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Thornton R, Davey MG, Kerin MJ. Evaluating the utility of robotic axillary lymph node dissection in patients with invasive breast cancer: a systematic review. Ir J Med Sci 2023:10.1007/s11845-023-03561-w. [PMID: 37971673 DOI: 10.1007/s11845-023-03561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Robot-assisted axillary lymph node dissection (RALND) has been proposed to improve surgical and oncological outcomes for patients with breast cancer. To perform a systematic review of current literature evaluating RALND in patients with invasive breast cancer. A systematic search was performed in accordance with the PRISMA guidelines. Studies outlining outcomes following RALND were included. Two studies involving 92 patients were included in this review. Of these, 41 underwent RALND using the da Vinci© robotic system (44.57%), and 51 underwent conventional axillary lymph node dissection (CALND) (55.43%). There was no significant difference observed with respect to intra-operative blood loss or duration of procedure in those undergoing CALND and RALND (P > 0.050). One study reported a significant difference in lymphoedema rates in support of RALND (6.67% vs 26.67%, P = 0.038). Overall, data in relation to postoperative fat necrosis (10.00% vs 33.33%, P = 0.028), wound infection rates (3.33% vs. 20.00%, P = 0.044), and wound ≤ 40 mm in length (63.63% vs. 19.05%, P = 0.020) supported RALND. Oncological outcomes were only reported in one of the studies, which concluded that there was no local or metastatic recurrence in either group at 3-month follow-up. These provisional results support RALND as a safe alternative to CALND. Notwithstanding, the paucity of data limits the robustness of conclusions which may be drawn surrounding the adoption of RALND as the standard of care. Further high-quality studies are required to ratify these findings.
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Affiliation(s)
- Róisín Thornton
- Department of Surgery, University of Galway, Galway, Republic of Ireland.
| | - Matthew G Davey
- Department of Surgery, University of Galway, Galway, Republic of Ireland
| | - Michael J Kerin
- Department of Surgery, University of Galway, Galway, Republic of Ireland
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2
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Tariq M, Richard V, Kerin MJ. MicroRNAs as Molecular Biomarkers for the Characterization of Basal-like Breast Tumor Subtype. Biomedicines 2023; 11:3007. [PMID: 38002007 PMCID: PMC10669494 DOI: 10.3390/biomedicines11113007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Breast cancer is a heterogeneous disease highlighted by the presence of multiple tumor variants and the basal-like breast cancer (BLBC) is considered to be the most aggressive variant with limited therapeutics and a poor prognosis. Though the absence of detectable protein and hormonal receptors as biomarkers hinders early detection, the integration of genomic and transcriptomic profiling led to the identification of additional variants in BLBC. The high-throughput analysis of tissue-specific micro-ribonucleic acids (microRNAs/miRNAs) that are deemed to have a significant role in the development of breast cancer also displayed distinct expression profiles in each subtype of breast cancer and thus emerged to be a robust approach for the precise characterization of the BLBC subtypes. The classification schematic of breast cancer is still a fluid entity that continues to evolve alongside technological advancement, and the transcriptomic profiling of tissue-specific microRNAs is projected to aid in the substratification and diagnosis of the BLBC tumor subtype. In this review, we summarize the current knowledge on breast tumor classification, aim to collect comprehensive evidence based on the microRNA expression profiles, and explore their potential as prospective biomarkers of BLBC.
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Affiliation(s)
| | - Vinitha Richard
- Discipline of Surgery, Lambe Institute for Translational Research, H91 TK33 Galway, Ireland;
| | - Michael J. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, H91 TK33 Galway, Ireland;
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Davey MG, Abbas R, Kerin EP, Casey MC, McGuire A, Waldron RM, Heneghan HM, Newell J, McDermott AM, Keane MM, Lowery AJ, Miller N, Kerin MJ. Circulating microRNAs can predict chemotherapy-induced toxicities in patients being treated for primary breast cancer. Breast Cancer Res Treat 2023; 202:73-81. [PMID: 37540289 PMCID: PMC10504160 DOI: 10.1007/s10549-023-07033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Prescribing NAC for breast cancer is a pragmatic treatment strategy for several reasons; however, certain patients suffer chemotherapy-induced toxicities. Unfortunately, identifying patients at risk of toxicity often proves challenging. MiRNAs are small non-coding RNA molecules which modulate genetic expression. The aim of this study was to determine whether circulating miRNAs are sensitive biomarkers that can identify the patients likely to suffer treatment-related toxicities to neoadjuvant chemotherapy (NAC) for primary breast cancer. METHODS This secondary exploratory from the prospective, multicentre translational research trial (CTRIAL ICORG10/11-NCT01722851) recruited 101 patients treated with NAC for breast cancer, from eight treatment sites across Ireland. A predetermined five miRNAs panel was quantified using RQ-PCR from patient bloods at diagnosis. MiRNA expression was correlated with chemotherapy-induced toxicities. Regression analyses was performed using SPSS v26.0. RESULTS One hundred and one patients with median age of 55 years were recruited (range: 25-76). The mean tumour size was 36 mm and 60.4% had nodal involvement (n = 61) Overall, 33.7% of patients developed peripheral neuropathies (n = 34), 28.7% developed neutropenia (n = 29), and 5.9% developed anaemia (n = 6). Reduced miR-195 predicted patients likely to develop neutropenia (P = 0.048), while increased miR-10b predicted those likely to develop anaemia (P = 0.049). Increased miR-145 predicted those experiencing nausea and vomiting (P = 0.019), while decreased miR-21 predicted the development of mucositis (P = 0.008). CONCLUSION This is the first study which illustrates the value of measuring circulatory miRNA to predict patient-specific toxicities to NAC. These results support the ideology that circulatory miRNAs are biomarkers with utility in predicting chemotherapy toxicity as well as treatment response.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland.
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, D02 YN77, Ireland.
| | - Ray Abbas
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - Eoin P Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - Maire Caitlin Casey
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - Andrew McGuire
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - Ronan M Waldron
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - Helen M Heneghan
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - John Newell
- School of Mathematics, Statistics and Applied Mathematics, University of Galway, Galway, H91 TK33, Ireland
| | - Ailbhe M McDermott
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospital, Galway, H71 YR71, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - Nicola Miller
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, H91 YR71, Ireland
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Dublin, D11 KXN4, Ireland
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Abbas Syed R, Davey MG, Richard V, Miller N, Kerin MJ. Biological Implications of MicroRNAs as Regulators and Biomarkers of Therapeutic Toxicities in Breast Cancer. Int J Mol Sci 2023; 24:12694. [PMID: 37628874 PMCID: PMC10454054 DOI: 10.3390/ijms241612694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Contemporary breast cancer management includes surgical resection combined with a multimodal approach, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapies. Breast cancer treatment is now personalised in accordance with disease and host factors, which has translated to enhanced outcomes for the vast majority of patients. Unfortunately, the treatment of the disease involves patients developing treatment-induced toxicities, with cardiovascular and metabolic side effects having negative implications for long-term quality-of-life metrics. MicroRNAs (miRNAs) are a class of small non-coding ribonucleic acids that are 17 to 25 nucleotides in length, which have utility in modifying genetic expression by working at a post-transcriptional cellular level. miRNAs have involvement in modulating breast cancer development, which is well described, with these biomarkers acting as important regulators of disease, as well as potential diagnostic and therapeutic biomarkers. This review focuses on highlighting the role of miRNAs as regulators and biomarkers of disease, particularly in breast cancer management, with a specific mention of the potential value of miRNAs in predicting treatment-related cardiovascular toxicity.
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Affiliation(s)
- Raza Abbas Syed
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 YR71 Galway, Ireland; (M.G.D.)
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Davey MG, Lowery AJ, Kerin MJ. Oncological safety of active surveillance for low-risk ductal carcinoma in situ - a systematic review and meta-analysis. Ir J Med Sci 2023; 192:1595-1600. [PMID: 36112315 DOI: 10.1007/s11845-022-03157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Current standard of care for patients diagnosed with "low-risk" ductal carcinoma in situ (DCIS) involves surgical resection. Ongoing phase III clinical trials are hoping to establish the oncological safety of active surveillance (AS) in managing "low-risk" DCIS. AIMS To evaluate the oncological safety of AS versus surgery for "low-risk" DCIS. METHODS A systematic review was performed in accordance with PRISMA guidelines. Survival outcomes were expressed as dichotomous variables and reported as odds ratios (OR) with 95% confidence intervals (95% CI) using the Mantel-Haenszel method. RESULTS Four studies including 9626 patients were included, 3.9% of which were managed using AS (374/9626) and 96.1% with surgery (9252/9626). The mean age of included patients was 50.3 years (range: 30-99 years) and mean follow-up was 6.1 years. Invasive cancer detection after surgery and AS were similar (OR: 0.93, 95% CI: 0.41-2.11, P = 0.860, heterogeneity (I2) = 0%). At 5 years, BCSS (surgery 99.5% vs. AS 98.7%, P = 0.116) and OS (surgery 95.8% vs. AS 95.7%, P = 0.876) were similar for both groups. At 10 years, BCSS (surgery 98.7% vs. AS 98.6%, P = 0.789) and OS (surgery 87.9% vs. AS 90.9%, P = 0.183) were similar for both groups. Overall, 10-year OS outcomes were similar for both management strategies (OR: 0.32, 95% CI: 0.02-6.42, P = 0.460, I2 = 69%). CONCLUSION This study outlines the provisional oncological safety of AS for cases of "low-risk" DCIS. While survival outcomes were comparable for both management strategies, ratification of these results in the ongoing phase III clinical trials is still required prior to changes to current management strategies. PROSPERO REGISTRATION CRD42022313241.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland.
- Department of Surgery, Galway University Hospitals, Galway, H91YR71, Republic of Ireland.
| | - Aoife J Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
| | - Michael J Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
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Calpin GG, Davey MG, Calpin P, Browne F, Lowery AJ, Kerin MJ. The impact of liver resection on survival for patients with metastatic breast cancer - A systematic review and meta-analysis. Surgeon 2023; 21:242-249. [PMID: 36333192 DOI: 10.1016/j.surge.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/23/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION There is uncertainty surrounding the role of resection as an option for curative treatment of breast cancer with liver metastases (BCLM). AIM To perform a systematic review and meta-analysis evaluating the role of liver resection for BCLM. METHODS A systematic review was performed as per PRISMA guidelines. Hazard ratio (HR) for overall survival (OS) and standard error was obtained from each study and expressed using the generic inverse variance method, with a corresponding 95% confidence interval (CI). OS outcomes at 1- 3- and 5-years were expressed as dichotomous variables and pooled as odds ratios (OR) using the Mantel-Haenszel method. RESULTS Nine studies with 1732 patients were included. Of these, 24.5% underwent surgical resection of BCLM (424/1732) and 75.5% did not (1308/1732). Overall, OS was significantly better among those who underwent surgery versus controls (HR: 0.69, 95% CI: 0.59-0.80, P < 0.00001). Mortality rates were significantly reduced at 1-year (7.5% (10/134) vs 20.3% (79/390), OR: 0.25, 95% CI: 0.08-0.74, P = 0.010) and 5-years (54.0% (190/352) vs 75.3% (940/1249), OR: 0.46, 95% CI: 0.25-0.87, P = 0.020) respectively for those undergoing surgery versus controls. Mortality rates at 3 years after surgery were lower than the control group (19.1% (29/152) vs 53.0% (222/419)), however this failed to achieve statistical significance at meta-analysis (OR: 0.32, 95% CI: 0.09-1.12, P = 0.070). CONCLUSION Liver resection may be considered at multidisciplinary meetings for those with BCLM and offers a potentially curative option. However, judicious patient selection is crucial prior to making decisions in relation to resection of BCLM.
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Affiliation(s)
- Gavin G Calpin
- Department of Surgery, University Hospital Galway, Galway, Ireland.
| | - Matthew G Davey
- Department of Surgery, University Hospital Galway, Galway, Ireland; Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Pádraig Calpin
- Department of Anaesthesiology, University Hospital Galway, Galway, Ireland
| | - Ferdia Browne
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, University Hospital Galway, Galway, Ireland; Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, University Hospital Galway, Galway, Ireland; Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Davey MG, Ryan ÉJ, Donlon NE, Ryan OK, Al Azzawi M, Boland MR, Kerin MJ, Lowery AJ. Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials. Langenbecks Arch Surg 2023; 408:180. [PMID: 37145303 PMCID: PMC10163131 DOI: 10.1007/s00423-023-02911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and robotic adrenalectomy (RA) for resecting adrenal tumours. AIM To evaluate outcomes for OA, TLA, PRA, and RA from RCTs. METHODS A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. RESULTS Eight RCTs with 488 patients were included (mean age: 48.9 years). Overall, 44.5% of patients underwent TLA (217/488), 37.3% underwent PRA (182/488), 16.4% underwent RA (80/488), and just 1.8% patients underwent OA (9/488). The mean tumour size was 35 mm in largest diameter with mean sizes of 44.3 mm for RA, 40.9 mm for OA, 35.5 mm for TLA, and 34.4 mm for PRA (P < 0.001). TLA had the lowest blood loss (mean: 50.6 ml), complication rates (12.4%, 14/113), and conversion to open rates (1.3%, 2/157), while PRA had the shortest intra-operative duration (mean: 94 min), length of hospital stay (mean: 3.7 days), lowest visual analogue scale pain scores post-operatively (mean: 3.7), and was most cost-effective (mean: 1728 euros per case). At NMA, there was a significant increase in blood loss for OA (mean difference (MD): 117.00 ml (95% confidence interval (CI): 1.41-230.00)) with similar blood loss observed for PRA (MD: - 10.50 (95% CI: - 83.40-65.90)) compared to TLA. CONCLUSION LTA and PRA are important contemporary options in achieving favourable outcomes following adrenalectomy. The next generation of RCTs may be more insightful for comparison surgical outcomes following RA, as this approach is likely to play a future role in minimally invasive adrenalectomy. PROSPERO REGISTRATION CRD42022301005.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland.
