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Luen SJ, Viale G, Nik-Zainal S, Savas P, Kammler R, Dell'Orto P, Biasi O, Degasperi A, Brown LC, Láng I, MacGrogan G, Tondini C, Bellet M, Villa F, Bernardo A, Ciruelos E, Karlsson P, Neven P, Climent M, Müller B, Jochum W, Bonnefoi H, Martino S, Davidson NE, Geyer C, Chia SK, Ingle JN, Coleman R, Solbach C, Thürlimann B, Colleoni M, Coates AS, Goldhirsch A, Fleming GF, Francis PA, Speed TP, Regan MM, Loi S. Genomic characterisation of hormone receptor-positive breast cancer arising in very young women. Ann Oncol 2023; 34:397-409. [PMID: 36709040 PMCID: PMC10619213 DOI: 10.1016/j.annonc.2023.01.009] [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: 08/09/2022] [Revised: 12/14/2022] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Very young premenopausal women diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+HER2-) early breast cancer (EBC) have higher rates of recurrence and death for reasons that remain largely unexplained. PATIENTS AND METHODS Genomic sequencing was applied to HR+HER2- tumours from patients enrolled in the Suppression of Ovarian Function Trial (SOFT) to determine genomic drivers that are enriched in young premenopausal women. Genomic alterations were characterised using next-generation sequencing from a subset of 1276 patients (deep targeted sequencing, n = 1258; whole-exome sequencing in a young-age, case-control subsample, n = 82). We defined copy number (CN) subgroups and assessed for features suggestive of homologous recombination deficiency (HRD). Genomic alteration frequencies were compared between young premenopausal women (<40 years) and older premenopausal women (≥40 years), and assessed for associations with distant recurrence-free interval (DRFI) and overall survival (OS). RESULTS Younger women (<40 years, n = 359) compared with older women (≥40 years, n = 917) had significantly higher frequencies of mutations in GATA3 (19% versus 16%) and CN amplifications (CNAs) (47% versus 26%), but significantly lower frequencies of mutations in PIK3CA (32% versus 47%), CDH1 (3% versus 9%), and MAP3K1 (7% versus 12%). Additionally, they had significantly higher frequencies of features suggestive of HRD (27% versus 21%) and a higher proportion of PIK3CA mutations with concurrent CNAs (23% versus 11%). Genomic features suggestive of HRD, PIK3CA mutations with CNAs, and CNAs were associated with significantly worse DRFI and OS compared with those without these features. These poor prognostic features were enriched in younger patients: present in 72% of patients aged <35 years, 54% aged 35-39 years, and 40% aged ≥40 years. Poor prognostic features [n = 584 (46%)] versus none [n = 692 (54%)] had an 8-year DRFI of 84% versus 94% and OS of 88% versus 96%. Younger women (<40 years) had the poorest outcomes: 8-year DRFI 74% versus 85% and OS 80% versus 93%, respectively. CONCLUSION These results provide insights into genomic alterations that are enriched in young women with HR+HER2- EBC, provide rationale for genomic subgrouping, and highlight priority molecular targets for future clinical trials.
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Affiliation(s)
- S J Luen
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - G Viale
- International Breast Cancer Study Group Central Pathology Office, IEO European Institute of Oncology IRCCS, University of Milan, Milan, Italy
| | - S Nik-Zainal
- Department of Medical Genetics & MRC Cancer Unit, The Clinical School, University of Cambridge, Cambridge, UK
| | - P Savas
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - R Kammler
- International Breast Cancer Study Group, Coordinating Center, Central Pathology Office, Bern, Switzerland
| | - P Dell'Orto
- International Breast Cancer Study Group Central Pathology Office, Department of Pathology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - O Biasi
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - A Degasperi
- Department of Medical Genetics & MRC Cancer Unit, The Clinical School, University of Cambridge, Cambridge, UK
| | - L C Brown
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - I Láng
- Istenhegyi Health Center Oncology Clinic, National Institute of Oncology, Budapest, Hungary
| | - G MacGrogan
- Biopathology Department, Institut Bergonié Comprehensive Cancer Centre, Bordeaux, France
| | - C Tondini
- Osp. Papa Giovanni XXIII, Bergamo, Italy
| | - M Bellet
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - F Villa
- Oncology Unit, Department of Oncology, Alessandro Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - A Bernardo
- ICS Maugeri IRCCS, Medical Oncology Unit of Pavia Institute, Italy
| | - E Ciruelos
- University Hospital 12 de Octubre, Madrid, Spain
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Neven
- Gynecologic Oncology and Multidisciplinary Breast Center, University Hospitals UZ-Leuven, KU Leuven, Leuven, Belgium
| | - M Climent
- Instituto Valenciano de Oncologia, Valencia, Spain
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Santiago, Chile
| | - W Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - H Bonnefoi
- Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1218, Bordeaux, France; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - S Martino
- The Angeles Clinic and Research Institute, Santa Monica, USA
| | - N E Davidson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, USA
| | - C Geyer
- Houston Methodist Cancer Center, NRG Oncology, Houston, USA
| | - S K Chia
- BC Cancer and Canadian Cancer Trials Group, Vancouver, Canada
| | - J N Ingle
- Mayo Clinic, Rochester, Minnesota, USA
| | - R Coleman
- National Institute for Health Research (NIHR) Cancer Research Network, University of Sheffield, Sheffield, UK
| | - C Solbach
- Breast Center, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - B Thürlimann
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland; Breast Center, Kantonsspital, St. Gallen, Switzerland
| | - M Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A S Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group (IBCSG), Bern Switzerland and IEO European Institute of Oncology IRCCS, Milan, Italy
| | - G F Fleming
- Section of Hematology Oncology, The University of Chicago, Chicago, USA
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - T P Speed
- Bioinformatics Division, Walter and Eliza Hall Institute, Melbourne, Australia
| | - M M Regan
- Division of Biostatistics, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
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Lenell J, Lindahl B, Karlsson P, Batra G, Erlinge D, Jernberg T, Spaak J, Baron T. Accuracy of estimating left ventricular ejection fraction in clinical routine. A SWEDEHEART registry validation study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1399] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Patients admitted to Swedish hospitals with myocardial infarction (MI) are reported to the nationwide Swedish registry for MI (SWEDEHEART). During hospital stay an echocardiography is routinely performed, and left ventricular ejection fraction (LVEF) is assessed according to the clinical praxis. LVEF is categorized as normal (>50%) or mild, moderate or severely impaired (40–49%, 30–39% and <30%, respectively) and reported to the registry by the treating center. The purpose of this study was to validate the reported LVEF assessments against independent echocardiography re-evaluation as this has never previously been done.
Methods
A random sample of 130 patient from three different hospitals were included. LVEF re-evaluation was performed by two independent reviewers using the modified biplane Simpson method and their mean LVEF was compared to the SWEDEHEART LVEF. Agreement between reported and re-evaluated LVEF was assessed using Gwet's AC2 statistics.
Results
Analysis showed good agreement between reported and reevaluated LVEF (AC2: 0.76 [95% CI 0.69–0.84]). The LVEF re-evaluations corresponded with registry reported categorized LVEF in 66.0% of cases. In 25.4% of cases the SWEDEHEART LVEF was lower than re-evaluated LVEF. The opposite relation was found in 8.6% of cases (p<0.005).
