Clinical Meaning of Stromal Tumor Infiltrating Lymphocytes (sTIL) in Early Luminal B Breast Cancer

Luminal breast cancer (BC) is associated with less immune activation, and the significance of stromal lymphocytic infiltration (sTIL) is more uncertain than in other BC subtypes. The aim of this study was to investigate the predictive and prognostic value of sTIL in early luminal BC. The study was performed with an observational design in a prospective cohort of 345 patients with predominantly high-risk luminal (hormone receptor positive, HER2 negative) BC and with luminal B features (n = 286), in which the presence of sTIL was analyzed with validated methods. Median sTIL infiltration was 5% (Q1-Q3 range (IQR), 0-10). We found that sTIL were associated with characteristics of higher biological and clinical aggressiveness (tumor and lymph node proliferation and stage, among others) and that the percentage of sTIL was predictive of pathologic complete response in patients treated with neoadjuvant chemotherapy (OR: 1.05, 95%CI 1.02-1.09, p < 0.001). The inclusion of sTIL (any level of lymphocytic infiltration: sTIL > 0%) in Cox regression multivariable prognostic models was associated with a shorter relapse-free interval (HR: 4.85, 95%CI 1.33-17.65, p = 0.016) and significantly improved its performance. The prognostic impact of sTIL was independent of other clinical and pathological variables and was mainly driven by its relevance in luminal B BC.

Prognostic and Predictive Effects of Tumor and Plasma miR-200c-3p in Locally Advanced and Metastatic Breast Cancer

While the role of miR-200c in cancer progression has been established, its expression and prognostic role in breast cancer is not completely understood. The predictive role of miR-200c in response to chemotherapy has also been suggested by some studies, but only limited clinical evidence is available. The purpose of this study was to investigate miR-200c-3p in the plasma and primary tumor of BC patients. The study design included two cohorts involving women with locally advanced (LABC) and metastatic breast cancer. Tumor and plasma samples were obtained before and after treatment. We found that miR-200c-3p was significantly higher in the plasma of BC patients compared with the controls. No correlation of age with plasma miR-200c-3p was found for controls or for BC patients. MiR-200c-3p tumor expression was also associated with poor overall survival in LABC patients treated with neoadjuvant chemotherapy, independently of pathological complete response or clinical stage. Our findings suggest that plasmatic miR-200c-3p levels could be useful for BC staging, while the tumor expression of miR-200c-3p might provide further prognostic information beyond residual disease in BC treated with neoadjuvant chemotherapy.

External validation of a prognostic model based on total tumor load of sentinel lymph node for early breast cancer patients

Background

A prognostic model based on the results of molecular analysis of sentinel lymph nodes (SLN) is needed to replace the information that staging the entire axilla provided. The aim of the study is to conduct an external validation of a previously developed model for the prediction of 5-year DFS in a group of breast cancer patients that had undergone SLN biopsy assessed by the One Step Nucleic Acid Amplification (OSNA) method.

Methods

We collected retrospective data of 889 patients with breast cancer, who had not received systemic treatment before surgery, and who underwent SLN biopsy and evaluation of all SLN by OSNA. The discrimination ability of the model was assessed by the area under the ROC curve (AUC ROC), and its calibration by comparing 5-years DFS Kaplan–Meier estimates in quartile groups of model predicted probabilities (MPP).

Results

The AUC ROC ranged from 0.78 (at 2 years) to 0.73 (at 5 years) in the training set, and from 0.78 to 0.71, respectively, in the validation set. The MPP allowed to distinguish four groups of patients with heterogeneous DFS (log-rank test p < 0.0001). In the highest risk group, the HR were 6.04 [95% CI 2.70, 13.48] in the training set and 4.79 [2.310, 9.93] in the validation set.

Conclusions

The model for the prediction of 5-year DFS was successfully validated using the most stringent form of validation, in centers different from those involved in the development of the model. The external validation of the model confirms its utility for the prediction of 5-year DFS and the usefulness of the TTL value as a prognostic variable.

Electronic supplementary material

The online version of this article (10.1007/s10549-020-05623-4) contains supplementary material, which is available to authorized users.

Incidental versus non-incidental thyroid carcinoma: Clinical presentation, surgical management and prognosis

BACKGROUND AND OBJECTIVE

Thyroid cancer may be clinically evident as a tumor mass in the neck or as a histopathological incidental finding after thyroid surgery for an apparent benign condition. Our objective was to assess the differences in clinical signs, surgical management, and course between incidental and clinically diagnosed thyroid tumors.

METHODS

A retrospective study was conducted on patients operated on for benign or malignant thyroid disease from January 2000 to March 2014. Among the 1415 patients who underwent any thyroid surgery, 264 neoplasms were found, of which 170 were incidental. A comparison was made of incidental versus non-incidental carcinomas. Among incidental carcinomas, cases whose indication for surgery was Graves' disease were compared to those with multinodular goiter.