- Department of Surgery, Galway University Hospitals, Galway, H91YR71, Republic of Ireland.
| | - Éanna J Ryan
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Noel E Donlon
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Odhrán K Ryan
- Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Mohammed Al Azzawi
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Michael R Boland
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Michael J Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland
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Bouz Mkabaah L, Davey MG, Lennon JC, Bouz G, Miller N, Kerin MJ. Assessing the Role of MicroRNAs in Predicting Breast Cancer Recurrence-A Systematic Review. Int J Mol Sci 2023; 24:ijms24087115. [PMID: 37108278 PMCID: PMC10138898 DOI: 10.3390/ijms24087115] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Identifying patients likely to develop breast cancer recurrence remains a challenge. Thus, the discovery of biomarkers capable of diagnosing recurrence is of the utmost importance. MiRNAs are small, non-coding RNA molecules which are known to regulate genetic expression and have previously demonstrated relevance as biomarkers in malignancy. To perform a systematic review evaluating the role of miRNAs in predicting breast cancer recurrence. A formal systematic search of PubMed, Scopus, Web of Science, and Cochrane databases was performed. This search was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist. A total of 19 studies involving 2287 patients were included. These studies identified 44 miRNAs which predicted breast cancer recurrence. Results from nine studies assessed miRNAs in tumour tissues (47.4%), eight studies included circulating miRNAs (42.1%), and two studies assessed both tumour and circulating miRNAs (10.5%). Increased expression of 25 miRNAs were identified in patients who developed recurrence, and decreased expression of 14 miRNAs. Interestingly, five miRNAs (miR-17-5p, miR-93-5p, miR-130a-3p, miR-155, and miR-375) had discordant expression levels, with previous studies indicating both increased and reduced expression levels of these biomarkers predicting recurrence. MiRNA expression patterns have the ability to predict breast cancer recurrence. These findings may be used in future translational research studies to identify patients with breast cancer recurrence to improve oncological and survival outcomes for our prospective patients.
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Affiliation(s)
- Luis Bouz Mkabaah
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 YR71 Galway, Ireland
| | - Matthew G Davey
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 YR71 Galway, Ireland
| | - James C Lennon
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 YR71 Galway, Ireland
| | - Ghada Bouz
- Faculty of Pharmacy in Hradec Králové, Charles University, 50005 Hradec Králové, Czech Republic
| | - Nicola Miller
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 YR71 Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 YR71 Galway, Ireland
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McVeigh TP, Sweeney KJ, Brennan DJ, McVeigh UM, Ward S, Strydom A, Seal S, Astbury K, Donnellan P, Higgins J, Keane M, Kerin MJ, Malone C, McGough P, McLaughlin R, O'Leary M, Rushe M, Barry MK, MacGregor G, Sugrue M, Yousif A, Al-Azawi D, Berkeley E, Boyle TJ, Connolly EM, Nolan C, Richardson E, Giffney C, Doyle SB, Broderick S, Boyd W, McVey R, Walsh T, Farrell M, Gallagher DJ, Rahman N, George AJ. A pilot study investigating feasibility of mainstreaming germline BRCA1 and BRCA2 testing in high-risk patients with breast and/or ovarian cancer in three tertiary Cancer Centres in Ireland. Fam Cancer 2023; 22:135-149. [PMID: 36029389 DOI: 10.1007/s10689-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
Abstract
In the Republic of Ireland (ROI), BRCA1/BRCA2 genetic testing has been traditionally undertaken in eligible individuals, after pre-test counselling by a Clinical Geneticist/Genetic Counsellor. Clinical Genetics services in ROI are poorly resourced, with routine waiting times for appointments at the time of this pilot often extending beyond a year. The consequent prolonged waiting times are unacceptable where therapeutic decision-making depends on the patient's BRCA status. "Mainstreaming" BRCA1/BRCA2 testing through routine oncology/surgical clinics has been implemented successfully in other centres in the UK and internationally. We aimed to pilot this pathway in three Irish tertiary centres. A service evaluation project was undertaken over a 6-month period between January and July 2017. Eligible patients, fulfilling pathology and age-based inclusion criteria defined by TGL clinical, were identified, and offered constitutional BRCA1/BRCA2 testing after pre-test counselling by treating clinicians. Tests were undertaken by TGL Clinical. Results were returned to clinicians by secure email. Onward referrals of patients with uncertain/pathogenic results, or suspicious family histories, to Clinical Genetics were made by the treating team. Surveys assessing patient and clinician satisfaction were sent to participating clinicians and a sample of participating patients. Data was collected with respect to diagnostic yield, turnaround time, onward referral rates, and patient and clinician feedback. A total of 101 patients underwent diagnostic germline BRCA1/BRCA2 tests through this pathway. Pathogenic variants were identified in 12 patients (12%). All patients in whom variants were identified were appropriately referred to Clinical Genetics. At least 12 additional patients with uninformative BRCA1/BRCA2 tests were also referred for formal assessment by Clinical Geneticist or Genetic Counsellor. Issues were noted in terms of time pressures and communication of results to patients. Results from a representative sample of participants completing the satisfaction survey indicated that the pathway was acceptable to patients and clinicians. Mainstreaming of constitutional BRCA1/BRCA2 testing guided by age- and pathology-based criteria is potentially feasible for patients with breast cancer as well as patients with ovarian cancer in Ireland.
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Affiliation(s)
- Terri Patricia McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK.
| | - Karl J Sweeney
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Donal J Brennan
- Mater Misericordiae University Hospital, Dublin, Ireland
- The National Maternity Hospital, Holles St, Dublin, Ireland
| | | | - Simon Ward
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Katherine Astbury
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Paul Donnellan
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Joanne Higgins
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Maccon Keane
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael J Kerin
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
- National University of Ireland, Galway, Ireland
| | - Carmel Malone
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
- National University of Ireland, Galway, Ireland
| | - Pauline McGough
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Ray McLaughlin
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael O'Leary
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Margaret Rushe
- Saolta Health Care Group, Galway University Hospital, Galway, Ireland
| | - Michael Kevin Barry
- Saolta Health Care Group, Mayo University Hospital, Co Mayo, Castlebar, Ireland
| | - Geraldine MacGregor
- Saolta University Health Care Group, Letterkenny University Hospital, Co Donegal, Letterkenny, Ireland
| | - Michael Sugrue
- Saolta University Health Care Group, Letterkenny University Hospital, Co Donegal, Letterkenny, Ireland
| | - Ala Yousif
- Saolta University Hospital Group, Sligo University Hospital, Sligo, Ireland
| | | | | | | | | | | | | | | | | | | | - William Boyd
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ruaidhri McVey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Thomas Walsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - David J Gallagher
- St James's University Hospital, Dublin, Ireland
- Mater Private Hospital, Dublin, Ireland
| | | | - Angela J George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
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Davey MG, Kerin EP, McLaughlin RP, Barry MK, Malone CM, Elwahab SA, Lowery AJ, Kerin MJ. Evaluating the Necessity for Routine Sentinel Lymph Node Biopsy in Postmenopausal Patients Being Treated for Clinically Node Negative Breast Cancer the Era of RxPONDER. Clin Breast Cancer 2023:S1526-8209(23)00080-0. [PMID: 37076364 DOI: 10.1016/j.clbc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Traditionally, sentinel lymph node biopsy (SLNB) was performed to inform adjuvant chemotherapy prescription and prognosis in breast cancer. Following RxPONDER, the OncotypeDX Recurrence Score (RS) guides adjuvant chemotherapy prescription for all postmenopausal patients with estrogen receptor positive, human epidermal growth factor receptor-2 negative (ER+/HER2-) breast cancer with 0 to 3 positive lymph nodes (0-3 + LN). AIMS To establish the oncological safety of omitting SLNB in postmenopausal patients with ER+/HER2- breast cancer indicated to undergo SLNB and to evaluate the primary determinants of chemotherapy prescription for these patients. PATIENTS AND METHODS A retrospective cohort study was undertaken. Cox regression and Kaplan-Meier analyses were performed. Data analytics was performed using SPSS v26.0. RESULTS Five hundred and seventy five consecutive patients were included (mean age: 66.5 years, range: 45-96). The median follow-up was 97.2 months (range: 3.0-181.6). Of the 575 patients, just 12 patients had positive SLNB (SLNB+) (2.1%). Using Kaplan-Meier analyses, SLNB+ failed to impact recurrence (P = .766) or mortality (P = .310). However, using Cox regression analyses, SLNB+ independently predicted poorer disease-free survival (hazard ratio: 1.001, 95% confidence interval (95% CI): 1.000-1.001, P = .029). Logistic regression analysis identified RS as the sole predictor of chemotherapy prescription (odds ratio: 1.171, 95% CI: 1.097-1.250, P < .001). CONCLUSION Omitting SLNB may be safe and justifiable in postmenopausal patients with ER+/HER2- breast cancer with clinically negative axillae. Following RxPONDER, RS is the most important guide of chemotherapy use in these patients and SLNB may be less important than previously perceived. Prospective, randomized clinical trials are required to fully establish the oncological safety of omitting SLNB in this setting.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland.
| | - Eoin P Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland
| | - Ray P McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael K Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Carmel M Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Sami Abd Elwahab
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
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11
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Richard V, Nair MG, Jaikumar VS, Jones S, Prabhu JS, Kerin MJ. Cell State Transitions and Phenotypic Heterogeneity in Luminal Breast Cancer Implicating MicroRNAs as Potential Regulators. Int J Mol Sci 2023; 24:ijms24043497. [PMID: 36834918 PMCID: PMC9967449 DOI: 10.3390/ijms24043497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Luminal breast cancer subtypes respond poorly to endocrine and trastuzumab treatments due to cellular heterogeneity arising from the phenotype transitions, accounted for mainly by the loss of receptor expression. The origins of basal-like and human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer subtypes have been attributed to genetic and protein modifications in stem-like cells and luminal progenitor cell populations, respectively. The post-transcriptional regulation of protein expression is known to be influenced by microRNAs (miRNAs) that are deemed to be master regulators of several biological processes in breast tumorigenesis and progression. Our objective was to identify the fractions of luminal breast cancer cells that share stemness potentials and marker profiles and to elucidate the molecular regulatory mechanism that drives transitions between fractions, leading to receptor discordances. Established breast cancer cell lines of all prominent subtypes were screened for the expression of putative cancer stem cell (CSC) markers and drug transporter proteins using a side population (SP) assay. Flow-cytometry-sorted fractions of luminal cancer cells implanted in immunocompromised mice generated a pre-clinical estrogen receptor alpha (ERα+) animal model with multiple tumorigenic fractions displaying differential expression of drug transporters and hormone receptors. Despite an abundance of estrogen receptor 1 (ESR1) gene transcripts, few fractions transitioned to the triple-negative breast cancer (TNBC) phenotype with a visible loss of ER protein expression and a distinct microRNA expression profile that is reportedly enriched in breast CSCs. The translation of this study has the potential to provide novel therapeutic miRNA-based targets to counter the dreaded subtype transitions and the failure of antihormonal therapies in the luminal breast cancer subtype.
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Affiliation(s)
- Vinitha Richard
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 V4AY Galway, Ireland
- Correspondence: (V.R.); (M.J.K.)
| | - Madhumathy G. Nair
- Division of Molecular Medicine, St. John’s Research Institute, Bangalore 560034, Karnataka, India
| | - Vishnu S. Jaikumar
- Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695585, Kerala, India
| | - Sara Jones
- Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695585, Kerala, India
| | - Jyothi S. Prabhu
- Division of Molecular Medicine, St. John’s Research Institute, Bangalore 560034, Karnataka, India
| | - Michael J. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, H91 V4AY Galway, Ireland
- Correspondence: (V.R.); (M.J.K.)
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12
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Davey MG, Kerin MJ. Molecular profiling in contemporary breast cancer management. Br J Surg 2023:7031506. [PMID: 36753055 PMCID: PMC10364497 DOI: 10.1093/bjs/znad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, University of Galway, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, University of Galway, Galway, Ireland
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13
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Davey MG, McGuire A, Casey MC, Waldron RM, Paganga M, Holian E, Newell J, Heneghan HM, McDermott AM, Keane MM, Lowery AJ, Miller N, Kerin MJ. Evaluating the Role of Circulating MicroRNAs in Predicting Long-Term Survival Outcomes in Breast Cancer: A Prospective, Multicenter Clinical Trial. J Am Coll Surg 2023; 236:317-327. [PMID: 36648259 PMCID: PMC9835657 DOI: 10.1097/xcs.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND While long-term outcomes have improved for patients with breast cancer, 20% to 30% will still develop recurrence, and identifying these patients remains a challenge. MicroRNAs (miRNAs) are small, noncoding molecules that modulate genetic expression and affect oncogenesis. STUDY DESIGN This prospective, multicenter trial (ICORG10/11-NCT01722851) recruited patients undergoing neoadjuvant chemotherapy across 8 Irish centers. Predetermined miRNAs were quantified from patient whole blood using quantitative reverse transcriptase polymerase chain reaction. Venous sampling was performed at diagnosis (timepoint 1) and midway during neoadjuvant chemotherapy (timepoint 2 [T2]). miRNA expression profiles were correlated with recurrence-free survival (RFS), disease-free survival (DFS), and overall survival. Data analysis was performed using R v3.2.3. RESULTS A total of 124 patients were recruited with a median age of 55.0 years. The median follow-up was 103.1 months. Increased miR-145 expression at T2 was associated with improved RFS (hazard ratio 0.00; 95% confidence interval [CI] 0.00 to 0.99; p = 0.050). Using survival regression tree analysis, a relative cutoff of increased miR-145 expression greater than 0.222 was associated with improved RFS (p = 0.041). Increased miR-145 expression at T2 trended towards significance in predicting improved DFS (hazard ratio 0.00; 95% CI 0.00 to 1.42; p = 0.067). Using survival regression tree analysis, a relative cutoff of increased miR-145 expression greater than 0.222 was associated with improved DFS (p = 0.012). No miRNAs correlated with overall survival. CONCLUSIONS ICORG10/11 is the first Irish multicenter, translational research trial evaluating circulatory miRNAs as biomarkers predictive of long-term survival and correlated increased miR-145 expression with enhanced outcomes in early-stage breast cancer. Validation of these findings is required in the next generation of translational research trials.