Conclusion
Independent validation of SWEDEHEART-reported LVEF shows an overall good agreement with the re-evaluated LVEF. However, a tendency to underestimation of LVEF was observed in patients with impaired LV systolic function, in whom the reported assessment of LVEF should be interpreted more cautiously.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Selanders Stiftelse
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Affiliation(s)
- J Lenell
- Uppsala Clinical Research Center, Dept. of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - B Lindahl
- Uppsala Clinical Research Center, Dept. of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - P Karlsson
- Uppsala University Hospital, Dept. of Cardiology and Clinical Physiology, Uppsala, Sweden
| | - G Batra
- Uppsala Clinical Research Center, Dept. of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - D Erlinge
- Lund University, Dept. of Clinical Sciences, Cardiology, Lund, Sweden
| | - T Jernberg
- Karolinska Institute, Dept. of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
| | - J Spaak
- Karolinska Institute, Dept. of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
| | - T Baron
- Uppsala Clinical Research Center, Dept. of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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Jerusalem G, Farah S, Courtois A, Chirgwin J, Aebi S, Karlsson P, Neven P, Hitre E, Graas MP, Simoncini E, Abdi E, Kamby C, Thompson A, Loibl S, Gavilá J, Kuroi K, Marth C, Müller B, O'Reilly S, Gombos A, Ruhstaller T, Burstein HJ, Rabaglio M, Ruepp B, Ribi K, Viale G, Gelber RD, Coates AS, Loi S, Goldhirsch A, Regan MM, Colleoni M. Continuous versus intermittent extended adjuvant letrozole for breast cancer: final results of randomized phase III SOLE (Study of Letrozole Extension) and SOLE Estrogen Substudy. Ann Oncol 2021; 32:1256-1266. [PMID: 34384882 DOI: 10.1016/j.annonc.2021.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/12/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Late recurrences in postmenopausal women with hormone receptor-positive breast cancers remain an important challenge. Avoidance or delayed development of resistance represents the main objective in extended endocrine therapy (ET). In animal models, resistance was reversed with restoration of circulating estrogen levels during interruption of letrozole treatment. This phase III, randomized, open-label Study of Letrozole Extension (SOLE) studied the effect of extended intermittent letrozole treatment in comparison with continuous letrozole. In parallel, the SOLE estrogen substudy (SOLE-EST) analyzed the levels of estrogen during the interruption of treatment. PATIENTS AND METHODS SOLE enrolled 4884 postmenopausal women with hormone receptor-positive, lymph node-positive, operable breast cancer between December 2007 and October 2012 and among them, 104 patients were enrolled in SOLE-EST. They must have undergone local treatment and have completed 4-6 years of adjuvant ET. Patients were randomized between continuous letrozole (2.5 mg/day orally for 5 years) and intermittent letrozole treatment (2.5 mg/day for 9 months followed by a 3-month interruption in years 1-4 and then 2.5 mg/day during all of year 5). RESULTS Intention-to-treat population included 4851 women in SOLE (n = 2425 in the intermittent and n = 2426 in the continuous letrozole groups) and 103 women in SOLE-EST (n = 78 in the intermittent and n = 25 in the continuous letrozole groups). After a median follow-up of 84 months, 7-year disease-free survival (DFS) was 81.4% in the intermittent group and 81.5% in the continuous group (hazard ratio: 1.03, 95% confidence interval: 0.91-1.17). Reported adverse events were similar in both groups. Circulating estrogen recovery was demonstrated within 6 weeks after the stop of letrozole treatment. CONCLUSIONS Extended adjuvant ET by intermittent administration of letrozole did not improve DFS compared with continuous use, despite the recovery of circulating estrogen levels. The similar DFS coupled with previously reported quality-of-life advantages suggest intermittent extended treatment is a valid option for patients who require or prefer a treatment interruption.
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Affiliation(s)
- G Jerusalem
- International Breast Cancer Study Group, Bern, Switzerland; Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium.
| | - S Farah
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA
| | - A Courtois
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium
| | - J Chirgwin
- Breast Cancer Trials-Australia and New Zealand, University of Newcastle, Callaghan, Australia; Box Hill and Maroondah Hospitals, Monash University, Clayton, Australia
| | - S Aebi
- Division of Medical Oncology, Cancer Center, Lucerne Cantonal Hospital, Lucerne, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Neven
- Gynecologic Oncology and Multidisciplinary Breast Center, University Hospitals UZ-Leuven, KU Leuven, Leuven, Belgium
| | - E Hitre
- Department of Medical Oncology and Clinical Pharmacology "B", National Institute of Oncology, Budapest, Hungary
| | | | - E Simoncini
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Abdi
- The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - C Kamby
- Danish Breast Cancer Group and Rigshospitalet, Copenhagen, Denmark
| | - A Thompson
- Scottish Cancer Trials Breast Group and Division of Surgical Oncology, Baylor College of Medicine, Houston, USA
| | - S Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - J Gavilá
- SOLTI Group and Fundación Instituto Valenciano de Oncologia, Valencia, Spain
| | - K Kuroi
- Japan Breast Cancer Research Group and Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - C Marth
- Austrian Breast & Colorectal Cancer Study Group and Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Providencia, Santiago, Chile
| | - S O'Reilly
- Cancer Trials Ireland, Dublin, Ireland; University College Cork, Cork University Hospital, Cork, Ireland
| | - A Gombos
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - T Ruhstaller
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Breast Center St. Gallen, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - H J Burstein
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium; Harvard Medical School, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Rabaglio
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Ruepp
- International Breast Cancer Study Group, Bern, Switzerland
| | - K Ribi
- International Breast Cancer Study Group, Bern, Switzerland
| | - G Viale
- Department of Pathology, University of Milan, Milan, Italy; IEO European Institute of Oncology IRCCS, Milan, Italy
| | - R D Gelber
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard TH Chan School of Public Health, Boston, USA; Frontier Science Foundation, Boston, USA
| | - A S Coates
- International Breast Cancer Study Group, Bern, Switzerland; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - S Loi
- International Breast Cancer Study Group, Bern, Switzerland; Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group, Bern, Switzerland; IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Colleoni
- International Breast Cancer Study Group, Bern, Switzerland; Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Agergaard J, Leth S, Pedersen TH, Harbo T, Blicher JU, Karlsson P, Østergaard L, Andersen H, Tankisi H. Reply to "Maybe myopathic EMG but not myopathy" and to "Exclude differentials before attributing post-COVID fatigue to myopathy". Clin Neurophysiol 2021; 132:2326-2327. [PMID: 34326011 DOI: 10.1016/j.clinph.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- J Agergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - S Leth
- Department of Medicine, Regional Hospital Unit West, Jutland, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - T Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - J U Blicher
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Centre of Functionally Integrated Neuroscience, Aarhus University, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Aarhus University, Denmark
| | - L Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
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Agergaard J, Leth S, Pedersen TH, Harbo T, Blicher JU, Karlsson P, Østergaard L, Andersen H, Tankisi H. Myopathic changes in patients with long-term fatigue after COVID-19. Clin Neurophysiol 2021; 132:1974-1981. [PMID: 34020890 PMCID: PMC8102077 DOI: 10.1016/j.clinph.2021.04.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 03/23/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022]
Abstract
Objective To investigate the peripheral nerve and muscle function electrophysiologically in patients with persistent neuromuscular symptoms following Coronavirus disease 2019 (COVID-19). Methods Twenty consecutive patients from a Long-term COVID-19 Clinic referred to electrophysiological examination with the suspicion of mono- or polyneuropathy were included. Examinations were performed from 77 to 255 (median: 216) days after acute COVID-19. None of the patients had received treatment at the intensive care unit. Of these, 10 patients were not even hospitalized. Conventional nerve conduction studies (NCS) and quantitative electromyography (qEMG) findings from three muscles were compared with 20 age- and sex-matched healthy controls. Results qEMG showed myopathic changes in one or more muscles in 11 patients (55%). Motor unit potential duration was shorter in patients compared to healthy controls in biceps brachii (10.02 ± 0.28 vs 11.75 ± 0.21), vastus medialis (10.86 ± 0.37 vs 12.52 ± 0.19) and anterior tibial (11.76 ± 0.31 vs 13.26 ± 0.21) muscles. All patients with myopathic qEMG reported about physical fatigue and 8 patients about myalgia while 3 patients without myopathic changes complained about physical fatigue. Conclusions Long-term COVID-19 does not cause large fibre neuropathy, but myopathic changes are seen. Significance Myopathy may be an important cause of physical fatigue in long-term COVID-19 even in non-hospitalized patients.
