DOI: 10.1002/jso.26248] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Metaplastic breast cancer (MBC) is a rare condition of breast tumor with different subtypes, considered a disease with worse prognosis; treatments and survival are often unclear and conflicting. METHODS We consecutively collected 153 primary MBCs of different subtypes. Breast surgery, neoadjuvant or adjuvant treatment, clinic-pathological factors, number and type of events during follow-up were considered to evaluate overall survival (OS) and invasive disease-free survival (IDFS). RESULTS The majority of MBC was triple-negative (TN) subtype (88.7%), G3 (95.3%), pN0 (70.6%), and with high levels of Ki-67 (93.5%). For OS and IDFS, no significant associations were seen between the different MBC subtypes. The matched triple-negative MBC (TNMBC) and ductal TNBC cohorts had similar prognosis both in terms of OS (p = .411) and IDFS (p = .981). We observed a positive trend for TNMBC patients treated in the adjuvant setting with the cyclofosfamide, methotrexate, 5-fluorouracil protocol for better OS (p = .090) and IDFS (p = .087). A poor or absent response rate was observed in the neoadjuvant setting. CONCLUSION Our results demonstrate that metaplastic and ductal breast cancers with TN phenotype are similar in terms of overall and disease-free survival. Metaplastic cancers are poorly responsive to neoadjuvant treatment, and in the absence of novel targeted therapies, surgical treatment remains the first choice.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Antonia Girardi
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Elisa De Camilli
- Division of Pathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Emilia Montagna
- Division of Breast Cancer Medical Treatments, European Institute of Oncology, IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Luca Bottiglieri
- Division of Pathology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Alessandra Invento
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Toesca
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabio Conforti
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Viale
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Pathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Angelo Colleoni
- Division of Breast Cancer Medical Treatments, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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