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Affiliation(s)
- Matthew G Davey
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
| | - Andrew McGuire
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
| | - Maire Caitlin Casey
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
| | - Ronan M Waldron
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
| | - Maxwell Paganga
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
- the School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland (Paganga, Holian, Newell)
| | - Emma Holian
- the School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland (Paganga, Holian, Newell)
| | - John Newell
- the School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland (Paganga, Holian, Newell)
| | - Helen M Heneghan
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
| | - Ailbhe M McDermott
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
| | - Maccon M Keane
- the Department of Medical Oncology, Galway University Hospital, Galway, Ireland (Keane)
| | - Aoife J Lowery
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
| | - Nicola Miller
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
| | - Michael J Kerin
- From the Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland (Davey, McGuire, Casey, Waldron, Heneghan, McDermott, Lowery, Miller, Kerin)
- the Cancer Trials Ireland, Innovation House, Dublin, Ireland (Kerin)
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14
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Davey MG, Kerin MJ. Targeted Endocrine Agents should be the Dominant Systemic Therapies Prescribed in Luminal A Breast Cancer. Breast Cancer (Auckl) 2023; 17:11782234221145409. [PMID: 36654912 PMCID: PMC9841871 DOI: 10.1177/11782234221145409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/21/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Matthew G Davey
- Matthew G Davey, Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway H91YR71, Ireland.
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15
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Davey MG, Browne F, Davey MS, Walsh SR, Kerin MJ, Lowery AJ. Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials. BJS Open 2023; 7:7055521. [PMID: 36821724 PMCID: PMC9949711 DOI: 10.1093/bjsopen/zrac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/17/2022] [Accepted: 12/06/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND At present, there is no consensus on optimal neck wound closure methods after thyroid and parathyroid surgery. The aim of this study was to perform a systematic review and network meta-analysis of RCTs evaluating the optimal neck closure method after thyroid and parathyroid surgery. METHODS A frequentist random-effects network meta-analysis was performed for RCTs comparing at least two closure methods according to PRISMA-network meta-analysis guidelines. Analysis was performed using R packages and Shiny. RESULTS Eighteen RCTs evaluating six closure methods (that is adhesive (28.5 per cent, 404 patients), absorbable subcuticular suture (18.1 per cent, 257 patients), non-absorbable subcuticular suture (16.8 per cent, 238 patients), staples (26.3 per cent, 372 patients), steristrips (8.1 per cent, 115 patients), and conventional suture (2.1 per cent, 30 patients)) in 1416 patients were included. At network meta-analysis, there was no difference in complication, infection, dehiscence, or haematoma rates irrespective of closure method used. Staples reduced closure duration versus absorbable subcuticular suture (mean difference (MD) 8.50, 95 per cent c.i. 6.90 to 10.10) and non-absorbable subcuticular suture (MD 0.30, 95 per cent c.i. 0.23 to 0.37), whereas adhesives (MD -1.05, 95 per cent c.i. -1.31 to -0.79) reduced closure time relative to staples. Cosmesis was improved after non-absorbable subcuticular suture (odds ratio (OR) 3.41, 95 per cent c.i. 1.66 to 7.00) relative to staples. Staples reduced patient satisfaction (OR 0.04, 95 per cent c.i. 0.00 to 0.33) and ability to shower (OR 0.04, 95 per cent c.i. 0.00 to 0.33) relative to adhesives. CONCLUSION Despite staples decreasing closure times, this advantage is offset by reduced patient satisfaction, ability to shower, and cosmesis compared with patients with wounds closed using adhesives, absorbable subcuticular suture, and non-absorbable subcuticular suture. Therefore, these closure methods are favourable for closing neck wounds due to more acceptable patient-reported outcomes, without compromising the safety of the procedure.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Ferdia Browne
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Martin S Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Stewart R Walsh
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Michael J Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
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16
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McAnena P, Moloney BM, Browne R, O’Halloran N, Walsh L, Walsh S, Sheppard D, Sweeney KJ, Kerin MJ, Lowery AJ. A radiomic model to classify response to neoadjuvant chemotherapy in breast cancer. BMC Med Imaging 2022; 22:225. [PMID: 36564734 PMCID: PMC9789647 DOI: 10.1186/s12880-022-00956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Medical image analysis has evolved to facilitate the development of methods for high-throughput extraction of quantitative features that can potentially contribute to the diagnostic and treatment paradigm of cancer. There is a need for further improvement in the accuracy of predictive markers of response to neo-adjuvant chemotherapy (NAC). The aim of this study was to develop a radiomic classifier to enhance current approaches to predicting the response to NAC breast cancer. METHODS Data on patients treated for breast cancer with NAC prior to surgery who had a pre-NAC dynamic contrast enhanced breast MRI were included. Response to NAC was assessed using the Miller-Payne system on the excised tumor. Tumor segmentation was carried out manually under the supervision of a consultant breast radiologist. Features were selected using least absolute shrinkage selection operator regression. A support vector machine learning model was used to classify response to NAC. RESULTS 74 patients were included. Patients were classified as having a poor response to NAC (reduction in cellularity < 90%, n = 44) and an excellent response (> 90% reduction in cellularity, n = 30). 4 radiomics features (discretized kurtosis, NGDLM contrast, GLZLM_SZE and GLZLM_ZP) were identified as pertinent predictors of response to NAC. A SVM model using these features stratified patients into poor and excellent response groups producing an AUC of 0.75. Addition of estrogen receptor status improved the accuracy of the model with an AUC of 0.811. CONCLUSION This study identified a radiomic classifier incorporating 4 radiomics features to augment subtype based classification of response to NAC in breast cancer.
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Affiliation(s)
- Peter McAnena
- grid.412440.70000 0004 0617 9371Department of Surgery, Clinical Sciences Institute, University Hospital Galway, Galway, Ireland
| | - Brian M. Moloney
- grid.412440.70000 0004 0617 9371Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Robert Browne
- grid.412440.70000 0004 0617 9371Department of Surgery, Clinical Sciences Institute, University Hospital Galway, Galway, Ireland
| | - Niamh O’Halloran
- grid.412440.70000 0004 0617 9371Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Leon Walsh
- grid.412440.70000 0004 0617 9371Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Sinead Walsh
- grid.412440.70000 0004 0617 9371Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Declan Sheppard
- grid.412440.70000 0004 0617 9371Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Karl J. Sweeney
- grid.412440.70000 0004 0617 9371Department of Surgery, Clinical Sciences Institute, University Hospital Galway, Galway, Ireland
| | - Michael J. Kerin
- grid.412440.70000 0004 0617 9371Department of Surgery, Clinical Sciences Institute, University Hospital Galway, Galway, Ireland ,grid.6142.10000 0004 0488 0789Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife J. Lowery
- grid.412440.70000 0004 0617 9371Department of Surgery, Clinical Sciences Institute, University Hospital Galway, Galway, Ireland ,grid.6142.10000 0004 0488 0789Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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17
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Davey MG, Keelan S, Lowery AJ, Kerin MJ. The Impact of Chemotherapy Prescription on Long-Term Survival Outcomes in Early-Stage Invasive Lobular Carcinoma - A Systematic Review and Meta-Analysis. Clin Breast Cancer 2022; 22:e843-e849. [PMID: 36229335 DOI: 10.1016/j.clbc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Invasive lobular carcinoma (ILCs) are typically endocrine responsive breast cancers which respond poorly to chemotherapy. The long-term survival advantage of prescribing chemotherapy in such cases remains unclear. To perform a systematic review and meta-analysis assessing, the impact of prescribing chemotherapy in such patients on long-term disease-free (DFS) and overall (OS) survival outcomes. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Ten-year DFS and OS were pooled as odds ratios (ORs) with 95% confidence intervals (CI) using the Mantel-Haenszel method. Time-to-effect modelling was performed using the generic inverse variance method. RESULTS Overall, 9 studies including 28,218 patients were included. The mean follow-up was 74 months (range: 0-150 months) and mean age was 60 years (range: 22-90 years). Of these, 34.7% received chemotherapy (9,797/28,218) and 66.3% did not receive chemotherapy (18,421/28,218). Chemotherapy prescription failed to improve 10-year DFS (OR: 0.89, 95% CI: 0.65-1.23) and OS (OR: 0.92, 95% CI: 0.72-1.18). When using time-to-effect modelling, chemotherapy prescription failed to improve DFS (hazard ratio (HR): 1.01, 95% CI: 0.78-1.31) and OS (HR: 1.07, 95% CI: 0.89-1.27, I2= 67%). CONCLUSION This meta-analysis illustrates no long-term survival advantage associated with chemotherapy prescription in the setting of early-stage ILC. In the absence of well-designed, prospective clinical trials evaluating the impact of chemotherapy on long-term outcomes in ILC, these results should be considered by the multidisciplinary team when deciding on the value of systemic chemotherapy prescription in ILC.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland.
| | - Stephen Keelan
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
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18
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Calpin GG, McAnena PF, Davey MG, Calpin P, Kerin MJ, McInerney N, Walsh SR, Lowery AJ. The role of tranexamic acid in reducing post-operative bleeding and seroma formation in breast surgery: A meta-analysis. Surgeon 2022. [PMID: 36572609 DOI: 10.1016/j.surge.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Tranexamic acid (TXA) reduces blood loss and blood transfusion requirements in surgery. Seroma and haematoma formation occur as complications of breast surgery. We aimed to perform a meta-analysis evaluating TXA in reducing post-operative haematoma and seroma formation for breast surgery. METHODS A systematic review was performed in accordance with PRISMA guidelines. Results were expressed as dichotomous variables pooled as odds ratios (OR) with corresponding 95% confidence intervals (CIs) using the Mantel-Haenszel method. RESULTS Seven studies including 1446 patients were included. There were 1830 breast surgery procedures performed with TXA administered in 797 cases (43.6%). There was a significant reduction in haematoma rates in the TXA group (TXA: 3.184% (22/691) vs Control: 6.787% (64/943), OR: 0.41, 95% CI: 0.20-0.86, P = 0.020). Based on surgical procedure, haematoma rates were similar for TXA and control groups in cancer surgery (P = 0.230). Haematoma rates reduced following TXA use in cosmetic procedures (TXA: 3.807% (15/394) vs. Control: 9.091% (34/374), OR: 0.41, 95% CI: 0.22-0.75, P = 0.004). Haematoma rates were also reduced in procedures where axillary lymph node dissection (ALND) was not performed; in the TXA group, 3.379% (22/651) developed a haematoma versus 6.623% (60/906) in the control group (OR: 0.45, 95% CI 0.27-0.77, P = 0.003). TXA administration did not impact seroma formation or infection rates. CONCLUSION Perioperative administration of TXA may impact the incidence of haematoma in breast surgery, particularly in cosmetic procedures and procedures without ALND. Well-designed randomised studies are required to determine its true efficacy. TXA has no effect on seroma formation or infection in breast surgery.
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Cleere EF, Davey MG, Crotty TJ, Young O, Lowery AJ, Kerin MJ. Hypocalcaemia following thyroidectomy among patients who have previously undergone bariatric surgery: systematic review and meta-analysis. Br J Surg 2022; 109:1198-1205. [PMID: 36047335 DOI: 10.1093/bjs/znac310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/18/2022] [Accepted: 08/07/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hypocalcaemia is a common complication after thyroidectomy. Bariatric surgery is associated with significant changes in calcium metabolism. Some studies have identified bariatric surgery as a risk factor for hypocalcaemia after thyroidectomy. This systematic review and meta-analysis assessed whether a history of bariatric surgery was associated with an increased risk of hypocalcaemia after thyroidectomy. METHODS This prospectively registered systematic review (PROSPERO; CRD42021295423) was performed in accordance with PRISMA guidelines. Meta-analysis was undertaken using the Mantel-Haenszel method, with outcomes reported as ORs with 95 per cent confidence intervals. RESULTS Twenty studies were included in the qualitative synthesis. Five studies incorporating 19 547 patients met the inclusion criteria for meta-analysis, of whom 196 (1.0 per cent) had a history of bariatric surgery. Patients with a history of bariatric surgery were more likely to develop hypocalcaemia after thyroidectomy (30.6 versus 13.0 per cent; OR 3.90, 95 per cent c.i. 1.50 to 10.12; P = 0.005). Among those with a history of bariatric surgery, patients who underwent a bypass procedure were more likely to develop hypocalcaemia after thyroidectomy than those who had a restrictive procedure (38 versus 23 per cent; OR 2.12, 1.14 to 3.97; P = 0.020). CONCLUSION Patients with a history of bariatric surgery have a significantly greater risk of hypocalcaemia after thyroidectomy, with a heightened risk among those who have had a bypass procedure. Surgeons performing thyroid surgery should be aware of the increased risk of hypocalcaemia after thyroidectomy among these patients.
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Affiliation(s)
- Eoin F Cleere
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
- Department of Otolaryngology Head and Neck surgery, Galway University Hospital, Galway, Ireland
| | - Matthew G Davey
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
| | - Thomas J Crotty
- Department of Otolaryngology Head and Neck surgery, Galway University Hospital, Galway, Ireland
| | - Orla Young
- Department of Otolaryngology Head and Neck surgery, Galway University Hospital, Galway, Ireland
| | - Aoife J Lowery
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
- Department of Breast and Endocrine surgery, Galway University Hospital, Galway, Ireland
| | - Michael J Kerin
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
- Department of Breast and Endocrine surgery, Galway University Hospital, Galway, Ireland
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20
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Kerin EP, Davey MG, McLaughlin RP, Sweeney KJ, Barry MK, Malone CM, Elwahab SA, Lowery AJ, Kerin MJ. Comparison of the Nottingham Prognostic Index and OncotypeDX© recurrence score in predicting outcome in estrogen receptor positive breast cancer. Breast 2022; 66:227-235. [PMID: 36335747 PMCID: PMC9647009 DOI: 10.1016/j.breast.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Traditionally, Nottingham prognostic index (NPI) informed prognosis in patients with estrogen receptor positive, human epidermal growth factor receptor-2 negative, node negative (ER+/HER2-/LN-) breast cancer. At present, OncotypeDX© Recurrence Score (RS) predicts prognosis and response to adjuvant chemotherapy (AC). AIMS To compare NPI and RS for estimating prognosis in ER + breast cancer. METHODS Consecutive patients with ER+/HER2-/LN- disease were included. Disease-free (DFS) and overall survival (OS) were determined using Kaplan-Meier and Cox regression analyses. RESULTS 1471 patients met inclusion criteria. The mean follow-up was 110.7months. NPI was calculable for 1382 patients: 19.8% had NPI≤2.4 (291/1471), 33.0% had NPI 2.41-3.4 (486/1471), 30.0% had NPI 3.41-4.4 (441/1471), 10.9% had NPI 4.41-5.4 (160/1471), and 0.3% had NPI>5.4 (4/1471). In total, 329 patients underwent RS (mean RS: 18.7) and 82.1% had RS < 25 (270/329) and 17.9% had RS ≥ 25 (59/329). Using multivariable Cox regression analyses (n = 1382), NPI independently predicted DFS (Hazard ratio (HR): 1.357, 95% confidence interval (CI): 1.140-1.616, P < 0.001) and OS (HR: 1.003, 95% CI: 1.001-1.006, P = 0.024). When performing a focused analysis of those who underwent both NPI and RS (n = 329), neither biomarker predicted DFS or OS. Using Kaplan Meier analyses, NPI category predicted DFS (P = 0.008) and (P = 0.026) OS. Conversely, 21-gene RS group failed to predict DFS (P = 0.187) and OS (P = 0.296). CONCLUSION In our focused analysis, neither NPI nor RS predicted survival outcomes. However, in the entire series, NPI independently predicted both DFS and OS. On the 40th anniversary since its derivation, NPI continues to provide accurate prognostication in breast cancer, outperforming RS in the current study.