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Affiliation(s)
- J Agergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - S Leth
- Department of Medicine, Regional Hospital Unit West, Jutland, Denmark
| | - T H Pedersen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - T Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - J U Blicher
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Centre of Functionally Integrated Neuroscience, Aarhus University, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Aarhus University, Denmark
| | - L Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.
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Gylfadottir SS, Itani M, Krøigård T, Kristensen AG, Christensen DH, Nicolaisen SK, Karlsson P, Callaghan BC, Bennett DL, Andersen H, Tankisi H, Nielsen JS, Andersen NT, Jensen TS, Thomsen RW, Sindrup SH, Finnerup NB. Diagnosis and prevalence of diabetic polyneuropathy: a cross-sectional study of Danish patients with type 2 diabetes. Eur J Neurol 2020; 27:2575-2585. [PMID: 32909392 DOI: 10.1111/ene.14469] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 05/27/2020] [Accepted: 07/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Diabetic polyneuropathy (DPN) is a common complication of diabetes. Using the Toronto criteria for diabetic polyneuropathy and the grading system for neuropathic pain, the performance of neuropathy scales and questionnaires were assessed by comparing them to a clinical gold standard diagnosis of DPN and painful DPN in a cohort of patients with recently diagnosed type 2 diabetes. METHODS A questionnaire on neuropathy and pain was sent to a cohort of 5514 Danish type 2 diabetes patients. A sample of 389 patients underwent a detailed clinical examination and completed neuropathy questionnaires and scales. RESULTS Of the 389 patients with a median diabetes duration of 5.9 years, 126 had definite DPN (including 53 with painful DPN), 88 had probable DPN and 53 had possible DPN. There were 49 patients with other causes of polyneuropathy, neuropathy symptoms or pain, 10 with subclinical DPN and 63 without DPN. The sensitivity of the Michigan Neuropathy Screening Instrument questionnaire to detect DPN was 25.7% and the specificity 84.6%. The sensitivity of the Toronto Clinical Neuropathy Scoring System, including questionnaire and clinical examination, was 62.9% and the specificity was 74.6%. CONCLUSIONS Diabetic polyneuropathy affects approximately one in five Danish patients with recently diagnosed type 2 diabetes but neuropathic pain is not as common as previously reported. Neuropathy scales with clinical examination perform better compared with questionnaires alone, but better scales are needed for future epidemiological studies.
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Affiliation(s)
- S S Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - M Itani
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - T Krøigård
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - A G Kristensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - D H Christensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S K Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark
| | - B C Callaghan
- Department of Neurology, University of Michigan, Ann Arbor,, MI, USA
| | - D L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - H Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - H Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - J S Nielsen
- Danish Centre for Strategic Research in Type 2 Diabetes, Steno Diabetes Center, Odense, Denmark
| | - N T Andersen
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - T S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - N B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Viitala A, Livanainen S, Silvoniemi M, Tukiainen S, Karlsson P, Papinaho O. CN37 Monitoring immuno-oncologically treated patients in cancer nursing: A collaborative project. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sjöström M, Chang SL, Fishbane N, Davicioni E, Zhao SG, Hartman L, Holmberg E, Feng FY, Speers CW, Pierce LJ, Malmström P, Fernö M, Karlsson P. Abstract P5-12-01: A novel gene expression signature prognostic for both locoregional and distant failure and predictive for adjuvant radiotherapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-12-01] [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: 11/16/2022]
Abstract
Abstract
Background: Most patients with early stage breast cancer (BC) are treated with adjuvant radiotherapy (RT) following breast conserving surgery (BCS) to prevent locoregional recurrences (LRR). No predictive tools are currently available to select patients for RT, resulting in considerable over- and under treatment. We aimed to create and validate a gene expression-based classifier to prognosticate for LRR and to stratify patients for treatment with RT.
Patients and methods: A 27-gene expression signature was developed using three publicly available early stage BC gene expression datasets where patients were treated with RT and had detailed local recurrence information. The largest of the datasets was used to train the signature, and the other two datasets were used for signature refinement. As age was the strongest clinical factor for the endpoint in the training dataset, it was included in the model, resulting in a final clinical-genomic classifier of 27 genes and age. The classifier was locked before external validation in the SweBCG91-RT trial. This phase III clinical trial included primary tumors from 765 patients and for which gene expression data was available. The trial randomized node-negative BC patients to +/- RT following BCS, with sparse use of adjuvant systemic treatment (9%) and a median follow-up of 14.0 years for LRR in patients free from event. The classifier was validated using Cox regression with LRR as the primary endpoint, and hazard ratios (HRs) were calculated using the raw continuous classifier score (range: 0.5 to 2.5).
Results: The novel classifier was highly prognostic for LRR in SweBCG91-RT patients treated with RT (HR=7.5[3.3-16.9], p<0.001), and remained prognostic in multivariate analysis (MVA) that included systemic treatment, subtype and grade (HR=7.2[3.1-16.4], p<0.001). To a lesser extent, the classifier was also prognostic for LRR in patients not treated with RT (HR=1.9[1.0-3.5], p=0.03; MVA HR=1.9[1.0-3.3], p=0.05). Patients at high risk of LRR had a smaller effect of RT, and the treatment predictive potential was confirmed by testing for interaction (pinteraction=0.008). In patients treated with RT, age and the genomic component of the model were both prognostic for LRR (p<0.01) as well as predictive for RT response (pinteraction<0.05) and provided independent information (p<0.01). The combined classifier has increased performance over its individual components (10-year AUC=0.72, 0.67, 0.65 for the classifier, age, and genomic component, respectively). While the novel signature was prognostic for metastasis (HR=4.3[2.3-7.8], p<0.0001), calculated scores from previously published signatures to the metastasis endpoint, including the Oncotype-like score, were not prognostic for LRR.
Conclusions: This novel gene expression signature is highly prognostic for LRR, can identify patients at risk of LRR despite RT, and appears to be treatment predictive for adjuvant RT. Furthermore, the current signature is highly prognostic for metastasis. In contrast, calculated scores of previously published signatures modeled for the metastasis endpoint had inferior performance for LRR. These results underscore both the importance of signatures prognostic for LRR and the similarities in the biology of LRR and distant failure.
Citation Format: Sjöström M, Chang SL, Fishbane N, Davicioni E, Zhao SG, Hartman L, Holmberg E, Feng FY, Speers CW, Pierce LJ, Malmström P, Fernö M, Karlsson P. A novel gene expression signature prognostic for both locoregional and distant failure and predictive for adjuvant radiotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-12-01.
