Circulating small-sized endothelial microparticles as predictors of clinical outcome after chemotherapy for breast cancer: an exploratory analysis

PURPOSE

Therapeutic exploitation of angiogenesis in breast cancer has been limited by the lack of reliable biomarkers. Circulating small-sized endothelial microparticles (sEMP) are likely to play a significant role as messengers of angiogenesis. Higher levels of EMP have been observed in cancer patients, but their prognostic value in breast cancer is unknown. Our aim was to determine the value of circulating sEMP as a marker of response to chemotherapy in breast cancer.

METHODS

We included patients with breast cancer treated with neoadjuvant or first-line chemotherapy. Baseline and post-treatment circulating sEMP (CD144+) were quantified using a flow cytometer approach specifically designed for analysis of small-sized particles (0.1-0.5 μm). Small-sized EMP response was defined as a post-treatment decrease of sEMP larger than the median decrease of sEMP after chemotherapy. Baseline and post-chemotherapy VEGFA levels were determined with ELISA.

RESULTS

Forty-four breast cancer patients were included (19 with metastatic and 25 with locally advanced disease). Median levels of sEMP decreased after chemotherapy (P = 0.005). Response to chemotherapy showed a non-significant trend to associate with sEMP response (P = 0.056). A sEMP response was observed in 51% of patients and was associated with better overall survival (HR 0.18; 95% CI 0.04-0.87; P = 0.02) and progression free survival (HR 0.30; 95% CI 0.09-0.99; P = 0.04) in the group of women with metastatic disease. Post-chemotherapy decrease of VEGFA levels was not associated with breast cancer prognosis.

CONCLUSIONS

Our results did not support sEMP as a marker of response to chemotherapy. However, our exploratory analysis suggests that in patients with metastatic breast cancer, the decrease of sEMP levels after chemotherapy is associated with better overall and disease free survival and might be superior to VEGFA levels as an angiogenesis-related prognostic marker.

[Epidemiologic aspects of snakebites in Vale do Ribeira, São Paulo, 1985-1989]

This study reports on the incidence of snakebites from January 1985 to December 1989 in Vale do Ribeira, S o Paulo, Brazil. Overall incidence ranged from 68.7 to 84.2/100,000. There were 840 snakebites during this period, with higher frequency from October to May. The highest incidence rates were observed in the districts of Jugui and Eldorado (159.4 and 131.4/100,000, respectively). Most of the patients were male. Agricultural workers were the most heavily affected. Most of the patients received treatment within 2 hours after the bite. Morbidity was not severe and lethality was 0.2%.

Critical Care Scoring System--new concept based on hemodynamic data

Based on the rationale that hemodynamic, oxygen transport, and perfusion derangements describe physiologically important abnormalities in critically ill patients, we devised a Critical Care Scoring System (CCSS). The database includes a retrospective analysis of 318 patients managed with pulmonary artery catheters during 1986 to 1988. For comparison, Acute Physiology and Chronic Health Evaluation (APACHE II) score was computed for these patients. CCSS includes a total of 17 variables with a weighted score of 71. The mortality rates for increases by 5 points were observed and were statistically significant (p less than .0001). The same was not true for APACHE II. Although neither of the scores could predict ICU days, both reflected the number of life-threatening complications. Serial CCSS that was computed at 24 +/- 4 h (CCSS-C) provided documentation for improvement in patient condition secondary to therapeutic interventions. Statistically improved mortality prediction was observed with CCSS-C. Since 70 (45.7%) of 153 patients died with an APACHE II score less than 14, it appears that this score is deficient in a specific group of patients, i.e., those requiring invasive monitoring. For patients with circulatory or respiratory failure, CCSS may offer a better tool to predict mortality and evaluate therapy.