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Affiliation(s)
- Eoin P. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland
| | - Matthew G. Davey
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Corresponding author. Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.
| | | | - Karl J. Sweeney
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael K. Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Carmel M. Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Sami Abd Elwahab
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Aoife J. Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael J. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland,Department of Surgery, Galway University Hospitals, Galway, Ireland
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21
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Davey MG, Kerin MJ. Evaluating the Fragility of Long-Term Outcomes for Neoadjuvant versus Adjuvant Chemotherapy Prescription in Early Breast Cancer: Pooled Data from 10 Randomised Clinical Trials. Breast Cancer (Dove Med Press) 2022; 14:343-350. [PMID: 36262332 PMCID: PMC9574564 DOI: 10.2147/bctt.s379393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/16/2022] [Indexed: 11/07/2022]
Abstract
Introduction Randomised clinical trials (RCTs) report similar outcomes following neoadjuvant (NAC) and adjuvant chemotherapy (AC) in breast cancer. “Fragility Indices” (FI) test significance reversal reported in RCTs. Aim To evaluate the FI of findings from RCTs assessing outcomes of NAC and AC. Methods A systematic review was performed as per PRISMA guidelines. RCTs of interest were identified and data pooled. Fisher’s exact test was used to calculate FI for reversal of statistical significance for dichotomous outcomes. “Fragility Quotient” (FQ) was calculated by division of the calculated FI by the sample size. Results Ten RCTs including 4928 patients. Mean follow-up was 8.2 years. For breast conservation surgery (BCS), the FI was 500 and FQ was 0.10781. For local recurrence (LR), the FI was 42 and FQ was 0.00852. FI and FQ varied for LR at 0–4 years (FI: 9), 5–9 years (FI: 2), 10–14 years (FI: 4), and 15+ years (FI: 3). Regarding distant recurrence (DR), the FI was 13 and FQ was 0.00264. FI and FQ trended downwards over time: 0–4 years (FI: 56), 5–9 years (FI: 18), 10–14 years (FI: 4), and 15+ years (FI: 4). For breast-cancer-specific mortality (BCSM), the overall FI was 51 and FQ was 0.01035. FI and FQ varied for BCSM at 0–4 years (FI: 5), 5–9 years (FI: 19), 10–14 years (FI: 8), and 15+ years (FI: 5). For overall survival (OS), the FI was 17 and FQ was 0.00345. FI and FQ were calculated with respect to OS at 0–4 years (FI: 19), 5–9 years (FI: 17), 10–14 years (FI: 19), and 15+ years (FI: 1). Conclusion FIs comparing survival following NAC and AC were of moderate-to-high fragility, indicating weak statistical significance. BCS eligibility following NAC was of low fragility, ratifying the oncological and surgical safety of NAC versus AC. Level of Evidence Systematic Review of Level I Randomised Control Trials.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland,Correspondence: Matthew G Davey, Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland, Tel +35391524411, Email
| | - Michael J Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
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22
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Jalali A, Miresse D, Fahey MR, Ni Mhaonaigh N, McGuire A, Bourke E, Kerin MJ, Brown JAL. Peripheral Blood Cell Ratios as Prognostic Indicators in a Neoadjuvant Chemotherapy-Treated Breast Cancer Cohort. Curr Oncol 2022; 29:7512-7523. [PMID: 36290868 PMCID: PMC9600104 DOI: 10.3390/curroncol29100591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 01/13/2023] Open
Abstract
Breast cancer represents a heterogeneous condition in which the interaction between host immune response and primary oncogenic events can impact disease progression. Ratios of systemic blood-based immunocytes have emerged as clinically-relevant prognostic biomarkers in cancer patients. The NLR (neutrophil-to-lymphocyte ratio) has been shown to be prognostic in a variety of cancers, including breast cancer. However, evaluation of the prognostic value for overall survival (OS) and disease-free survival (DFS) of other key immunocyte ratios-neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-white cell count ratio (NWR), lymphocyte-to-white cell count ratio (LWR), monocyte-to-white cell count ratio (MWR), platelet-to-lymphocyte (PLR)-by breast cancer subtypes in a neoadjuvant chemotherapy (NAC) cohort remains to be fully explored. An NAC-treated breast cancer cohort, comprised of Luminal A, Luminal B, HER2-positive, and triple negative/basal breast cancers, treated at a tertiary referral center (minimum 3-year follow-up), was used to calculate immunocyte ratios and immunocyte cut-off values, calculated with >80% specificity (using decision tree modeling). The association with subtype-specific OS, DFS, and tumor grade was analyzed using cut offs calculated using both receiver operating characteristic curves and decision tree modelling. Decision tree calculated ratios showed that LMR (5.29) and MWR (0.06) were significantly associated with Luminal A OS (p = 0.004 and p = 0.022) and DFS (p = 0.004 and p = 0.022), and Luminal B OS (p = 0.027 and p = 0.008) and DFS (p = 0.005 and p = 0.007). NLR (1.79) and LWR (0.30) were significantly associated with HER2-positive OS (p = 0.013 and p = 0.043). NLR (1.79) and NWR (0.62) were significantly associated with DFS (p = 0.035 and p = 0.021). No significant association we observed between any immunocyte ratio in the triple negative cohort. Our results demonstrate the subtype-specific prognostic value of immunocyte ratios in NAC-treated breast cancer patients. Further validation of immunocyte ratios will provide clinicians with a new prognostic aid for disease management and monitoring.
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Affiliation(s)
- Amirhossein Jalali
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
- Health Research Institute (HRI), University of Limerick, V94 T9PX Limerick, Ireland
| | - David Miresse
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Matthew R. Fahey
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Niamh Ni Mhaonaigh
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Andrew McGuire
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Emer Bourke
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Centre for Chromosome Biology, University of Galway, H91 TK33 Galway, Ireland
| | - Michael J. Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - James A. L. Brown
- Health Research Institute (HRI), University of Limerick, V94 T9PX Limerick, Ireland
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Centre for Chromosome Biology, University of Galway, H91 TK33 Galway, Ireland
- Limerick Digital Cancer Research Centre (LDCRC), Bernal Institute, University of Limerick, V94 T9PX Limerick, Ireland
- Correspondence:
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23
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Davey MG, Davey CM, Bouz L, Kerin E, McFeetors C, Lowery AJ, Kerin MJ. Relevance of the 21-gene expression assay in male breast cancer: A systematic review and meta-analysis. Breast 2022; 64:41-46. [PMID: 35512428 PMCID: PMC9079225 DOI: 10.1016/j.breast.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/22/2022] [Accepted: 04/26/2022] [Indexed: 12/19/2022] Open
Affiliation(s)
- Matthew G Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland.
| | - Ciara M Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
| | - Luis Bouz
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
| | - Eoin Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
| | - Carson McFeetors
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
| | - Aoife J Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
| | - Michael J Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, H91YR71, Ireland
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Browne R, McAnena P, O'Halloran N, Moloney BM, Crilly E, Kerin MJ, Lowery AJ. Preoperative Breast Magnetic Resonance Imaging as a Predictor of Response to Neoadjuvant Chemotherapy. Breast Cancer (Auckl) 2022; 16:11782234221103504. [PMID: 35769423 PMCID: PMC9234834 DOI: 10.1177/11782234221103504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: The ability to accurately predict pathologic complete response (pCR) after
neoadjuvant chemotherapy (NAC) in breast cancer would improve patient
selection for specific treatment strategies, would provide important
information for patients to aid in the treatment selection process, and
could potentially avoid the need for more extensive surgery. The diagnostic
performance of magnetic resonance imaging (MRI) in predicting pCR has
previously been studied, with mixed results. Magnetic resonance imaging
performance may also be influenced by tumour and patient factors. Methods: Eighty-seven breast cancer patients who underwent NAC were studied. Pre-NAC
and post-NAC MRI findings were compared with pathologic findings
postsurgical excision. The impact of patient and tumour characteristics on
MRI accuracy was evaluated. Results: The mean (SD) age of participants was 48.7 (10.3) years. The rate of pCR
based on post-NAC MRI was 19.5% overall (19/87). The sensitivity,
specificity, positive predictive value (PPV), negative predictive value, and
accuracy in predicting pCR were 52.9%, 77.1%, 36.0%, 87.1%, and 72.4%,
respectively. Positive predictive value was the highest in nonluminal versus
Luminal A disease (45.0% vs 25.0%, P < .001), with
higher rates of false positivity in nonluminal subtypes
(P = .002). Tumour grade, T category, and histological
subtype were all independent predictors of MRI accuracy regarding post-NAC
tumour size. Conclusion: Magnetic resonance imaging alone is insufficient to accurately predict pCR in
breast cancer patients post-NAC. Magnetic resonance imaging predictions of
pCR are more accurate in nonluminal subtypes. Tumour grade, T category, and
histological subtype should be considered when evaluating post-NAC tumour
sizes.
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Affiliation(s)
- Robert Browne
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Peter McAnena
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Niamh O'Halloran
- Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Brian M Moloney
- Department of Radiology, University Hospital Galway, Galway, Ireland
| | - Emily Crilly
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, University Hospital Galway, Galway, Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, University Hospital Galway, Galway, Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
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25
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Davey MG, Feeney G, Annuk H, Paganga M, Holian E, Lowery AJ, Kerin MJ, Miller N. MicroRNA Expression Profiling Predicts Nodal Status and Disease Recurrence in Patients Treated with Curative Intent for Colorectal Cancer. Cancers (Basel) 2022; 14:cancers14092109. [PMID: 35565239 PMCID: PMC9106021 DOI: 10.3390/cancers14092109] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Approximately one-third of colorectal cancer (CRC) patients will suffer recurrence. MiRNAs are small non-coding RNAs that play important roles in gene expression. We aimed to correlate miRNA expression with aggressive clinicopathological characteristics and survival outcomes in CRC. Methods: Tumour samples were extracted from 74 CRC patients. MiRNAs were quantified using real-time reverse transcriptase polymerase chain reaction. Descriptive statistics and Cox regression analyses were performed to correlate miRNA targets with clinicopathological and outcome data. Results: Aberrant miR-21 and miR-135b expression correlate with increased nodal stage (p = 0.039, p = 0.022). Using univariable Cox regression analyses, reduced miR-135b (β-coefficient −1.126, hazard ratio 0.324, standard error (SE) 0.4698, p = 0.017) and increased miR-195 (β-coefficient 1.442, hazard ratio 4.229, SE 0.446, p = 0.001) predicted time to disease recurrence. Survival regression trees analysis illustrated a relative cut-off of ≤0.488 for miR-195 and a relative cut-off of >−0.218 for miR-135b; both were associated with improved disease recurrence (p < 0.001, p = 0.015). Using multivariable analysis with all targets as predictors, miR-195 (β-coefficient 3.187, SE 1.419, p = 0.025) was the sole significant independent predictor of recurrence. Conclusion: MiR-195 has strong value in predicting time to recurrence in CRC patients. Additionally, miR-21 and miR-135b predict the degree nodal burden. Future studies may include these findings to personalize therapeutic and surgical decision making.
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Affiliation(s)
- Matthew G. Davey
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (G.F.); (H.A.); (A.J.L.); (M.J.K.); (N.M.)
- Correspondence:
| | - Gerard Feeney
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (G.F.); (H.A.); (A.J.L.); (M.J.K.); (N.M.)
| | - Heidi Annuk
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (G.F.); (H.A.); (A.J.L.); (M.J.K.); (N.M.)
| | - Maxwell Paganga
- School of Mathematical and Statistical Sciences, National University of Ireland, H91 H3CY Galway, Ireland; (M.P.); (E.H.)
| | - Emma Holian
- School of Mathematical and Statistical Sciences, National University of Ireland, H91 H3CY Galway, Ireland; (M.P.); (E.H.)
| | - Aoife J. Lowery
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (G.F.); (H.A.); (A.J.L.); (M.J.K.); (N.M.)
| | - Michael J. Kerin
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (G.F.); (H.A.); (A.J.L.); (M.J.K.); (N.M.)
| | - Nicola Miller
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (G.F.); (H.A.); (A.J.L.); (M.J.K.); (N.M.)
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Davey MG, Cleere EF, O'Donnell JP, Gaisor S, Lowery AJ, Kerin MJ. Value of the 21-gene expression assay in predicting locoregional recurrence rates in estrogen receptor-positive breast cancer: a systematic review and network meta-analysis. Breast Cancer Res Treat 2022; 193:535-544. [PMID: 35426541 PMCID: PMC9114034 DOI: 10.1007/s10549-022-06580-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
The Oncotype DX© 21-gene Recurrence Score (RS) estimates the risk of distant disease recurrence in early-stage estrogen receptor-positive, human epidermal growth factor receptor-2-negative (ER+/HER2− ) breast cancer. Using RS to estimate risk of locoregional recurrence (LRR) is less conclusive. We aimed to perform network meta-analysis (NMA) evaluating the RS in estimating LRR in ER+/HER2− breast cancer.
Methods
A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny.