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Affiliation(s)
- M Sjöström
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - SL Chang
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - N Fishbane
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - E Davicioni
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - SG Zhao
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - L Hartman
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - E Holmberg
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - FY Feng
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - CW Speers
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - LJ Pierce
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - P Malmström
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - M Fernö
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
| | - P Karlsson
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; PFS Genomics, Vancouver, Canada; GenomeDx Biosciences, Vancouver, Canada; University of Michigan, Michigan, MI; Gothenburg University, Sahlgrenska Academy, Gothenburg, Sweden; University of California, San Francisco, San Francisco, CA
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Adra J, Karlsson P, Killander F, Lundstedt D, Alkner S. Abstract PD8-11: Distribution of locoregional breast cancer recurrences in relation to previous radiotherapy and biological subtype. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd8-11] [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: 11/16/2022]
Abstract
Abstract
Background: Adjuvant locoregional radiotherapy (LRRT) reduces risk of locoregional failures (LRF) and improves survival for node positive breast cancer (BC) patients. However, LRRT increases the risk for toxicity as edema in the arm, lung cancer and cardiac mortality. Modern radiotherapy allows a more conform therapy which makes knowledge of LRF-patterns very important, in order not to underdose volumes with high risk for microscopic disease and simultaneously restrict dose to risk organs. In addition, BC-subtype may affect radiosensitivity and could possibly be used to individualize LRRT in the future.
Methods: We investigated outcome for BC-patients receiving LRRT in the Southwest Sweden (2004-2008) in order to identify LRFs. During this period patients with >3 positive lymph nodes were given LRRT (50Gy in 2Gy fractions) to the breast/thoracic wall, axilla level II+III, supra- and infraclavicular lymph nodes according to a target definition atlas introduced in 2002. Patients with LRF as first event were identified, with distant failures and death considered as competing risks. The anatomical distribution of LRF was compared with the contouring atlas, radiotherapy given, and biological subtype based on immunohistochemistry.
Results: 904 patients received LRRT. Median follow-up time was 9.8 years (0.2-14.6) for patients without an event. 59 patients (6,5%) developed a LRF, 30 of which were local failures (LF) and 31 regional failures (RF) (2 simultaneous LF/RF). Median time to LRF was 2.8 years. 37 of the 59 (63%) LRF-patients developed generalized disease within 3 months from the LRF. Of the 845 patients without LRF 316 developed distant metastases as first recurrence, 1 an isolated RF in the contralateral axilla, 64 died from other causes, and for 5 patients recurrence-status was unclear. 459 were alive at end of follow-up.
Of the LF 19 developed after mastectomy (MRM) and 11 after breast conserving surgery (BCS). LF-location after MRM: 9 in-field, 6 at field margin, 2 both in/out of field, 1 out of field, and for 1 not yet determined. After BCS: 8 in-field, 1 at field margin, and for 2 not yet determined. Of the RF 28 developed after MRM and 3 after BCS. Location of RF after MRM: 11 in-field, 6 at field margin, 1 both in/out of field, 2 out of field, and for 8 not yet determined. After BCS: 1 in-field, 1 at field margin, and 1 not yet determined. The most common location for RF close to /out of field was superior to the treated area in fossa supraclavicularis.
Biological approximate subtype was available for 885 of the primary tumours; luminal (ER+ and/or PR+ HER2-/?) 67% (589/885), HER2+ 19% (169/885), triple negative (ER- and PR- HER2-/?) (TN) 14% (127/885). Subtype distribution of BC later causing LRF despite LRRT was: luminal 44% (26/59), HER2+ 27% (16/59), TN 29% (17/59). Among primary tumours causing a LRF within irradiated volume 77% (24/31) were HER2+ or TN.
Conclusion: In this high risk cohort of BC-patients, we found a low incidence of LRFs. The majority of LRFs developed within irradiated volume. BCs of the HER2+ and TN-subtype may be more radioresistant and have a higher risk of LRF. Updated information as well as figures mapping all recurrences in relation to previous LRRT will be presented at the symposium.
Citation Format: Adra J, Karlsson P, Killander F, Lundstedt D, Alkner S. Distribution of locoregional breast cancer recurrences in relation to previous radiotherapy and biological subtype [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-11.
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Affiliation(s)
- J Adra
- Institute of Clinical Sciences, Sahlgrenska Academy/Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Lund University, Faculty of Medicine, Lund, Sweden
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy/Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Lund University, Faculty of Medicine, Lund, Sweden
| | - F Killander
- Institute of Clinical Sciences, Sahlgrenska Academy/Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Lund University, Faculty of Medicine, Lund, Sweden
| | - D Lundstedt
- Institute of Clinical Sciences, Sahlgrenska Academy/Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Lund University, Faculty of Medicine, Lund, Sweden
| | - S Alkner
- Institute of Clinical Sciences, Sahlgrenska Academy/Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Lund University, Faculty of Medicine, Lund, Sweden
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Parris TZ, Larsson P, Biermann J, Engqvist H, Werner-Rönnerman E, Kovács A, Karlsson P, Helou K. Abstract P2-06-19: The effect of UBE2C expression on intrinsic chemosensitivity in breast cancer cell lines. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-06-19] [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: 11/16/2022]
Abstract
Abstract
Background: The ubiquitin-proteasome pathway plays a crucial role in cancer-related processes by inducing cell cycle arrest through the degradation of mitotic cyclins and other cell cycle regulatory proteins. We recently showed that elevated levels of ubiquitin-conjugating enzyme E2C (UBE2C) were associated with aggressive tumor features and unfavorable clinical outcome in breast carcinoma (BC). UBE2C suppression has been achieved using the FDA-approved proteasome inhibitor bortezomib (VELCADE®) in colorectal carcinoma, but little is known about the efficacy of UBE2C-targeted therapy with proteasome inhibitors in breast cancer.
Methods: Cell viability assays were used to determine the intrinsic chemosensitivity of five BC cell lines (MCF-7, MDA-MB-436, HCC38, HCC1395, and ZR-75-30; stratified by UBE2C expression and ER status) and the MCF-10A epithelial cell line to proteasome inhibitors (n=8), mitosis inhibitors (n=2), and platinum agents (n=3). UBE2C expression analysis was performed using quantitative real-time PCR and Western blot. IC50 values and growth inhibition metrics (GR50 and GRmax) were calculated for each compound to determine drug potency and efficiency after 24 hour treatment. Proteasome activity was assessed using bortezomib-treated cells.
Results: Heterogeneous UBE2C expression levels were found in the different cell lines, with higher UBE2C levels in ER-negative BC cell lines (HCC38, HCC1395, MDA-MB-436) than ER-positive BC (MCF-7 and ZR-75-30) and MCF-10A control cells (ER-negative). Proteasome inhibition levels close to 50% and 100% were seen in all cell lines after 10 nM and 100 - 1000 nM bortezomib, respectively. As expected, bortezomib blocked cell cycle progression by inducing G2/M phase arrest in HCC38 cells. Due to differences in cell growth rates, calculation of the IC50 value was an ineffective method to determine drug potency. In contrast, the normalized growth rate inhibition method with GR50 and GRmax values demonstrated a correlation between sensitivity to proteasome inhibitors in ER-negative BC cell lines and high UBE2C expression levels. However, MDA-MB-436 cells (GR50, range 1.8-286.1 nM; GRmax, range -0.42- -0.93) were generally less sensitive to proteasome inhibitors than HCC38 cells (GR50, range 8.2-936.8 nM; GRmax, range -0.97- -0.99) though both cell lines were ER-negative, which was possibly due to the lower expression of UBE2C in MDA-MB-436 cells. Compared with the other tested drugs, no cell line was sensitive to the mitosis inhibitors and platinum agents were most effective in HCC38 cells.
