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Niță I, Nițipir C, Toma ȘA, Limbău AM, Pîrvu E, Bădărău IA, Suciu I, Suciu G, Manolescu LSC. Histological Aspects and Quantitative Assessment of Ki67 as Prognostic Factors in Breast Cancer Patients: Result from a Single-Center, Cross Sectional Study. ACTA ACUST UNITED AC 2020; 56:medicina56110600. [PMID: 33182401 PMCID: PMC7698204 DOI: 10.3390/medicina56110600] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
Background and objectives: Our aim is to explore the relationship between the levels of protein encoded by Ki67 and the histopathological aspects regarding the overall survival and progression-free survival in a single university center. A secondary objective was to examine other factors that can influence these endpoints. New approaches to the prognostic assessment of breast cancer have come from molecular profiling studies. Ki67 is a nuclear protein associated with cell proliferation. Together with the histological type and tumor grade, it is used to appreciate the aggressiveness of the breast tumors. Materials and Methods: We conducted a retrospective single-institution study, at Elias University Emergency Hospital, Bucharest, Romania, in which we enrolled women with stage I to III breast cancer. The protocol was amended to include the immunohistochemistry determination of Ki67 and the histological aspects. The methodology consisted in using a Kaplan-Meier analysis for the entire sample and restricted mean survival time up to 36 months. Results: Both lower Ki67 and low tumor grade are associated with better prognosis in terms of overall survival (OS) and progression-free survival (PFS) for our patients' cohort. In our group, the histological type did not impact the time to progression or survival. Conclusions: Both overall survival and progression-free survival may be influenced by the higher value of Ki67 and less differentiated tumors. Further studies are needed in order to establish if the histologic type may impact breast cancer prognostic, probably together with other histologic and molecular markers.
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Affiliation(s)
- Irina Niță
- Faculty of Medicine, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (I.A.B.)
- Clinic of Oncology, Elias Universitary Emergency Hospital, 011461 Bucharest, Romania
- Correspondence: (I.N.); (L.S.C.M.); Tel.: +40-722515917 (I.N.); +40-723699253 (L.S.C.M.)
| | - Cornelia Nițipir
- Faculty of Medicine, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (I.A.B.)
- Clinic of Oncology, Elias Universitary Emergency Hospital, 011461 Bucharest, Romania
| | | | - Alexandra Maria Limbău
- Dermatology Department, Municipal Hospital Curtea de Argeș, 115300 Curtea de Argeș, Romania;
| | - Edvina Pîrvu
- Medical Oncology Department, Clinical Hospital Colţea, 927180 Bucharest, Romania;
| | - Ioana Anca Bădărău
- Faculty of Medicine, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (I.A.B.)
| | - Ioana Suciu
- BEIA consult International, Peroni 16, 041386 Bucharest, Romania; (I.S.); (G.S.)
| | - George Suciu
- BEIA consult International, Peroni 16, 041386 Bucharest, Romania; (I.S.); (G.S.)
| | - Loredana Sabina Cornelia Manolescu
- Faculty of Medicine, Faculty of Midwifery and Nursing, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (I.A.B.)
- Correspondence: (I.N.); (L.S.C.M.); Tel.: +40-722515917 (I.N.); +40-723699253 (L.S.C.M.)