Results
16 studies with 21,037 patients were included (mean age: 55.1 years (range: 22–96)). The mean RS was 17.1 and mean follow-up was 66.4 months. Using traditional RS cut-offs, 49.7% of patients had RS < 18 (3944/7935), 33.8% had RS 18–30 (2680/7935), and 16.5% had RS > 30 (1311/7935). Patients with RS 18–30 (risk ratio (RR): 1.76, 95% confidence interval (CI): 1.32–2.37) and RS > 30 (RR: 3.45, 95% CI: 2.63–4.53) were significantly more likely to experience LRR than those with RS < 18. Using TAILORx cut-offs, 16.2% of patients had RS < 11 (1974/12,208), 65.8% had RS 11–25 (8036/12,208), and 18.0% with RS > 30 (2198/12,208). LRR rates were similar for patients with RS 11–25 (RR: 1.120, 95% CI: 0.520–2.410); however, those with RS > 25 had an increased risk of LRR (RR: 2.490, 95% CI: 0.680–9.390) compared to those with RS < 11. There was a stepwise increase in LRR rates when applying traditional and TAILORx cut-offs (both P < 0.050).
Conclusion
RS testing accurately estimates LRR risk for patients being treated for early-stage ER+/HER2− breast cancer. Future prospective, randomized studies may validate the predictive value of RS in estimating LRR.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Republic of Ireland.
| | - Eoin F Cleere
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Republic of Ireland
| | - John P O'Donnell
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Republic of Ireland
| | - Sara Gaisor
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Republic of Ireland
| | - Aoife J Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Republic of Ireland
| | - Michael J Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Republic of Ireland
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Richard V, Davey MG, Annuk H, Miller N, Kerin MJ. The double agents in liquid biopsy: promoter and informant biomarkers of early metastases in breast cancer. Mol Cancer 2022; 21:95. [PMID: 35379239 PMCID: PMC8978379 DOI: 10.1186/s12943-022-01506-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023] Open
Abstract
Breast cancer continues to be a major global problem with significant mortality associated with advanced stage and metastases at clinical presentation. However, several findings suggest that metastasis is indeed an early occurrence. The standard diagnostic techniques such as invasive core needle biopsy, serological protein marker assays, and non-invasive radiological imaging do not provide information about the presence and molecular profile of small fractions of early metastatic tumor cells which are prematurely dispersed in the circulatory system. These circulating tumor cells (CTCs) diverge from the primary tumors as clusters with a defined secretome comprised of circulating cell-free nucleic acids and small microRNAs (miRNAs). These circulatory biomarkers provide a blueprint of the mutational profile of the tumor burden and tumor associated alterations in the molecular signaling pathways involved in oncogenesis. Amidst the multitude of circulatory biomarkers, miRNAs serve as relatively stable and precise biomarkers in the blood for the early detection of CTCs, and promote step-wise disease progression by executing paracrine signaling that transforms the microenvironment to guide the metastatic CTCs to anchor at a conducive new organ. Random sampling of easily accessible patient blood or its serum/plasma derivatives and other bodily fluids collectively known as liquid biopsy (LB), forms an efficient alternative to tissue biopsies. In this review, we discuss in detail the divergence of early metastases as CTCs and the involvement of miRNAs as detectable blood-based diagnostic biomarkers that warrant a timely screening of cancer, serial monitoring of therapeutic response, and the dynamic molecular adaptations induced by miRNAs on CTCs in guiding primary and second-line systemic therapy.
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Davey MG, Cleere EF, Lowery AJ, Kerin MJ. Intraoperative recurrent laryngeal nerve monitoring versus visualisation alone - A systematic review and meta-analysis of randomized controlled trials. Am J Surg 2022; 224:836-841. [DOI: 10.1016/j.amjsurg.2022.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 02/08/2023]
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Davey MG, O'Donnell JPM, Boland MR, Ryan ÉJ, Walsh SR, Kerin MJ, Lowery AJ. Optimal localization strategies for non-palpable breast cancers –A network meta-analysis of randomized controlled trials. Breast 2022; 62:103-113. [PMID: 35151049 PMCID: PMC8844725 DOI: 10.1016/j.breast.2022.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Mammographic screening programmes have increased detection rates of non-palpable breast cancers. In these cases, wire-guided localization (WGL) is the most common approach used to guide breast conserving surgery (BCS). Several RCTs have compared WGL to a range of novel localization techniques. We aimed to perform a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing methods of non-palpable breast cancer localization. Methods A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. Results 24 RCTs assessing 9 tumour localization methods in 4236 breasts were included. Margin positivity and reoperation rates were 16.9% (714/4236) and 14.3% (409/2870) respectively. Cryo-assisted localization had the highest margin positivity (28.2%, 58/206) and reoperation (18.9%, 39/206) rates. Compared to WGL (n = 2045 from 24 RCTs) only ultrasound guided localization (USGL) (n = 316 from 3 RCTs) significantly lowered margin positivity (odds ratio (OR): 0.192, 95% confidence interval (CI): 0.079–0.450) and reoperation rates (OR: 0.182, 95%CI: 0.069–0.434). Anchor-guided localization (n = 52, 1 RCT) significantly lowered margin positivity (OR: 0.229, 95%CI: 0.050–0.938) and magnetic-marker localization improved patient satisfaction (OR: 0.021, 95%CI: 0.001–0.548). There was no difference in operation duration, overall complications, haematoma, seroma, surgical site infection rates, or specimen size/vol/wt between methods. Conclusion USGL and AGL are non-inferior to WGL for the localization of non-palpable breast cancers. The reported data suggests that these techniques confer reduced margin positivity rates and requirement for re-operation. However, caution when interpreting results relating to RCTs with small sample sizes and further validation is required in larger prospective, randomized studies. Ultrasound-guided (USGL) and anchor-guided (AGL) localization had optimal outcomes. These methods significantly lowered margin positivity (odds ratio: 0.192 & 0.229). However, small sample sizes in trials evaluating USGL and AGL limit these results. Operation duration, complications, or specimen data were comparable for all methods.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland.
| | - John P M O'Donnell
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Michael R Boland
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Éanna J Ryan
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Stewart R Walsh
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Michael J Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
| | - Aoife J Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland
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Davey MG, Davey MS, Richard V, Wyns W, Soliman O, Miller N, Lowery AJ, Kerin MJ. Overview of MicroRNA Expression in Predicting Response to Neoadjuvant Therapies in Human Epidermal Growth Receptor-2 Enriched Breast Cancer - A Systematic Review. Breast Cancer (Auckl) 2022; 16:11782234221086684. [PMID: 35340888 PMCID: PMC8943461 DOI: 10.1177/11782234221086684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/17/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose: Increased appreciation of the human epidermal growth factor receptor-2
(HER2/neu) signalling pathway has led to the development of targeted
therapeutic agents used in conjunction with chemotherapy to improve outcomes
for HER2 overexpressing (HER2+) breast cancer. For neoadjuvant therapy,
response rates can be unpredictable – novel biomarkers predicting
effectiveness are required to enhance oncological outcomes for these
patients, and microRNA may prove effective. Our objective was to identify
microRNA (miRNA) expression patterns predictive of response to neoadjuvant
chemotherapy (NAC) and/or anti-HER2 targeted therapies in patients being
treated for early-stage HER2+ breast cancer. Methods: A search was performed of the PUBMED, SCOPUS, Web of Science, and EMBASE in
accordance to Preferred Reporting Items for Systematic Review and
Meta-Analyses (PRISMA) guidelines. Results: Overall, 15 studies including 1335 patients were included. These studies
highlighted an expression profile of 73 miRNA and their ability to predict
tumour response to neoadjuvant therapies was correlated. Results from 11
studies were in relation to circulatory miRNA and 4 studies included data
from tumour tissue. Overall, upregulation and downregulation of 41 miRNA and
29 miRNA, respectively, predicted differential response to neoadjuvant
therapy. Expression levels of 3 miRNA (miR-21, miR-210, and miR-376c-3p)
were inconclusive in predicting therapeutic response, while ‘aberrant’
expression of circulating miR-199a predicted pathological complete response
(pCR) to NAC. Conclusions: This systematic review outlines expression patterns of a number of miRNA
which correlate with response to NAC and/or anti-HER2 therapies. Future
translational research evaluating predictive biomarkers of primary response
to neoadjuvant therapy in HER2+ breast cancer may consider these
results.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.,Precision Cardio-Oncology Research Enterprise (P-CORE), National University of Ireland, Galway, Galway, Ireland.,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Martin S Davey
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Vinitha Richard
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.,Precision Cardio-Oncology Research Enterprise (P-CORE), National University of Ireland, Galway, Galway, Ireland
| | - William Wyns
- Precision Cardio-Oncology Research Enterprise (P-CORE), National University of Ireland, Galway, Galway, Ireland.,Discipline of Cardiology, CORRIB Core Laboratory, National University of Ireland, Galway, Galway, Ireland
| | - Osama Soliman
- Precision Cardio-Oncology Research Enterprise (P-CORE), National University of Ireland, Galway, Galway, Ireland.,Discipline of Cardiology, CORRIB Core Laboratory, National University of Ireland, Galway, Galway, Ireland
| | - Nicola Miller
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.,Precision Cardio-Oncology Research Enterprise (P-CORE), National University of Ireland, Galway, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.,Precision Cardio-Oncology Research Enterprise (P-CORE), National University of Ireland, Galway, Galway, Ireland
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Cleere EF, Davey MG, O’Neill S, Corbett M, O’Donnell JP, Hacking S, Keogh IJ, Lowery AJ, Kerin MJ. Radiomic Detection of Malignancy within Thyroid Nodules Using Ultrasonography-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12040794. [PMID: 35453841 PMCID: PMC9027085 DOI: 10.3390/diagnostics12040794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Despite investigation, 95% of thyroid nodules are ultimately benign. Radiomics is a field that uses radiological features to inform individualized patient care. We aimed to evaluate the diagnostic utility of radiomics in classifying undetermined thyroid nodules into benign and malignant using ultrasonography (US). Methods: A diagnostic test accuracy systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Sensitivity, specificity, and area under curve (AUC) delineating benign and malignant lesions were recorded. Results: Seventy-five studies including 26,373 patients and 46,175 thyroid nodules met inclusion criteria. Males accounted for 24.6% of patients, while 75.4% of patients were female. Radiomics provided a pooled sensitivity of 0.87 (95% CI: 0.86−0.87) and a pooled specificity of 0.84 (95% CI: 0.84−0.85) for characterizing benign and malignant lesions. Using convolutional neural network (CNN) methods, pooled sensitivity was 0.85 (95% CI: 0.84−0.86) and pooled specificity was 0.82 (95% CI: 0.82−0.83); significantly lower than studies using non-CNN: sensitivity 0.90 (95% CI: 0.89−0.90) and specificity 0.88 (95% CI: 0.87−0.89) (p < 0.05). The diagnostic ability of radiologists and radiomics were comparable for both sensitivity (OR 0.98) and specificity (OR 0.95). Conclusions: Radiomic analysis using US provides a reproducible, reliable evaluation of undetermined thyroid nodules when compared to current best practice.
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Affiliation(s)
- Eoin F. Cleere
- The Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (M.G.D.); (A.J.L.); (M.J.K.)
- Department of Otolaryngology, Galway University Hospitals, H91 YR71 Galway, Ireland; (M.C.); (I.J.K.)
- Correspondence:
| | - Matthew G. Davey
- The Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (M.G.D.); (A.J.L.); (M.J.K.)
| | - Shane O’Neill
- Department of Breast and Endocrine Surgery, Galway University Hospitals, H91 YR71 Galway, Ireland;
| | - Mel Corbett
- Department of Otolaryngology, Galway University Hospitals, H91 YR71 Galway, Ireland; (M.C.); (I.J.K.)
| | - John P O’Donnell
- Department of Radiology, Galway University Hospitals, H91 YR71 Galway, Ireland;
| | - Sean Hacking
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Ivan J. Keogh
- Department of Otolaryngology, Galway University Hospitals, H91 YR71 Galway, Ireland; (M.C.); (I.J.K.)
| | - Aoife J. Lowery
- The Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (M.G.D.); (A.J.L.); (M.J.K.)
- Department of Breast and Endocrine Surgery, Galway University Hospitals, H91 YR71 Galway, Ireland;
| | - Michael J. Kerin
- The Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (M.G.D.); (A.J.L.); (M.J.K.)
- Department of Breast and Endocrine Surgery, Galway University Hospitals, H91 YR71 Galway, Ireland;
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Courtney D, Davey MG, Moloney BM, Barry MK, Sweeney K, McLaughlin RP, Malone CM, Lowery AJ, Kerin MJ. Breast cancer recurrence: factors impacting occurrence and survival. Ir J Med Sci 2022; 191:2501-2510. [PMID: 35076871 DOI: 10.1007/s11845-022-02926-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/13/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Breast cancer mortality has decreased due to improved screening and treatment options. Nevertheless, 25-30% of patients develop disease recurrence and die from the disease dissemination. Patients who develop metastatic disease represent a heterogeneous group and management plans are dependent on molecular subtype, disease burden and metastatic site. AIM To determine predictive clinicopathological factors of disease recurrence and their impact on survival in the molecular era. METHODS Consecutive patients who breast cancer developed recurrence at our tertiary referral centre between 2000 and 2015 were included. Clinicopathological and treatment data were assessed using descriptive statistics. Oncological outcome was assessed using Cox regression and Kaplan Meier analyses. RESULTS Two hundred sixty-five consecutive patients who developed breast cancer recurrence were included; median age at metastasis was 59.3 years (range 27-87 years), and median time to recurrence (TTR) was 47.7 ± 38.5 months (range 3.0-194.3 months). Survival was 24.2% (64/265) 53.2% were luminal A (LABC) (141/265), 18.5% were luminal B (LBBC) (49/265), 18.5% were triple negative (TNBC) (49/265), and 9.8% were human epidermal growth factor receptor-2 overexpressing (HER2 +) (26/265). TTR for patients with LABC was 56.0 ± 41.3 months, LBBC was 48.4 ± 41.1 months, TNBC was 26.9 ± 28.5 months and HER2 + was 34.3 ± 21.8 months. Increased grade (P < 0.001), Nottingham Prognostic Indices (P < 0.001), TNBC (P < 0.001), HER2 + subtype (P < 0.001) and receiving targeted therapy (P = 0.006) predicted shorted TTR. Estrogen receptor positivity (P < 0.001), progesterone receptor positivity (P = 0.010), invasive lobular carcinoma (P = 0.009) and receiving endocrine therapy (P = 0.001) predicted longer TTR. CONCLUSION Readily available clinicopathological factors predict risk of metastatic dissemination. Developing a tailored program to identify patients at risk of recurrence is crucial in controlling metastatic dissemination of breast cancer.