Conclusions: Taken together, these findings suggest an association between UBE2C expression and response to proteasome inhibition, regardless of ER status.
Citation Format: Parris TZ, Larsson P, Biermann J, Engqvist H, Werner-Rönnerman E, Kovács A, Karlsson P, Helou K. The effect of UBE2C expression on intrinsic chemosensitivity in breast cancer cell lines [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-06-19.
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Affiliation(s)
- TZ Parris
- University of Gothenburg, Sahlgrenska Cancer Center, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Larsson
- University of Gothenburg, Sahlgrenska Cancer Center, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Biermann
- University of Gothenburg, Sahlgrenska Cancer Center, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Engqvist
- University of Gothenburg, Sahlgrenska Cancer Center, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Werner-Rönnerman
- University of Gothenburg, Sahlgrenska Cancer Center, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Kovács
- University of Gothenburg, Sahlgrenska Cancer Center, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Karlsson
- University of Gothenburg, Sahlgrenska Cancer Center, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Helou
- University of Gothenburg, Sahlgrenska Cancer Center, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
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Biermann J, Parris TZ, Nemes S, Danielsson A, Engqvist H, Werner Rönnerman E, Forssell-Aronsson E, Kovács A, Karlsson P, Helou K. Abstract P3-07-09: Tumour clonality in paired invasive breast carcinomas. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-07-09] [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: 11/16/2022]
Abstract
Abstract
Background: Multiple invasive breast tumours may represent either independent primary tumours or clonal recurrences of the first tumour, where the same progenitor cell gives rise to all of the detected tumours. Consequently, the driver events for the progenitor cell need to have been identical in early tumour development. Molecular classification of tumour clonality is not currently evaluated in multiple invasive breast carcinomas, despite evidence suggesting common clonal origins. Furthermore, there is no consensus about which type of biological data (e.g. copy number, mutation, histology) and especially which statistical method is most suitable to distinguish clonal recurrences from independent primary tumours.
Methods: Thirty-seven invasive breast tumour pairs were stratified by laterality (bilateral vs. ipsilateral) and the time interval between the diagnoses of the first and second tumours (synchronous vs. metachronous). Both tumours from the same patient were analysed by integrating clinical characteristics (n = 37), DNA copy number (n = 37), DNA methylation (n = 8), gene expression microarray (n = 7), RNA sequencing (n = 3), and SNP genotyping data (n = 3). Different statistical methods, e.g. the diagnostic similarity index (SI), distance measure, shared segment analysis etc., were used to classify the tumours from the same patient as clonally related recurrences or independent primary tumours.
Results: The SI applied on DNA copy numbers derived from aCGH (array comparative genomic hybridization) data was determined as the strongest indicator of clonal relatedness as it showed the highest concordance with all other methods. The distance measure was the most conservative method and the shared segment analysis most liberal. Concordant evidence for tumour clonality was found in 46% (17/37) of the patients. Notably, no significant association was found between the clinical characteristics and molecular tumour features.
Conclusions: A more accurate classification of clonal relatedness between multiple breast tumours may help to mitigate treatment failure and relapse by integrating tumour-associated molecular features, clinical parameters, and statistical methods. In cases of extremely similar or different tumour pairs, the results showed consistency regardless of the method used. The SI can be easily integrated into clinical routine using FFPE samples to obtain copy number data. However, clinical guidelines with exact thresholds need to be defined to standardize clonality testing in a routine diagnostic setting.
Citation Format: Biermann J, Parris TZ, Nemes S, Danielsson A, Engqvist H, Werner Rönnerman E, Forssell-Aronsson E, Kovács A, Karlsson P, Helou K. Tumour clonality in paired invasive breast carcinomas [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-07-09.
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Affiliation(s)
- J Biermann
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - TZ Parris
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S Nemes
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Danielsson
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Engqvist
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Werner Rönnerman
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Forssell-Aronsson
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - A Kovács
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Helou
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
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Dubsky P, Curigliano G, Burstein HJ, Winer EP, Gnant M, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. Reply to 'The St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017: the point of view of an International Panel of Experts in Radiation Oncology' by Kirova et al. Ann Oncol 2018; 29:281-282. [PMID: 29045519 DOI: 10.1093/annonc/mdx543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- P Dubsky
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.,Klinik St. Anna, Luzern, Switzerland
| | - G Curigliano
- Breast Cancer Program, Istituto Europeo di Oncologia, Milan, Italy
| | - H J Burstein
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - E P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Gnant
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Colleoni
- Breast Cancer Program, Istituto Europeo di Oncologia, Milan, Italy
| | - M M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | | | - H-J Senn
- Tumor and Breast Center ZeTuP, St Gallen, Switzerland
| | - B Thürlimann
- Breast Center, Kantonsspital St. Gallen, St Gallen, Switzerland
| | | | - F André
- Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bergh
- Karolinska Institute and University Hospital, Stockholm, Sweden
| | - H Bonnefoi
- University of Bordeaux, Bordeaux, France
| | - S Y Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen, Germany
| | - F Cardoso
- Champalimaud Cancer Centre, Lisbon, Portugal
| | - L Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - E Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Denkert
- Institut für Pathologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Di Leo
- Azienda Usl Toscana Centro, Prato, Italy
| | | | - P Francis
- Peter McCallum Cancer Centre, Melbourne, Australia
| | - V Galimberti
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - J Garber
- Klinik St. Anna, Luzern, Switzerland
| | - B Gulluoglu
- Marmara University School of Medicine, Istanbul, Turkey
| | - P Goodwin
- University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - N Harbeck
- University of Munich, München, Germany
| | - D F Hayes
- Comprehensive Cancer Center, University of Michigan, Ann-Arbor, USA
| | - C-S Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - H Khaled
- The National Cancer Institute, Cairo University, Cairo, Egypt
| | - J Jassem
- Medical University of Gdansk, Gdansk, Poland
| | - Z Jiang
- Hospital Affiliated to Military Medical Science, Beijing, China
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrensky University Hospital, Gothenburg, Sweden
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - R Orecchia
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | | | - O Pagani
- Institute of Oncology Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | | | - K Pritchard
- University of Toronto, Sunnybrook Odette Cancer Center, Toronto, Canada
| | - J Ro
- National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
| | - E J T Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F Sedlmayer
- LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - V Semiglazov
- N.N.Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | - Z Shao
- Fudan University Cancer Hospital, Shanghai, China
| | - I Smith
- The Royal Marsden, Sutton, Surrey, UK
| | - M Toi
- Graduate School of Medicine Kyoto University, Sakyo-ku Kyoto City, Japan
| | - A Tutt
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - G Viale
- University of Milan, Milan, Italy.,Istituto Europeo di Oncologia, Milan, Italy
| | - T Watanabe
- Hamamatsu Oncology Center, Hamamatsu, Japan
| | | | - B Xu
- National Cancer Center, Chaoyang District, Beijing, China