RESULTS

Incidental carcinomas were in earlier stages and required less aggressive surgery. There were no differences in surgical complications between incidental and clinical tumors, but mortality and relapses were markedly higher in non-incidental cancers (4.4% vs 0% and 13.2% vs 4.8% respectively). Carcinomas developing on Graves' disease showed no differences from all other incidental tumors in terms of complications, mortality, or relapse after surgery.

CONCLUSIONS

Early stage thyroid cancer has better survival and prognosis after surgical treatment.

Effects of conventional neoadjuvant chemotherapy for breast cancer on tumor angiogenesis

The effects of breast cancer conventional chemotherapy on tumor angiogenesis need to be further characterized. Neoadjuvant chemotherapy is an ideal model to evaluate the results of chemotherapy, allowing intra-patient direct comparison of antitumor and antiangiogenic effects. We sought to analyze the effect of neoadjuvant chemotherapy on tumor angiogenesis and its clinical significance in breast cancer. Breast cancer patients (n = 108) treated with neoadjuvant sequential anthracyclines and taxanes were studied. Pre- and post-chemotherapy microvessel density (MVD) and mean vessel size (MVS) were analyzed after CD34 immunohistochemistry and correlated with tumor expression of pro- and antiangiogenic factors (VEGFA, THBS1, HIF1A, CTGF, and PDGFA) by qRT-PCR. Angiogenic measures at diagnosis varied among breast cancer subtypes. Pre-treatment higher MVS was associated with triple-negative subtype and more advanced disease. Higher MVS was correlated with higher VEGFA (p = 0.003), while higher MVD was correlated with lower antiangiogenic factors expression (THBS1, p < 0.0001; CTGF, p = 0.001). Increased angiogenesis at diagnosis (high MVS and glomeruloid microvascular proliferation) and higher VEGFA expression were associated with tumor recurrence (p = 0.048 and 0.009, respectively). Chemotherapy-induced angiogenic response (defined as decreased MVD) was present in 35.2 % of patients. This response correlated with an increase in antiangiogenic factors (THBS1) without changes in VEGFA expression, and it was associated with tumor downstaging, but not with clinical response, pathologic complete response, or prognosis. Global effects of chemotherapy mainly consisted in an increased expression of antiangiogenic factors (THBS1, CTGF), with significant changes neither of tumor VEGFA nor of MVS. Conventionally scheduled neoadjuvant chemotherapy exerts antiangiogenic effects, through an increase in antiangiogenic factors, THBS1 and CTGF, but the expression of VEGFA is maintained after treatment. Better markers of angiogenic response and a better understanding of the cooperation of chemotherapy and antiangiogenic therapy in the neoadjuvant clinical scenario are needed.

Abstract P5-09-06: Decrease of tumor F3 expression after neoadjuvant chemotherapy associates to lower survival in breast cancer

Background:

Pathologic complete response (pCR) is the main prognostic factor after neoadjuvant chemotherapy (nCT) for breast cancer (BC). However, in cases without pCR, additional prognostic biomarkers are needed for subsequent prognostic and therapeutic stratification of patients. Tissue factor (F3) is the protease initiator of blood coagulation cascade and is expressed in solid tumors including BC. F3 oncogenic functions derive both from coagulation activation and from its cytoplasmic domain, although they are not well known yet. Prognostic impact of F3 circulating levels and tumor expression seems to be variable, and no studies evaluating F3 expression changes in the residual tumor after nCT are available. Our aim was to evaluate chemotherapy-mediated changes in F3 mRNA levels and their prognostic value in BC treated with nCT.

Methods:

RNA was isolated from FFPE samples of pre- and post-CT tumors. Post-CT F3 levels were analyzed only in patients without primary tumor pCR. Quantification of F3 was performed by RT-qPCR. F3 expression was categorized as no expression or above/below median expression. Change in expression levels (ΔF3), defined as pre-nCT minus post-nCT, was categorized by value of change (positive vs. negative). Association of F3 levels with clinical and pathological characteristics and analysis of paired samples was evaluated with non-parametric tests. Kaplan-Meier curves, log-rank test and Cox proportional hazard regression multivariate models were used for survival analysis. To externally validate our results, we also studied the correlation between F3 and the rest of the set of genes in the TCGA database. The best 150 directly and 150 inversely correlated genes (r &gt;0.3 and &lt;-0.3 respectively) were selected and functional prediction was performed using Genemania software for both groups.