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Affiliation(s)
- Donald Courtney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Matthew G Davey
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland.
| | - Brian M Moloney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Michael K Barry
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Karl Sweeney
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Ray P McLaughlin
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Carmel M Malone
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Aoife J Lowery
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
| | - Michael J Kerin
- Department of Surgery, National University of Ireland, Galway, H91YR71, Republic of Ireland
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Abstract
Background Axillary lymph node status remains the most powerful prognostic indicator in invasive breast cancer. Ductal carcinoma in situ (DCIS) is a non-invasive disease and does not spread to axillary lymph nodes. The presence of an invasive component to DCIS mandates nodal evaluation through sentinel lymph node biopsy (SLNB). Quantification of the necessity of upfront SLNB for DCIS requires investigation. The aim was to establish the likelihood of having a positive SLNB (SLNB+) for DCIS and to establish parameters predictive of SLNB+. Methods A systematic review was performed as per the PRISMA guidelines. Prospective studies only were included. Characteristics predictive of SLNB+ were expressed as dichotomous variables and pooled as odds ratios (o.r.) and associated 95 per cent confidence intervals (c.i.) using the Mantel–Haenszel method. Results Overall, 16 studies including 4388 patients were included (mean patient age 54.8 (range 24 to 92) years). Of these, 72.5 per cent of patients underwent SLNB (3156 of 4356 patients) and 4.9 per cent had SLNB+ (153 of 3153 patients). The likelihood of having SLNB+ for DCIS was less than 1 per cent (o.r. <0.01, 95 per cent c.i. 0.00 to 0.01; P < 0.001, I2 = 93 per cent). Palpable DCIS (o.r. 2.01, 95 per cent c.i. 0.64 to 6.24; P = 0.230, I2 = 0 per cent), tumour necrosis (o.r. 3.84, 95 per cent c.i. 0.85 to 17.44; P = 0.080, I2 = 83 per cent), and grade 3 DCIS (o.r. 1.34, 95 per cent c.i. 0.80 to 2.23; P = 0.270, I2 = 0 per cent) all trended towards significance in predicting SLNB+. Conclusion While aggressive clinicopathological parameters may guide SLNB for patients with DCIS, the absolute and relative risk of SLNB+ for DCIS is less than 5 per cent and 1 per cent, respectively. Well-designed randomized controlled trials are required to establish fully the necessity of SLNB for patients diagnosed with DCIS. Registration number CRD42021284194 (https://www.crd.york.ac.uk/prospero/)
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Affiliation(s)
- Matthew G. Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
- Correspondence to: Matthew G. Davey, Department of Surgery, Galway University Hospitals, Galway H91YR71, Republic of Ireland (e-mail: )
| | - Colm O’Flaherty
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Eoin F. Cleere
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife Nohilly
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - James Phelan
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Evan Ronane
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife J. Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J. Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Affiliation(s)
- Matthew G. Davey
- Department of Surgery, Galway University Hospitals, Galway, Ireland
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
- Correspondence to: Matthew G. Davey, Department of Surgery, Galway University Hospitals, Galway H91YR71, Republic of Ireland (e-mail: )
| | - Ferdia Browne
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Nicola Miller
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife J. Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J. Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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O'Connor DJ, Davey MG, Barkley LR, Kerin MJ. Differences in sensitivity to neoadjuvant chemotherapy among invasive lobular and ductal carcinoma of the breast and implications on surgery-A systematic review and meta-analysis. Breast 2021; 61:1-10. [PMID: 34864494 PMCID: PMC8649952 DOI: 10.1016/j.breast.2021.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 12/21/2022] Open
Abstract
Meta-analysis of >87,000 patients demonstrates that patients with invasive lobular carcinoma of the breast are far less likely to achieve pCR of the breast or axilla compared to their ductal counterparts, receive less BCS and more frequently return positive margins. BACKGROUND Neoadjuvant chemotherapy (NACT) facilitates tumour downstaging, increases breast conserving surgery (BCS) and assesses tumour chemosensitivity. Despite clinicopathological differences in Invasive Ductal Carcinoma (IDC) and Invasive Lobular Carcinoma (ILC), decision making surrounding the use NACT does not take account of histological differences. AIM To determine the impact NACT on pathological complete response (pCR), breast conserving surgery (BCS), margin status and axillary pCR in ILC and IDC. METHODS A systematic review was performed in accordance with the PRISMA guidelines. Studies reporting outcomes among ILC and IDCs following NACT were identified. Dichotomous variables were pooled as odds ratios (ORs) with 95% confidence intervals_(CI) using the Mantel-Haenszel method. P-values <0.05 were statistically significant. RESULTS 40 studies including 87,303 (7596 ILC [8.7%]and 79,708 IDC [91.3%]) patients were available for analysis. Mean age at diagnosis was 54.9 vs. 50.9 years for ILC and IDC, respectively. IDCs were significantly more likely to achieve pCR (22.1% v 7.4%, OR: 3.03 [95% CI 2.5-3.68] p < 0.00001), axillary pCR (23.6% vs. 13.4%, OR: 2.01 [95% CI 1.77-2.28] p < 0.00001) and receive BCS (45.7% vs. 33.3%, OR 2.14 [95% CI 1.87-2.45] p < 0.00001) versus ILCs. ILCs were significantly more likely to have positive margins at the time of surgery (36% vs 13.5%, OR 4.84 [95% CI 2.88-8.15] p < 0.00001). CONCLUSION This is the largest study comparing the impact of NACT among ILC and IDC with respect to pCR and BCS. ILC has different outcomes to IDC following NACT and incorporate it into treatment decisions and future clinical guidelines.
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Affiliation(s)
- Dómhnall J O'Connor
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland; Department of Surgery, Royal College of Surgeons Ireland, Dublin 2, Ireland
| | - Matthew G Davey
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.
| | - Laura R Barkley
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland; Department of Surgery, Galway University Hospital, Galway, Ireland
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Davey MS, Davey MG, Ryan ÉJ, Hogan AM, Kerin MJ, Joyce M. The use of radiomic analysis of magnetic resonance imaging in predicting distant metastases of rectal carcinoma following surgical resection: A systematic review and meta-analysis. Colorectal Dis 2021; 23:3065-3072. [PMID: 34536962 DOI: 10.1111/codi.15919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/03/2021] [Accepted: 09/12/2021] [Indexed: 12/24/2022]
Abstract
AIM Estimating prognosis in rectal carcinoma (RC) is challenging, with distant recurrence (DR) occurring in up to 30% of cases. Radiomics is a novel field using diagnostic imaging to investigate the tumour heterogeneity of cancers and may have the potential to predict DR. The aim of the study was to perform a systematic review of the current literature evaluating the use of radiomics in predicting DR in patients with resected RC. METHODS A systematic review was performed as per PRISMA guidelines to identify studies reporting radiomic analysis of magnetic resonance imaging (MRI) to predict DR in patients diagnosed with RC. Sensitivity and specificity of radiomic analyses were included for meta-analysis. RESULTS A total of seven studies including 1497 patients (998 males) were included, seven, five and one of whom reported radiomics, respectively. The overall pooled rate of DR from all included studies was 17.1% (256/1497), with 15.6% (236/1497), 1.3% (19/1497) and 0.2% (3/1497) of patients having hepatic, pulmonary and peritoneal metastases. Meta-analysis demonstrated that radiomics correctly predicted DR with pooled sensitivities and specificities of MRI 0.76 (95% CI: 0.73, 0.78) and 0.85 (95% CI: 0.83, 0.88), respectively. CONCLUSION This systematic review suggests the benefit of radiomic analysis of preoperative MRI in identifying patients with resected RC at an increased risk of DR. Our findings warrant validation in larger prospective studies as modalities to predict DR is a significant unmet need in RC. Radiomics may allow for tailored therapeutic strategies for high-risk groups.
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Affiliation(s)
- Martin S Davey
- Discipline of Surgery, Galway University Hospitals, Galway, Ireland
| | - Matthew G Davey
- Discipline of Surgery, Galway University Hospitals, Galway, Ireland
| | - Éanna J Ryan
- Discipline of Surgery, Galway University Hospitals, Galway, Ireland
| | - Aisling M Hogan
- Discipline of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Galway University Hospitals, Galway, Ireland
| | - Myles Joyce
- Discipline of Surgery, Galway University Hospitals, Galway, Ireland
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Richard V, Davey MG, Annuk H, Miller N, Dwyer RM, Lowery A, Kerin MJ. MicroRNAs in Molecular Classification and Pathogenesis of Breast Tumors. Cancers (Basel) 2021; 13:5332. [PMID: 34771496 PMCID: PMC8582384 DOI: 10.3390/cancers13215332] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/21/2022] Open
Abstract
The current clinical practice of breast tumor classification relies on the routine immunohistochemistry-based expression analysis of hormone receptors, which is inadequate in addressing breast tumor heterogeneity and drug resistance. MicroRNA expression profiling in tumor tissue and in the circulation is an efficient alternative to intrinsic molecular subtyping that enables precise molecular classification of breast tumor variants, the prediction of tumor progression, risk stratification and also identifies critical regulators of the tumor microenvironment. This review integrates data from protein, gene and miRNA expression studies to elaborate on a unique miRNA-based 10-subtype taxonomy, which we propose as the current gold standard to allow appropriate classification and separation of breast cancer into a targetable strategy for therapy.
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Affiliation(s)
- Vinitha Richard
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (M.G.D.); (H.A.); (N.M.); (R.M.D.); (A.L.)
| | | | | | | | | | | | - Michael J. Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, H91 YR71 Galway, Ireland; (M.G.D.); (H.A.); (N.M.); (R.M.D.); (A.L.)
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Davey MG, Davey MS, Boland MR, Ryan ÉJ, Lowery AJ, Kerin MJ. Radiomic differentiation of breast cancer molecular subtypes using pre-operative breast imaging - A systematic review and meta-analysis. Eur J Radiol 2021; 144:109996. [PMID: 34624649 DOI: 10.1016/j.ejrad.2021.109996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Breast cancer has four distinct molecular subtypes which are discriminated using gene expression profiling following biopsy. Radiogenomics is an emerging field which utilises diagnostic imaging to reveal genomic properties of disease. We aimed to perform a systematic review of the current literature to evaluate the value radiomics in differentiating breast cancers into their molecular subtypes using diagnostic imaging. METHODS A systematic review was performed as per PRISMA guidelines. Studies assessing radiomictumour analysis in differentiatingbreast cancer molecular subtypeswere included. Quality was assessed using the radiomics quality score (RQS). Diagnostic sensitivity and specificity of radiomic analyses were included for meta-analysis; Study specific sensitivity and specificity were retrieved and summary ROC analysis were performed to compile pooled sensitivities and specificities. RESULTS Forty-one studies were included. Overall, there were 10,090 female patients (mean age of 47.6 ± 11.7 years, range: 21-93) and molecular subtypewas reported in 7,693 of cases, with Luminal A (LABC), Luminal B (LBBC), Human Epidermal Growth Factor Receptor-2 overexpressing (HER2+), and Triple Negative (TNBC) breast cancers representing 51.3%, 19.9%, 12.3% and 16.3% of tumour respectively. Seven studies provided radiomic analysis to determine molecular subtypes using mammography to differentiateTNBCvs.others (sensitivity: 0.82,specificity:0.79). Thirty-five studies reported on radiomic analysis of magnetic resonance imaging (MRI); LABC versus others(sensitivity:0.78,specificity:0.83),HER2+versusothers(sensitivity:0.87,specificity:0.88), andLBBCversusTNBC (sensitivity: 0.79,specificity:0.88) respectively. CONCLUSION Radiomic tumour assessment of contemporary breast imaging provide a novel option in determining breast cancer molecular subtypes. However, amelioration of such techniques are required and genetic expression assessment will remain the gold standard.
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Affiliation(s)
- Matthew G Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway H91 YR91, Ireland.
| | - Martin S Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway H91 YR91, Ireland
| | - Michael R Boland
- The Lambe Institute for Translational Research, National University of Ireland, Galway H91 YR91, Ireland
| | - Éanna J Ryan
- The Lambe Institute for Translational Research, National University of Ireland, Galway H91 YR91, Ireland
| | - Aoife J Lowery
- The Lambe Institute for Translational Research, National University of Ireland, Galway H91 YR91, Ireland
| | - Michael J Kerin
- The Lambe Institute for Translational Research, National University of Ireland, Galway H91 YR91, Ireland
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Davey MG, Kerin E, O'Flaherty C, Maher E, Richard V, McAnena P, McLaughlin RP, Sweeney KJ, Barry MK, Malone CM, Wyns W, Soliman O, Miller N, Keane MM, Lowery AJ, Kerin MJ. Clinicopathological response to neoadjuvant therapies and pathological complete response as a biomarker of survival in human epidermal growth factor receptor-2 enriched breast cancer - A retrospective cohort study. Breast 2021; 59:67-75. [PMID: 34171619 PMCID: PMC8234352 DOI: 10.1016/j.breast.2021.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human epidermal growth factor receptor-2 (HER2) is overexpressed in 20-25% of breast cancers. Complete eradication of disease following neoadjuvant therapies and chemotherapy has been referred to as pathological complete response (pCR). AIMS To determine clinicopathological predictors of pCR to neoadjuvant therapies and to evaluate pCR as a surrogate to enhanced survival. METHODS Consecutive female patients with HER2 positive (HER+) breast cancer managed surgically in a single institution between 2005 and 2015 were included. Descriptive statistics and binary logistic regression were used to determine predictors of pCR. Appraisal of pCR as a predictor of survival was performed using Kaplan-Meier curves and Cox regression analysis. RESULTS 451 patients were included with a mean age of 56.6 ± 13.4 years (range 23-95). Disease-free (DFS) and overall survival (OS) was 82.3% (371/451) and 82.6% (376/451) respectively with a median follow-up of 108.0 months (range 3-184.0). 118 were treated in the neoadjuvant setting (26.2%): tumour size <50 mm (Odds Ratio (OR): 12.156, P = 0.023) and progesterone receptor negativity (OR: 2.762, P = 0.008) independently predicted breast pCR, while ductal carcinoma (OR: 3.203, P = 0.030) and grade 3 disease (OR: 2.788, P = 0.018) predicted axillary pCR. Both breast and axillary pCR predicted enhanced DFS (Hazard Ratio (HR): 0.470 & HR: 0.449) and OS (HR: 0.383 & HR: 0.307). Axillary pCR independently predicted improved OS (HR: 0.326). CONCLUSION pCR is sensitive biomarker and surrogate to survival outcomes in HER2+ breast cancer. Patients likely to achieve pCR may be predicted from traditional clinicopathological characteristics and molecular parameters.