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Targeted next-generation sequencing identifies genomic abnormalities potentially driving the prognosis of early-stage invasive lobular breast carcinoma patients stratified according to a validated clinico-pathological model. Breast 2020; 50:56-63. [PMID: 32028173 PMCID: PMC7375560 DOI: 10.1016/j.breast.2020.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction The clinico-pathological and molecular factors that drive the prognosis of invasive lobular breast carcinoma (ILC) are not entirely explored. In this regard, the development and validation of a prognostic model for ILC and the investigation of the distribution of molecular abnormalities (focusing on CDK4/6 alterations) according to prognosis were the aims of this study. Patients and methods Two clinico-pathological multi-center data-sets of early-stage ILC patients (Training/Validation Set, TS/VS) were gathered. A 3-class model was developed according to the multivariate analysis for disease-free-survival (DFS) and externally validated. Mutational, copy number variation and transcriptomic analyses by targeted next generation sequencing (NGS) were performed (and validated with quantitative PCR) in an explorative cohort of patients with poor and good prognosis. Results Data from overall 773 patients (TS/VS: 491/282) were gathered. The developed model significantly discriminated low/intermediate/high risk in the TS (10-years DFS: 76.3%/67.6%/39.8%, respectively, p<0.0001) and in the VS (p<0.0001). In the explorative cohort for molecular analysis (34 patients), CDK4 gain was present exclusively in the poor prognosis group (35.0%, p = 0.03; OR 7.98, 95%CI 1.51–42.1, p = 0.014). Moreover, CDK4 and 6 overexpression showed a trend toward an association with poor prognosis (OR 2.7, 95%CI 0.4–18.1, p = 0.3; OR 3.29, 95%CI 0.56–19.25, p = 0.18). Conclusions A risk stratification model, able to accurately separate early-stage ILC patients’ prognosis into different risk classes according to clinico-pathological variables, allowed to investigate potential biomarkers of prognosis with targeted NGS. CDK4 gain is suggested for future validation as a prognostic biomarker and a potential therapeutic opportunity in ILC patients. The current multicenter analysis developed and validated a prognostic nomogram for early stage ILC. A next-generation sequencing analysis was performed in prognostic ‘outlier’ patients. CDK4 gain emerges as a potential negative prognostic factor in ILC patients. .
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Carbognin L, Sperduti I, Fabi A, Dieci MV, Kadrija D, Griguolo G, Pilotto S, Guarneri V, Zampiva I, Brunelli M, Orvieto E, Nortilli R, Fiorio E, Parolin V, Manfrin E, Caliò A, Nisticò C, Pellini F, Scarpa A, Pollini GP, Conte P, Tortora G, Bria E. Prognostic impact of proliferation for resected early stage 'pure' invasive lobular breast cancer: Cut-off analysis of Ki67 according to histology and clinical validation. Breast 2017. [PMID: 28628772 DOI: 10.1016/j.breast.2017.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The intent of this analysis was to investigate and validate the prognostic potential of Ki67 in a multi-center series of patients affected by early stage 'pure' invasive lobular carcinoma (ILC). METHODS Clinical-pathological data of patients affected by ILC were correlated with overall survival and disease-free survival (OS/DFS); data from a parallel invasive ductal carcinoma (IDC) patients' cohort were gathered as well. The maximally selected Log-Rank statistics analysis was applied to Ki67 continuous variable to estimate the appropriate cut-off. The Subpopulation Treatment Effect Pattern Plot (STEPP) analysis was performed as well. RESULTS Data from overall 1097 (457/222 ILC: training/validation set; 418 IDC) patients were gathered. The identified optimal Ki67 cut-offs were 4% and 14% for DFS in ILC and IDC cohort, respectively. In ILC patients, the Ki67 cut-off was an independent OS predictor. Ten-years OS and DFS were 89.9% and 77.2% (p = 0.007) and 79.4% and 69.2% (p = 0.03) for patients with Ki67 ≤ 4% and >4%, respectively. In IDC patients, 10-years OS was 93.8% and 71.7%, p = 0.02, DFS was 84.0% and 52.6%, p = 0.0003, for patients with Ki67 ≤ 14% and >14%, respectively. In the validation set, the optimal Ki67 OS cut-off was 5%. The STEPP analysis showed that in the presence of low Ki67 values, IDC patients have a better DFS than ILC patients, while with the increase of values the prognosis tends to overlap. CONCLUSIONS Despite the retrospective design of the study, the prognostic relevance of Ki67 (as well as its optimal cut-off) seems to significantly differ according to breast cancer histology.
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Affiliation(s)
- Luisa Carbognin
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Maria Vittoria Dieci
- Division of Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Dzenete Kadrija
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gaia Griguolo
- Division of Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Sara Pilotto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Ilaria Zampiva
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Department of Pathology and Diagnostic, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Enrico Orvieto
- Department of Pathology, Azienda Ospedaliera di Padova, Padova, Italy
| | - Rolando Nortilli
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elena Fiorio
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Veronica Parolin
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Erminia Manfrin
- Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Department of Pathology and Diagnostic, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Anna Caliò
- Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Department of Pathology and Diagnostic, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Francesca Pellini
- Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Breast Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Aldo Scarpa
- Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Department of Pathology and Diagnostic, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Paolo Pollini
- Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Breast Surgery, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Pierfranco Conte
- Division of Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giampaolo Tortora
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emilio Bria
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; Breast Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
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