Results:

We included 108 consecutive women with invasive BC, mostly with stages IIB or IIIA-C; Her2+: 25.0%, triple negative: 22.2%. After nCT including anthracyclines and taxanes, pCR rate was 19.4%. nCT significantly increased F3 expression (p&lt;0.000001). Pre-CT F3 levels were not associated with prognostic or predictive variables in our series. Loss or low post-CT F3 levels were associated with poor prognosis only in the univariate analysis. However, a nCT-induced decrease in F3 expression had a negative impact on overall survival in both univariate and multivariate analysis including cN (p=0.001 and 0.013 respectively). Both in our series and in external databases, F3 mRNA levels have an inverse correlation with proliferative genes, and nCT enhances these correlations (pre-CT: MYBL2: r=-0.358, p=0.001; MKI67: r=-0.267, p=0.019; post-CT: MYBL2: r=-0.495, p&lt;0.001; MKI67: r=-0.498, p&lt;0.001). A functional strong inverse correlation between F3 and mitotic functions was also confirmed in TCGA database.

Conclusion:

Our data demonstrate that nCT consistently increases tumor F3 expression. However, those cases with decreased expression of F3 after chemotherapy show poor overall survival rates. Functional analysis in our series and in public databases demonstrate that decreased F3 mRNA expression correlates with an increased mitotic activity, suggesting that low F3 mRNA levels could be a marker of active and resistant to treatment tumors.

Citation Format: Ginés Luengo-Gil, Enrique González-Billalabeitia, Rocío González-Conejero, Asunción Chaves-Benito, Elena García-Martínez, Gloria Soler-Sánchez, Elisa García-Garre, Lorena Velázquez, Vicente Vicente, Francisco Ayala de la Peña. Decrease of tumor F3 expression after neoadjuvant chemotherapy associates to lower survival in breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-09-06.

Abstract P4-07-15: Prognostic impact of miR-18a expression in residual tumor after neoadjuvant chemotherapy for locally advanced breast cancer

Background: microRNAs (miRNAs) are small ribonucleic acids that regulate protein expression through gene silencing mechanisms and show differential expression between cancer subtypes. Several studies have demonstrated that over- or under-expression of miRNA levels in tumors can modulate the expression levels of their gene/protein targets and thus their behavior. In breast cancer, the members of cluster miR-17-92 increase their expression levels as the histological grade increases, behaving like an oncogene, and are preferentially expressed in basal-like carcinomas. Moreover, mature components of this cluster are involved in estrogen receptor pathways and epithelial-mesenchymal transition, which suggest their implication in resistance to chemotherapy. The aim of this study was to determine the prognostic impact of miR-18a expression in the residual (resistant-to-treatment) tumor after neoadjuvant chemotherapy (nQT) in patients with locally advanced breast cancer (BC).

Methods: Small RNA was isolated from FFPE samples of post-chemotherapy residual tumor in patients without pathological complete response (pCR). Quantification of miR-18a was performed by RT-qPCR. Expression levels were determined by 2-DDCt method using snRNAU6 as endogenous control. We used the quartiles of expression as cutoff point. Association of miR-18a levels with clinical and pathological characteristics was evaluated with non-parametric tests. Kaplan-Meier curves, log-rank test and Cox proportional hazard regression multivariate models were used for disease free (DFS) and overall (OS) survival analysis. Statistical analysis was performed with SPSS 18.0 software.

Results: 121 consecutive women with invasive BC were included, mostly with stages IIB (28%) or IIIA-C (56.4%). Patients were immunohistochemically (IHC) classified as Her2- hormone-sensitive (HS) in 50.4% of cases; other phenotypes: Her2+ HS, 13.2%; Her2+ non-HS, 10.7%; triple negative, 21.5%. Treatment included sequential anthracyclines and taxanes (80.4% docetaxel) and a pCR was obtained in 17.4% of patients. Median overall survival (OS) and disease free survival (DFS) were not reached after a median follow-up of 60 months. High (above the median) expression levels of miR-18a in post-chemotherapy residual tumor were associated with pre-treatment grade 3 (p = 0.008), cN2-3 (p = 0.004), non-HS (p = 0.006) and triple negative phenotype (p = 0.01). No other associations with clinical or pathologic tumor characteristics (stage, HER2NEU overexpression) were found. High expression levels of miR-18a in residual tumors were also associated with reduced DFS and OS (log-rank test; p = 0.004 and p = 0.041 respectively). This negative prognostic impact was also confirmed for DFS in a multivariate analysis that included IHC phenotype and ypN+ (Table 1).

Table 1 OR95%CIPPhenotype1.571.11-2.230.010ypN+7.291.67-31.800.008miR-18a high3.091.01-9.410.047

Conclusion: High expression levels of miR-18a in chemotherapy-resistant residual breast cancer associates with pre-treatment aggressive biological characteristics and independently predicts disease recurrence. Our results suggest that post-treatment miR-18a might serve as a marker of treatment resistance and as a new target for BC treatment.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-07-15.