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Affiliation(s)
- Matthew G Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Eoin Kerin
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - C O'Flaherty
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Elizabeth Maher
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Vinitha Richard
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Peter McAnena
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Ray P McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Karl J Sweeney
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael K Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Carmel M Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - William Wyns
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, Galway University Hospitals, Galway, Ireland
| | - Nicola Miller
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospitals, Galway, Ireland
| | - Aoife J Lowery
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Michael J Kerin
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
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Moloney BM, McAnena PF, Elwahab SM, Fasoula A, Duchesne L, Gil Cano JD, Glynn C, O'Connell A, Ennis R, Lowery AJ, Kerin MJ. The Wavelia Microwave Breast Imaging system-tumour discriminating features and their clinical usefulness. Br J Radiol 2021; 94:20210907. [PMID: 34581186 PMCID: PMC8631021 DOI: 10.1259/bjr.20210907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The Wavelia Microwave Breast Imaging (MBI) system, based on non-ionising imaging technology, has demonstrated exciting potential in the detection and localisation of breast pathology in symptomatic patients. In this study, the ability of the system to accurately estimate the size and likelihood of malignancy of breast lesions is detailed, and its clinical usefulness determined. METHODS Institutional review board and Health Products Regulatory Authority (HPRA) approval were obtained. Patients were recruited from the symptomatic unit to three groups; breast cancer (Group-1), unaspirated cysts (Group-2) and biopsied benign lesions (Group-3). MBI, radiological and histopathological findings were reviewed. MBI size estimations were compared with the sizes determined by conventional imaging and histopathology. A Quadratic Discriminant Analysis (QDA) classifier was trained in a 3D feature space to discriminate malignant from benign lesions. An independent review was performed by two independent breast radiologists. RESULTS 24 patients (11 Group-1, 8 Group-2 and 5 Group-3) underwent MBI. The Wavelia system was more accurate than conventional imaging in size estimation of breast cancers. The QDA accurately separated benign from malignant breast lesions in 88.5% of cases. The addition of MBI and the Wavelia malignancy risk calculation was deemed useful by the two radiologists in 70.6% of cases. CONCLUSION The results from this MBI investigation demonstrate the potential of this novel system in estimating size and malignancy risk of breast lesions. This system holds significant promise as a potential non-invasive, comfortable, and harmless adjunct for breast cancer diagnosis. Further larger studies are under preparation to validate the findings of this study. ADVANCES IN KNOWLEDGE This study details the potential of the Wavelia MBI system in delineating size and malignancy risk of benign and malignant breast lesions in a symptomatic cohort. The usefulness of the Wavelia system is assessed in the clinical setting.
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Affiliation(s)
- Brian M Moloney
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, Toronto, Canada
| | - Peter F McAnena
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland
| | - Sami M Elwahab
- Department of Surgery, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland
| | | | | | | | - Catherine Glynn
- Department of Radiology, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland
| | - AnnaMarie O'Connell
- Department of Radiology, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland
| | - Rachel Ennis
- Department of Radiology, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Department of Surgery, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland
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James DL, Ryan ÉJ, Davey MG, Quinn AJ, Heath DP, Garry SJ, Boland MR, Young O, Lowery AJ, Kerin MJ. Radioiodine Remnant Ablation for Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:544-552. [PMID: 33792650 DOI: 10.1001/jamaoto.2021.0288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Postoperative radioactive iodine (RAI) remnant ablation for differentiated thyroid cancer (DTC) facilitates the early detection of recurrence and represents an adjuvant therapy that targets persistent microscopic disease. The optimal activity of RAI in low- and intermediate-risk DTC remains controversial. Objective To evaluate the long-term cure rate of different RAI activities in low- and intermediate-risk DTC. Secondary outcomes included successful remnant ablation, adverse effects, and hospital length of stay. Data Source A systematic search of the databases PubMed, Cochrane Collaboration, Embase, Scopus, and Web of Science was performed to identify randomized clinical trials (RCTs) and observational studies that compared long-term outcomes (>12 months) for American Thyroid Association-classified low- and intermediate-risk DTC based on receipt of either low-activity or high-activity RAI postoperatively. Study Selection All RCTs or observational studies evaluating patients with low- and intermediate-risk DTC who were treated initially with total/near-total thyroidectomy, followed by remnant RAI ablation with either low or high activities. Eligible studies had to present odds ratio, relative risk (RR), or hazard ratio estimates (with 95% CIs), standard errors, or the number of events necessary to calculate these for the outcome of interest rate. Data Extraction Two investigators reviewed the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Dichotomous variables were pooled as risk ratios and continuous data as weighted-mean differences. Quality assessment of the included studies was performed using the Newcastle-Ottawa and Jadad scales. Main Outcomes and Measures Disease recurrence was the primary outcome. Secondary outcomes included successful ablation, adverse effects, and length of stay. Results Ten studies that included 3821 patients met inclusion criteria, including 6 RCTs and 4 observational studies. There was no difference in long-term cure recurrence rates (RR, 0.88; 95% CI, 0.62-1.27, P = .50) or successful remnant ablation (RR, 0.95; 95% CI, 0.87-1.03; P = .20) between low-activity and high-activity RAI. Conclusions and Relevance In this systematic review and meta-analysis, low-activity RAI was comparable with high-activity RAI regarding successful ablation and recurrence rates. This suggests that low-activity RAI is preferable to high-activity in low- and intermediate-risk DTC because of its similar efficacy but reduced morbidity. Trial Registration PROSPERO Identifier: CRD42020166780.
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Affiliation(s)
- Danielle L James
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - Éanna J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Matthew G Davey
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Alanna Jane Quinn
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - David P Heath
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Stephen James Garry
- Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Michael R Boland
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Orla Young
- Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
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Davey MG, Davey MS, Ryan ÉJ, Boland MR, McAnena PF, Lowery AJ, Kerin MJ. Is radiomic MRI a feasible alternative to OncotypeDX® recurrence score testing? A systematic review and meta-analysis. BJS Open 2021; 5:6388195. [PMID: 34633438 PMCID: PMC8504445 DOI: 10.1093/bjsopen/zrab081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/03/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND OncotypeDX® recurrence score (RS) aids therapeutic decision-making in oestrogen-receptor-positive (ER+) breast cancer. Radiomics is an evolving field that aims to examine the relationship between radiological features and the underlying genomic landscape of disease processes. The aim of this study was to perform a systematic review of current evidence evaluating the comparability of radiomics and RS. METHODS A systematic review was performed as per PRISMA guidelines. Studies comparing radiomic MRI tumour analyses and RS were identified. Sensitivity, specificity and area under curve (AUC) delineating low risk (RS less than 18) versus intermediate-high risk (equal to or greater than 18) and low-intermediate risk (RS less than 30) and high risk (RS greater than 30) were recorded. Log rate ratios (lnRR) and standard error were determined from AUC and 95 per cent confidence intervals. RESULTS Nine studies including 1216 patients met inclusion criteria; the mean age at diagnosis was 52.9 years. Mean RS was 16 (range 0-75); 401 patients with RS less than 18, 287 patients with RS 18-30 and 100 patients with RS greater than 30. Radiomic analysis and RS were comparable for differentiating RS less than 18 versus RS 18 or greater (RR 0.93 (95 per cent c.i. 0.85 to 1.01); P = 0.010, heterogeneity (I2)=0%) as well as RS less than 30 versus RS 30 or greater (RR 0.76 (95 per cent c.i. 0.70 to 0.83); P < 0.001, I2=0%). MRI sensitivity and specificity for RS less than 18 versus 18 or greater was 0.89 (95 per cent c.i. 0.85 to 0.93) and 0.72 (95 per cent c.i. 0.66 to 0.78) respectively, and 0.79 (95 per cent c.i. 0.72 to 0.86) and 0.74 (95 per cent c.i. 0.68 to 0.80) for RS less than 30 versus 30 or greater. CONCLUSION Radiomic tumour analysis is comparable to RS in differentiating patients into clinically relevant subgroups. For patients requiring MRI, radiomics may complement and enhance RS for prognostication and therapeutic decision making in ER+ breast cancer.
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Affiliation(s)
- M G Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M S Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - É J Ryan
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M R Boland
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - P F McAnena
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - A J Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M J Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Davey MG, Richard V, Lowery AJ, Kerin MJ. OncotypeDX© Recurrence Score in BRCA mutation carriers: a systematic review and meta-analysis. Eur J Cancer 2021; 154:209-216. [PMID: 34284256 DOI: 10.1016/j.ejca.2021.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There are limited data comparing the OncotypeDX© Recurrence Score (RS) among BRCA mutation carriers and patients with sporadic breast cancer. AIM To compare RS results among BRCA mutation carriers and patients with sporadic breast cancer in oestrogen receptor positive (ER+), human epidermal growth factor receptor-2 negative (HER2-) breast cancer. METHODS A systematic review was performed in accordance with PRISMA and MOOSE guidelines. Retrospective cohort studies comparing RS in BRCA mutation carriers and cases of sporadic cancer were included. Dichotomous variables were pooled as odds ratios (ORs) and associated 95% confidence intervals (CIs) using the Mantel-Haenszel method. RESULTS Five studies involving 4286 patients were included with a mean age of 60 years (range 22-85). Overall, 7.8% were BRCA mutation carriers (333/4286). The mean RS was 18.0 (range 0-71), and the mean RS in BRCA carriers was 25 (range 10-71) versus 18.4 in cases of sporadic disease (range 0-62). Patients with sporadic cancers were more likely to have RS < 18 (OR 0.27, 95% CI 0.14-0.51, P = 0.010). BRCA mutation carriers were more likely to have RS 18-30 (OR 1.74, 95% CI 1.28-2.37, P < 0.001) and RS > 30 (OR 3.71, 95% CI 2.55-5.40, P < 0.001). CONCLUSION There is an increased likelihood of high-risk RS among patients with known germline BRCA mutations when compared to patients developing sporadic ER+/HER2-early breast cancer. This study offers insight into genomic testing results within BRCA mutation carriers which may be useful in counselling patients with BRCA mutations in future practice.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.
| | - Vinitha Richard
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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O'Donnell JPM, Murphy D, Ryan ÉJ, Gasior SA, Sugrue R, O'Neill BL, Boland MR, Lowery AJ, Kerin MJ, McInerney NM. Optimal reconstructive strategies in the setting of post-mastectomy radiotherapy - A systematic review and network meta-analysis. Eur J Surg Oncol 2021; 47:2797-2806. [PMID: 34301444 DOI: 10.1016/j.ejso.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/17/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A third of breast cancer patients require mastectomy. In some high-risk cases postmastectomy radiotherapy (PMRT) is indicated, threatening reconstructive complications. Several PMRT and reconstruction combinations are used. Autologous flap (AF) reconstruction may be immediate (AF→PMRT), delayed-immediate with tissue expander (TE [TE→PMRT→AF]) or delayed (PMRT→AF). Implant-based breast reconstruction (IBBR) includes immediate TE followed by PMRT and conversion to permanent implant (PI [TE→PMRT→PI]), delayed TE insertion (PMRT→TE→PI), and prosthetic implant conversion prior to PMRT (TE→PI→PMRT). AIM Perform a network metanalysis (NMA) assessing optimal sequencing of PMRT and reconstructive type. METHODS A systematic review and NMA was performed according to PRISMA-NMA guidelines. NMA was conducted using R packages netmeta and Shiny. RESULTS 16 studies from 4182 identified, involving 2322 reconstructions over three decades, met predefined inclusion criteria. Studies demonstrated moderate heterogeneity. Multiple comparisons combining direct and indirect evidence established AF-PMRT as the optimal approach to avoid reconstructive failure, compared with IBBR strategies (versus PMRT→TE→PI; OR [odds ratio] 0.10, CrI [95% credible interval] 0.02 to 0.55; versus TE→PMRT→PI; OR 0.13, CrI 0.02 to 0.75; versus TE→PI→PMRT OR 0.24, CrI 0.05 to 1.05). PMRT→AF best avoided infection, demonstrating significant improvement versus PMRT→TE→PI alone (OR 0.12, CrI 0.02 to 0.88). Subgroup analysis of IBBR found TE→PI→PMRT reduced failure rates (OR 0.35, CrI 0.15-0.81) compared to other IBBR strategies but increased capsular contracture. CONCLUSION Immediate AF reconstruction is associated with reduced failure in the setting of PMRT. However, optimal reconstructive strategy depends on patient, surgeon and institutional factors. If IBBR is chosen, complication rates decrease if performed prior to PMRT. PROSPERO REGISTRATION CRD 42020157077.