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Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol 2018; 29:2153. [PMID: 29733336 DOI: 10.1093/annonc/mdx806] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McAdam K, Vas C, Kimpton H, Faizi A, Liu C, Porter A, Synnerdahl T, Karlsson P, Rodu B. Ethyl carbamate in Swedish and American smokeless tobacco products and some factors affecting its concentration. Chem Cent J 2018; 12:86. [PMID: 30043180 PMCID: PMC6057859 DOI: 10.1186/s13065-018-0454-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/02/2018] [Accepted: 07/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We are interested in comparing the levels of harmful or potentially harmful constituents in Swedish and American smokeless tobacco products (STPs). We report here the concentrations of the IARC Group 2 A (probable human) carcinogen ethyl carbamate (EC) in seventy commercial STPs from the US and Sweden, representing 80-90% of the market share of the major STP categories in these countries. We also examine the effects of various additives, processing and storage conditions on EC concentrations in experimental snus samples. RESULTS EC was determined from aqueous extracts of the STPs using ultra performance liquid chromatography tandem mass spectrometry (UPLC/MS/MS). EC was undetectable (< 20 ng/g wet weight basis WWB) in 60% of the commercial STPs, including all the chewing tobacco (CT), dry snuff (DS), hard pellet (HP), soft pellet (SP), and plug products. Measurable levels of EC were found in 11/16 (69%) of the moist snuff (MS) samples (average 154 ng/g in those samples containing EC) and 19/32 (59%) of the Swedish snus samples (average 35 ng/g). For the experimental snus samples, EC was only observed in ethanol treated samples. EC concentrations increased significantly with ethanol concentrations (0-4%) and with storage time (up to 24 weeks) and temperature (8 °C vs 20 °C). EC concentrations were lower at lower pHs but were unaffected by adding nitrogenous precursors identified from food studies (citrulline and urea), increasing water content or by pasteurisation. Added EC was stable in the STP matrix, but evaporative losses were significant when samples were stored for several weeks in open containers at 8 °C. CONCLUSIONS EC was found in measurable amounts only in some moist STPs i.e. pasteurised Swedish snus and unpasteurised US MS; it is not a ubiquitous contaminant of STPs. The presence of ethanol contributed significantly to the presence of EC in experimental snus samples, more significantly at higher pH levels. Sample age also was a key determinant of EC content. In contrast, pasteurisation and fermentation do not appear to directly influence EC levels. Using published consumption rates and mouth level exposures, on average STP consumers are exposed to lower EC levels from STP use than from food consumption.
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Affiliation(s)
- K. McAdam
- Group Research & Development, British American Tobacco, Regents Park Road, Southampton, SO15 8TL UK
| | - C. Vas
- Group Research & Development, British American Tobacco, Regents Park Road, Southampton, SO15 8TL UK
| | - H. Kimpton
- Group Research & Development, British American Tobacco, Regents Park Road, Southampton, SO15 8TL UK
| | - A. Faizi
- Group Research & Development, British American Tobacco, Regents Park Road, Southampton, SO15 8TL UK
| | - C. Liu
- Group Research & Development, British American Tobacco, Regents Park Road, Southampton, SO15 8TL UK
| | - A. Porter
- 3810 St. Antoine W, Montreal, QC H4C 1B4 Canada
| | - T. Synnerdahl
- Eurofins Food & Feed Testing Sweden AB, Sjöhagsgatan 3, 531 40 Lidköping, Sweden
| | - P. Karlsson
- Eurofins Food & Feed Testing Sweden AB, Sjöhagsgatan 3, 531 40 Lidköping, Sweden
| | - B. Rodu
- Department of Medicine, School of Medicine, University of Louisville, Room 208, 505 South Hancock Street, Louisville, KY 40202 USA
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Galosi E, La Cesa S, Di Stefano G, Karlsson P, Fasolino A, Leone C, Biasiotta A, Cruccu G, Truini A. A pain in the skin. Regenerating nerve sprouts are distinctly associated with ongoing burning pain in patients with diabetes. Eur J Pain 2018; 22:1727-1734. [PMID: 29885017 DOI: 10.1002/ejp.1259] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUNDS Patients with diabetic polyneuropathy commonly suffer from ongoing burning pain and dynamic mechanical allodynia. In this clinical and skin biopsy study, we aimed at assessing how intraepidermal regenerating nerve sprouts are associated with these two types of pain. METHODS We consecutively enrolled 85 patients with diabetic polyneuropathy. All patients underwent skin biopsy at the distal leg. Intraepidermal nerve fibres were immunostained with the anti-protein gene product 9.5 (PGP9.5) to quantify all intraepidermal nerve fibres, and the growth-associated protein 43 (GAP43) to quantify regenerating nerve sprouts. RESULTS We found that the GAP43-stained intraepidermal nerve fibre density and the ratio GAP43/PGP9.5 were significantly higher in patients with ongoing burning pain than in those without. The area of receiver operating characteristic (ROC) curve for the ratio GAP43/PGP9.5 was 0.74 and yielded a sensitivity and specificity for identifying ongoing burning pain of 72% and 71%, respectively. Conversely, although the density of PGP9.5 and GAP43 intraepidermal nerve fibre was higher in patients with dynamic mechanical allodynia than in those without, this difference was statistically weak and the ROC curve analysis of skin biopsy variables for this type of pain failed to reach the statistical significance. CONCLUSION Our clinical and skin biopsy study showed that ongoing burning pain was strongly associated with regenerating sprouts, as assessed with GAP43 immunostaining. This finding improves our understanding on the mechanisms underlying neuropathic pain in patients with diabetic polyneuropathy and suggests that the GAP43/PGP 9.5 ratio might be used as an objective marker for ongoing burning pain due to regenerating sprouts. SIGNIFICANCE Our skin biopsy study showing that regenerating sprouts, as assessed with GAP43-staining, were strongly associated with ongoing burning pain, improves our knowledge on the mechanisms underlying neuropathic pain in patients with diabetes.
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Affiliation(s)
- E Galosi
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - S La Cesa
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - G Di Stefano
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - P Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark.,Core Center for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Denmark
| | - A Fasolino
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - C Leone
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - A Biasiotta
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - G Cruccu
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - A Truini
- Department Human Neuroscience, Sapienza University, Rome, Italy
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Nyqvist J, Persson F, Parris T, Helou K, Kenne Sarenmalm E, Einbeigi Z, Borg A, Karlsson P, Kovács A. Metachronous and synchronous occurrence of five primary malignancies in a breast cancer patient between 1997–2013: A case report with germline and somatic genetic analysis. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30655-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nyqvist J, De Lara S, Parris T, Helou K, Kenne-Sarenmalm E, Einbeigi Z, Karlsson P, Kovács A. FOXA1, Nestin, GATA3 and Mammaglobin expression in 164 breast cancer metastases – a retrospective immunohistochemical study of a 10-year period (2004–2014). Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Svensson H, Hällje M, Chakarova R, Lundstedt D, Gustavsson M, Karlsson P. EP-1916: Treatment techniques and plan quality for breast irradiation with simultaneous integrated boost. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ribi K, Luo W, Colleoni M, Karlsson P, Chirgwin J, Aebi S, Jerusalem G, Neven P, Di Lauro V, Gomez HL, Ruhstaller T, Abdi E, Di Leo A, Müller B, Maibach R, Gelber RD, Goldhirsch A, Coates AS, Regan MM, Bernhard J. Abstract P5-18-01: Extended continuous vs intermittent adjuvant letrozole in postmenopausal women with lymph node-positive, early breast cancer (IBCSG 37-05/BIG 1-07 SOLE): Impact on patient-reported symptoms and quality of life. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-18-01] [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: 11/16/2022]
Abstract
Abstract
Background: SOLE efficacy results presented at ASCO 2017 showed that extended intermittent vs continuous letrozole for 5 years did not improve disease-free survival in postmenopausal women who had received 4-6 years of adjuvant endocrine therapy for hormone-receptor positive (HR+), lymph-node positive breast cancer. Previous studies showed that the burden by symptoms related to endocrine therapy can be substantial. Even if symptoms improve during the treatment course, extending treatment implies continuation of symptoms. We compared differences in patient-reported symptoms (PRS) and quality of life (QoL) between extended continuous and intermittent letrozole over the first two years of trial treatment.
Methods: From Nov 2007 to Dec 2010, 956 postmenopausal women who were disease-free following 4-6 years of prior adjuvant endocrine therapy for HR+, node-positive breast cancer were enrolled in the QoL substudy of the randomized phase III trial SOLE at selected centers. Patients receive extended continuous letrozole (2.5 mg daily) for 5 years or intermittent letrozole, taken for the first 9 months of years 1-4, and 12 months in year 5. 955 patients completed the 18-item Breast Cancer Prevention Trial (BCPT) Symptom Scales and further symptom-specific and global QoL indicators at baseline, and at 6, 12, 18 and 24 months after randomization. Differences in change of PRS and QoL from baseline between the two administration schedules were tested at 12 and 24 months for 8 symptom scales, 4 additional symptom and 4 global QoL indicators using mixed models with repeated measures.
Results: Small changes in PRS and QoL scores were observed between baseline and 12 months after randomization, i.e. at the end of the first treatment-free interval in the intermittent arm. These changes showed a consistent pattern of greater worsening for patients receiving continuous compared to patients receiving intermittent letrozole. Patients receiving continuous letrozole reported a significantly greater worsening in vaginal problems (p<.02), musculoskeletal pain (p<.03), sleep disturbance (p<.01), physical wellbeing (p<.01) and mood (p<.03). At 24 months (after 2nd treatment-free interval) patients with intermittent letrozole reported a greater improvement in hot flushes (p<.03) than those with continuous letrozole. Changes in the other outcomes did not significantly differ between arms at 24 months.
Conclusion: Although changes in PRS and QoL were small, there was a consistent pattern favoring the intermittent arm. For several symptoms and global QoL indicators, significantly less worsening was observed with the intermittent administration, mainly during the first year of extended treatment, due to small improvements during the treatment-free interval. Froma QoL perspective, women who suffer from endocrine side-effects in the extended setting may benefit from an intermittent administration.
Citation Format: Ribi K, Luo W, Colleoni M, Karlsson P, Chirgwin J, Aebi S, Jerusalem G, Neven P, Di Lauro V, Gomez HL, Ruhstaller T, Abdi E, Di Leo A, Müller B, Maibach R, Gelber RD, Goldhirsch A, Coates AS, Regan MM, Bernhard J. Extended continuous vs intermittent adjuvant letrozole in postmenopausal women with lymph node-positive, early breast cancer (IBCSG 37-05/BIG 1-07 SOLE): Impact on patient-reported symptoms and quality of life [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-18-01.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group, Breast International Group
| | - W Luo
- International Breast Cancer Study Group, Breast International Group
| | - M Colleoni
- International Breast Cancer Study Group, Breast International Group
| | - P Karlsson
- International Breast Cancer Study Group, Breast International Group
| | - J Chirgwin
- International Breast Cancer Study Group, Breast International Group
| | - S Aebi
- International Breast Cancer Study Group, Breast International Group
| | - G Jerusalem
- International Breast Cancer Study Group, Breast International Group
| | - P Neven
- International Breast Cancer Study Group, Breast International Group
| | - V Di Lauro
- International Breast Cancer Study Group, Breast International Group
| | - HL Gomez
- International Breast Cancer Study Group, Breast International Group
| | - T Ruhstaller
- International Breast Cancer Study Group, Breast International Group
| | - E Abdi
- International Breast Cancer Study Group, Breast International Group
| | - A Di Leo
- International Breast Cancer Study Group, Breast International Group
| | - B Müller
- International Breast Cancer Study Group, Breast International Group
| | - R Maibach
- International Breast Cancer Study Group, Breast International Group
| | - RD Gelber
- International Breast Cancer Study Group, Breast International Group
| | - A Goldhirsch
- International Breast Cancer Study Group, Breast International Group
| | - AS Coates
- International Breast Cancer Study Group, Breast International Group
| | - MM Regan
- International Breast Cancer Study Group, Breast International Group
| | - J Bernhard
- International Breast Cancer Study Group, Breast International Group
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Wärnberg F, Garmo H, Folkvaljon Y, Holmberg L, Karlsson P, Sandelin K, Linke S, Lyle S, Simin K, Leesman G, Barry T, Savala J, Whitworth P, Bremer T. Abstract GS5-08: A validation of DCIS biological risk profile in a randomised study for radiation therapy with 20 year follow-up (SweDCIS). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs5-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Women diagnosed with ductal carcinoma in situ (DCIS) and their physicians need tools that assess individualized risk and predict treatment benefit. A DCIS biologic signature was previously validated in an observational study at Kaiser Permanente NW. We evaluated the results of the signature for predictive utility in a national randomized clinical trial (SweDCIS) by assessing the 10-year benefit of adjuvant radiotherapy (RT) on ipsilateral breast event (IBE) and invasive breast cancer (IBC) risks.
Methods: The signature was validated in a prospective-retrospective study in women from the SweDCIS trial (n=1046) performed by the Swedish Breast Cancer Group. Women were treated with breast conserving surgery (BCS) between 1987-1999 and randomized to RT or no RT. A central pathology review of paraffin embedded tissue blocks (n=873) was performed at Uppsala University (UU). Freshly cut slides were provided to PreludeDx for biomarker testing. Extended follow-up of SweDCIS was published in 2014.
A panel of biomarkers (HER2, PR, Ki67, COX2, p16/INK4A, FOXA1 and SIAH2) were assayed and scored in PreludeDx's CLIA lab by board-certified pathologists. Continuous Decision Scores (DS) were calculated with the biologic signature using the biomarker and clinical factors (age, size, margin, and palpability) blinded to patient outcome. The DS results were provided to the Uppsala Regional Cancer Center for analysis. A predefined and co-developed statistical analysis plan was executed. Absolute 10-year RT benefit was assessed using Kaplan-Meier survival analysis. Hazard ratios (HR) were determined using Cox proportional hazards analysis and the interaction of the DS and RT benefit was assessed.
Results: Complete biomarker and clinical information was available in 584 women. In women with clear margins (n=506), 78 IBEs, including 31 IBCs, were recorded within 10 years of diagnosis. The multivariate analysis of DS (0-10 unit scale) and the RT interaction was significant for risk of IBC (p=0.048) and IBE (p<0.001) at 10 years. The DS defined an elevated risk group (>3) for which there was pronounced 10-year benefit of RT (p=0.01) with an absolute risk reduction of 9% for IBC (Table 1). The corresponding low risk group (≤3), which included 48% of all patients, demonstrated no significant RT benefit (p=0.70) with an absolute risk reduction of 1%. The continuous DS variable was correlated with IBE risk, HR 1.49/per 5 units 95%CI[1.02,2.18] (p=0.038), in addition to the RT benefit for IBE in low (p=0.04) and elevated (p<0.001) risk groups.