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Affiliation(s)
- J P M O'Donnell
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland.
| | - D Murphy
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - É J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - S A Gasior
- University of Limerick School of Medicine, University of Limerick, Ireland
| | - R Sugrue
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - B Lane O'Neill
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - M R Boland
- Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - A J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland; The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland; The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - N M McInerney
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
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Davey MG, Ryan ÉJ, Burke D, McKevitt K, McAnena PF, Kerin MJ, Lowery AJ. Evaluating the Clinical Utility of Routine Sentinel Lymph Node Biopsy and the Value of Adjuvant Chemotherapy in Elderly Patients Diagnosed With Oestrogen Receptor Positive, Clinically Node Negative Breast Cancer. Breast Cancer (Auckl) 2021; 15:11782234211022203. [PMID: 34177266 PMCID: PMC8207274 DOI: 10.1177/11782234211022203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
Background Sentinel lymph node biopsy (SLNB) provides staging information and guides adjuvant therapy in early breast cancer (EBC). Routine SLNB in oncogeriatricians with low-risk EBC remains controversial. Aims To evaluate axillary management in elderly patients diagnosed with oestrogen receptor positive (ER+), clinically lymph node negative (cLN-) EBC, and to assess whether SLNB affects further axillary management or adjuvant chemotherapy (ACTX) decision making. Methods Female patients aged > 65 years, diagnosed with ER+, human epidermal growth factor receptor-2 negative (HER2-), and cLN- breast cancer (BC), who underwent surgery and SLNB were included. Clinicopathological predictors of ACTX and completion axillary lymph node dissection (CALND) were determined. Kaplan-Meier analyses assessed survival outcomes. Results A total of 253 patients were included (median age: 72 years, range: 66-90), all underwent SLNB; 50 (19.8%) had lymphatic metastasis on SLNB (SLNB+). Of these, 19 proceeded to CALND (38.0%), 10 (52.6%) of whom had further axillary disease (ALND+). 20 of the 50 SLNB+ patients received ACTX (40.0%) as did 31 of the 203 SLNB- patients (15.2%) (P < .001). Oncotype DX (ODX) testing was utilized in 82 cases (32.8%). Younger age (P < .001), SLNB+ (P < .001) and ODX score (P = .003) were all associated with ACTX prescription. ODX > 25 (OR: 4.37, 95% CI: 1.38-13.80, P = .012) independently predicted receiving ACTX. Receiving ACTX and proceeding to CALND did not improve disease-free (P = .485 and P = .345) or overall survival (P = .981 and P = .646). Conclusions Routine SNLB may not be necessary in elderly patients diagnosed with ER+, cLN- EBC. Future oncogeriatric practice is likely to see genomic testing guiding ACTX prescription in this group.
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Affiliation(s)
- Matthew G Davey
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Éanna J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland
| | - Daniel Burke
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland
| | - Kevin McKevitt
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland
| | - Peter F McAnena
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Michael J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Aoife J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Republic of Ireland.,Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
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Davey MG, Ryan ÉJ, Folan PJ, O'Halloran N, Boland MR, Barry MK, Sweeney KJ, Malone CM, McLaughlin RJ, Kerin MJ, Lowery AJ. The impact of progesterone receptor negativity on oncological outcomes in oestrogen-receptor-positive breast cancer. BJS Open 2021; 5:6278498. [PMID: 34013318 PMCID: PMC8134515 DOI: 10.1093/bjsopen/zrab040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/20/2021] [Accepted: 03/13/2021] [Indexed: 12/11/2022] Open
Abstract
Background Oestrogen receptor (ER) status provides invaluable prognostic and therapeutic information in breast cancer (BC). When clinical decision making is driven by ER status, the value of progesterone receptor (PgR) status is less certain. The aim of this study was to describe clinicopathological features of ER-positive (ER+)/PgR-negative (PgR-) BC and to determine the effect of PgR negativity in ER+ disease. Methods Consecutive female patients with ER+ BC from a single institution were included. Factors associated with PgR- disease were assessed using binary logistic regression. Oncological outcome was assessed using Kaplan–Meier and Cox regression analysis. Results In total, 2660 patients were included with a mean(s.d.) age of 59.6(13.3) years (range 21–99 years). Median follow-up was 97.2 months (range 3.0–181.2). Some 2208 cases were PgR+ (83.0 per cent) and 452 were PgR- (17.0 per cent). Being postmenopausal (odds ratio (OR) 1.66, 95 per cent c.i. 1.25 to 2.20, P < 0.001), presenting with symptoms (OR 1.71, 95 per cent c.i. 1.30 to 2.25, P < 0.001), ductal subtype (OR 1.51, 95 per cent c.i. 1.17 to 1.97, P = 0.002) and grade 3 tumours (OR 2.20, 95 per cent c.i. 1.68 to 2.87, P < 0.001) were all associated with PgR negativity. In those receiving neoadjuvant chemotherapy (308 patients), pathological complete response rates were 10.1 per cent (25 of 247 patients) in patients with PgR+ disease versus 18.0 per cent in PgR- disease (11 of 61) (P = 0.050). PgR negativity independently predicted worse disease-free (hazard ratio (HR) 1.632, 95 per cent c.i. 1.209 to 2.204, P = 0.001) and overall survival (HR 1.774, 95 per cent c.i. 1.324 to 2.375, P < 0.001), as well as worse overall survival in ER+/HER2- disease (P = 0.004). Conclusions In ER+ disease, PgR- tumours have more aggressive clinicopathological features and worse oncological outcomes. Neoadjuvant and adjuvant therapeutic strategies should be tailored according to PgR status.
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Affiliation(s)
- M G Davey
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - É J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - P J Folan
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - N O'Halloran
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M R Boland
- Department of Surgery, The Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - M K Barry
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - K J Sweeney
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - C M Malone
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - R J McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - M J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - A J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Davey MG, Ryan ÉJ, Boland MR, Barry MK, Lowery AJ, Kerin MJ. Clinical utility of the 21-gene assay in predicting response to neoadjuvant endocrine therapy in breast cancer: A systematic review and meta-analysis. Breast 2021; 58:113-120. [PMID: 34022714 PMCID: PMC8142274 DOI: 10.1016/j.breast.2021.04.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION OncotypeDX© Recurrence Score (RS) is a multigene panel used to aid therapeutic decision making in early-stage, estrogen receptor positive (ER+)/human epidermal growth factor receptor-2 negative (HER2-) breast cancer. AIM To compare responses to neoadjuvant endocrine therapy (NET) in patients with ER+/HER2-breast cancer following substratification by RS testing. METHODS This systematic review was performed in accordance to the PRISMA guidelines. Studies evaluating pathological complete response (pCR), partial response (PR), and successful conversion to breast conservation surgery (BCS) rates following NET guided by RS were retrieved. Dichotomous outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs) following estimation by Mantel-Haenszel method. RESULTS Eight prospective studies involving 691 patients were included. The mean age was 62.6 years (range 25-85) and the mean RS was 14.5 (range 0-68). Patients with RS < 25 (OR: 4.60, 95% CI: 2.53-8.37, P < 0.001) and RS < 30 (OR: 3.40, 95% CI: 1.96-5.91, P < 0.001) were more likely to achieve PR than their counterparts. NET prescription failed to increase BCS conversion rates for patients with RS < 18 (OR: 0.23, 95% CI: 0.04-1.47, P = 0.120) and RS > 30 (OR: 1.27, 95% CI: 0.64-2.49, P = 0.490) respectively. Only 22 patients achieved pCR (2.8%) and RS group failed to predict pCR following NET (P = 0.850). CONCLUSION Estimations from this analysis indicate that those with low-intermediate RS on core biopsy are four times more likely to respond to NET than those with high-risk RS. Performing RS testing on diagnostic biopsy may be useful in guiding NET prescription.
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Affiliation(s)
- M G Davey
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.
| | - É J Ryan
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M R Boland
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M K Barry
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - A J Lowery
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M J Kerin
- The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Davey MG, Ryan ÉJ, Davey MS, Lowery AJ, Miller N, Kerin MJ. Clinicopathological and prognostic significance of programmed cell death ligand 1 expression in patients diagnosed with breast cancer: meta-analysis. Br J Surg 2021; 108:622-631. [PMID: 33963374 PMCID: PMC10364926 DOI: 10.1093/bjs/znab103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 02/25/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Uncertainty exists regarding the clinical relevance of programmed cell death ligand 1 (PD-L1) expression in breast cancer. METHODS A systematic review was performed in accordance with PRISMA guidelines. Observational studies that compared high versus low expression of PD-L1 on breast cancer cells were identified. Log hazard ratios (HRs) for disease-free and overall survival and their standard errors were calculated from Kaplan-Meier curves or Cox regression analyses, and pooled using the inverse-variance method. Dichotomous variables were pooled as odds ratios (ORs) using the Mantel-Haenszel method. RESULTS Sixty-five studies with 19 870 patients were included; 14 404 patients were classified as having low and 4975 high PD-L1 expression. High PD-L1 was associated with achieving a pathological complete response following neoadjuvant chemotherapy (OR 3.30, 95 per cent confidence interval 1.19 to 9.16; P < 0.01; I2 = 85 per cent). Low PD-L1 expression was associated with human epidermal growth factor receptor 2 (OR 3.98, 1.81 to 8.75; P < 0.001; I2 = 96 per cent) and luminal (OR 14.93, 6.46 to 34.51; P < 0.001; I2 = 99 per cent) breast cancer subtypes. Those with low PD-L1 had favourable overall survival rates (HR 1.30, 1.05 to 1.61; P = 0.02; I2 = 85 per cent). CONCLUSION Breast cancers with high PD-L1 expression are associated with aggressive clinicopathological and immunohistochemical characteristics and are more likely to achieve a pathological complete response following neoadjuvant chemotherapy. These breast cancers are, however, associated with worse overall survival outcomes.
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Affiliation(s)
- M G Davey
- Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - É J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M S Davey
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A J Lowery
- Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - N Miller
- Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.,Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - M J Kerin
- Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland.,Department of Surgery, Galway University Hospitals, Galway, Ireland
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O'Connor DJ, Kerin MJ, Barkley LR. O13: TUMOUR STROMAL CELLS - A CULPRIT IN BREAST CANCER RECURRENCE AFTER NEOADJUVANT CHEMOTHERAPY. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
The goal of neoadjuvant chemothepaeutics(NACs) and surgical excision of breast cancer is to control and ultimately eliminate the malignant tumour. Despite advances in treatment, a subset of patients will develop disease recurrence. Tumour stromal cells(TSCs) are non-cancerous cells that support malignancy within the tumour microenvironment(TME). In particular, TSCs can suppress the host immune response to tumour. It is unclear if NACs affect the survival of–or alter the immunosuppressive functions of TSCs in breast cancer patients and if this correlates with recurrance or chemoresistance?
Method
TSCs and Tumour Associated Normal Stromal Cells(TANs) were isolated from tissue harvested from breast cancer patients at surgery. Clonogenic survival assays were performed following exposure to increasing doses of Paclitaxel (range 0-1000nM), Cyclophosphamide (range 0-3μM) and Doxorubicin (0-100nM). TSCs were co-cultured with CD4+ and CD8+ T-cells to determine the effect of chemotherapeutics on their ability to suppress T-cell proliferation.
Result
TSCs(n=5) are less susceptible to the cytotoxic effects of chemotherapy compared to TANs with 21%(p-0.0001), 21%(p-0.001) and 15%(p-0.026) more colonies across all doses of Paclitaxel, Cyclophosphamide and Doxorubicin respectively. Chemo naïve TSCs suppressed CD4+ and CD8+ T-Cell proliferation by 44% and 20.5% respectively(p-0.001, p-0.042). Interestingly, Paclitaxel-treated TSCs suppressed CD4+ proliferation by a further 11.1%(p-0.047) and CD8+ proliferation by 35.6%(p-0.017). Additionally, Cyclophosphamide-treated TSCs enhanced CD8+ suppression by 25.6%(p-0.029).
Conclusion
Our data indicate that NACs enhance the immunosuppressive function of TSCs - potentially creating an immune inert TME in vivo. Future studies will explore the correlation between NAC treatment, immunosuppressive activities within patient tumours/blood and recurrence.
Take-home message
After neoadjuvant chemotherapy, Tumour stromal cells are highly immunosuppressive and may contribute to breast cancer recurrence.
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Affiliation(s)
- DJ O'Connor
- Department of Surgery, Lambe Institute, NUI Galway
| | - MJ Kerin
- Department of Surgery, Lambe Institute, NUI Galway
| | - LR Barkley
- Department of Surgery, Lambe Institute, NUI Galway
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Collins PM, Elliott JA, Brennan MJ, McNamara M, O'Malley E, Barry K, Sweeney K, Malone C, Lowery A, McLaughlin R, Kerin MJ. O78: SARCOPENIA IN LOCALLY ADVANCED BREAST CANCER: PREVALENCE, AND IMPACT ON CLINICAL AND ONCOLOGIC OUTCOMES. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Sarcopenia in cancer may confer negative outcomes, but its prevalence and impact in the modern multimodal management of locally advanced breast cancer have not been systematically studied.
Method
Patients undergoing neoadjuvant therapy and surgery for locally advanced breast cancer between 2010 and 2015 were studied. Skeletal muscle index (SMI) and lean body mass (LBM) were determined. Sarcopenia was defined by computed tomography (CT) at L3 as SMI<38.5cm2/m2. Multivariable linear, logistic, and Cox regression analysis was undertaken to determine the independent impact of sarcopenia on clinical and oncologic outcome.
Result
258 patients were studied. Sarcopenia was present in 23.0%, 7.8% and 0.0% of patients with normal weight, overweight and obesity, respectively (P=0.001). Sarcopenia was not associated with baseline cT and cN stage, tumour grade, histologic type or receptor status. Patients with sarcopenia exhibited equivalent indices of neoadjuvant therapy response including ypT and ypN stage, pathologic complete response and Sataloff grade following surgical resection. Postoperatively, sarcopenia was not independently associated with comprehensive complications index (P=0.242), length of stay (P=0.716) or overall morbidity (P=0.365). However, on multivariable analysis, lower LBM independently predicted reduced invasive disease-free (P=0.049,HR0.93[95%CI0.87-1.00]) and overall (P=0.028,HR0.92[0.85-0.99]), but not disease-specific survival (P=0.070).
Conclusion
Consistent with a lack of association with baseline and post-treatment pathologic features, sarcopenia in locally advanced breast cancer is associated with reduced overall, but not disease-specific, survival. These data indicate that the prognostic impact of sarcopenia may be mediated by impaired performance status and increased non-cancer mortality.
Take-home message
Consistent with a lack of association with baseline and post-treatment pathologic features, sarcopenia in locally advanced breast cancer is associated with reduced overall, but not disease-specific, survival. These data indicate that the prognostic impact of sarcopenia may be mediated by impaired performance status and increased non-cancer mortality.
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Affiliation(s)
- PM Collins
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - JA Elliott
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - MJ Brennan
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - M McNamara
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - E O'Malley
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | | | - K Sweeney
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - C Malone
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - A Lowery
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
- Lambe Institute for Translational Research, National University of Ireland Galway, University Road, Galway, Ireland
| | - R McLaughlin
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
| | - MJ Kerin
- Department of Breast Surgery, University Hospital Galway, Galway, Ireland
- Lambe Institute for Translational Research, National University of Ireland Galway, University Road, Galway, Ireland
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