Table 1. 10-year RT benefit in women from the SweDCIS trial.DS Risk GroupsIBC eventsIn Situ or IBC eventsnAbsolute RT-benefitHR [95%CI] Absolute RT-benefit HR [95%CI]Low Risk Group (DS≤3)2431%0.83 [0.32, 2.16]9%0.48 [0.24-0.97]Elevated Risk Group (DS>3)2639%0.24 [0.08, 0.73]17%0.31 [0.17-0.59]
Discussion: Evaluation of the SweDCIS trial validated prognostic and RT predictive utility of the biologic signature. Women diagnosed with DCIS and treated with BCS±RT were stratified into clinically relevant low and elevated risk groups (≤3 vs >3). Women in the elevated risk group had twice the treatment benefit for IBC from RT compared to prior randomized trials, while the low risk group had no benefit from RT.
Citation Format: Wärnberg F, Garmo H, Folkvaljon Y, Holmberg L, Karlsson P, Sandelin K, Linke S, Lyle S, Simin K, Leesman G, Barry T, Savala J, Whitworth P, Bremer T. A validation of DCIS biological risk profile in a randomised study for radiation therapy with 20 year follow-up (SweDCIS) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS5-08.
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Affiliation(s)
- F Wärnberg
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - H Garmo
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - Y Folkvaljon
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - L Holmberg
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - P Karlsson
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - K Sandelin
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - S Linke
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - S Lyle
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - K Simin
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - G Leesman
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - T Barry
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - J Savala
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - P Whitworth
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - T Bremer
- Uppsala University, Uppsala, Sweden; King's College London, Medical School, Division of Cancer Studies, King's College London, London, United Kingdom; Sahlgrenska University Hospital, Göteborg, Sweden; Karolinska Institutet, Stockholm, Sweden; PreludeDx, Laguna Hills, CA; University of Massachusetts Medical School, Worcester, MA; Spectrum Pathology, Mission Viejo, CA; Nashville Breast Center, Nashville, TN; Regional Cancer Centre, Uppsala University, Uppsala, Sweden
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Parris TZ, Biermann J, Engqvist H, Werner Rönnerman E, Truvé K, Nemes S, Forssell-Aronsson E, Solinas G, Kovács A, Karlsson P, Helou K. Abstract P3-04-07: Novel genetic features associated with 8p11-p12 amplification in breast carcinoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-04-07] [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: 11/16/2022]
Abstract
Abstract
Background: Genome instability contributes to the neoplastic phenotype by promoting gene loss and duplications, which in turn can have a detrimental effect on patient outcome by inactivating tumor suppressor genes or hyperactivating oncogenes. In breast carcinoma, DNA amplification of the 8p11-p12 genomic region has been associated with tumor progression and poor prognosis. The aim of this study was to characterize recurrent genetic features (other than DNA amplification) associated with 8p11-p12 amplification in breast carcinoma.
Methods: DNA copy number profiling data for 229 primary invasive breast carcinomas (corresponding to 185 patients diagnosed in Western Sweden between 1988 and 1999) were evaluated to identify 8p11-p12 amplified cases. Illumina paired-end whole transcriptome sequencing (RNA-seq) and whole-genome SNP genotyping were subsequently performed on 23 breast carcinomas harboring high-level regional 8p11-p12 amplification to characterize recurrent genetic variants (SNPs and indels), expressed gene fusions, gene expression profiles and allelic imbalances. The 23 samples were stratified into the molecular subtypes, resulting in 16 Luminal B/HER2-, two Luminal B/HER2+, four HER2/ER-, and one Basal-like sample. The Cancer Genome Atlas (TCGA) RNA-seq data for 10 primary breast carcinomas lacking the 8p11-p12 amplicon (SNP segmented mean < 0.4) were used as controls. Gene fusions were validated using dual-color fluorescence in situ hybridization (FISH) with co-hybridized biotin-16-dUTP and dioxigenin-11-dUTP labeled bacterial artificial chromosome (BAC) probes.
Results: Here, we report that despite the high number of gene fusions (133±31 (±SEM)) and exonic variants (411±16) identified per tumor, few gene fusions (n=46) and exonic variants (n=11) spanned the 8p11-p12 genomic region. Gene fusions predominantly contained at least one fusion partner spanning non-coding RNAs (ncRNAs; 86%), in particular MALAT1, which is induced by estrogen and of prognostic value in breast cancer. The majority of fusion breakpoints were associated with DNA copy number gains and losses, as well as, extensive intratumoral heterogeneity for specific fusion events. Intriguingly, novel 8p11-p12 amplification-specific genetic variants (HIST1H1E frameshift insertion, UQCRHL nonsynonymous SNV, MTUS1 frameshift insertion, NPIPA5 frameshift deletion) were identified that also resulted in mutation-dependent changes in gene expression levels.
Conclusions: Taken together, these findings have provided further insight into the genetic landscape of 8p11-p12 amplified breast carcinomas, including novel gene fusions and genetic variants. However, further studies are required to develop effective strategies to target 8p11-p12 amplification in breast carcinoma.
Citation Format: Parris TZ, Biermann J, Engqvist H, Werner Rönnerman E, Truvé K, Nemes S, Forssell-Aronsson E, Solinas G, Kovács A, Karlsson P, Helou K. Novel genetic features associated with 8p11-p12 amplification in breast carcinoma [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-04-07.
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Affiliation(s)
- TZ Parris
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - J Biermann
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - H Engqvist
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - E Werner Rönnerman
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - K Truvé
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - S Nemes
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - E Forssell-Aronsson
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - G Solinas
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - A Kovács
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
| | - K Helou
- Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Bioinformatics Core Facility, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden; The Wallenberg Laboratory, University of Gothenburg, Gothenburg, Sweden
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Gripe I, Ramstedt M, Karlsson P, Danielsson AK. Is cannabis use among young people in Sweden related to socioeconomic status? Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I Gripe
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - M Ramstedt
- Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - P Karlsson
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - A-K Danielsson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Isak B, Pugdahl K, Karlsson P, Tankisi H, Finnerup N, Furtula J, Johnsen B, Sunde N, Jakobsen J, Fuglsang-frederiksen A. Functional and structural assessment of sensory nerve fibers in motor neuron disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Dai D, Holgersson T, Karlsson P. Expected and unexpected values of individual Mahalanobis distances. COMMUN STAT-THEOR M 2017. [DOI: 10.1080/03610926.2016.1200096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- D. Dai
- Department of Economics and Statistics, Linnaeus University, Växjö, Sweden
| | - T. Holgersson
- Centre for Data Intensive Sciences and Applications, Linnaeus University, Växjö, Sweden
| | - P. Karlsson
- Department of Economics and Statistics, Linnaeus University, Växjö, Sweden
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Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol 2017; 28:1700-1712. [PMID: 28838210 PMCID: PMC6246241 DOI: 10.1093/annonc/mdx308] [Citation(s) in RCA: 696] [Impact Index Per Article: 99.4] [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] [Indexed: 12/11/2022] Open
Abstract
The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escalate or de-escalate therapies based on likely benefits as predicted by tumor stage and tumor biology. The Panel favored several interventions that may reduce surgical morbidity, including acceptance of 2 mm margins for DCIS, the resection of residual cancer (but not baseline extent of cancer) in women undergoing neoadjuvant therapy, acceptance of sentinel node biopsy following neoadjuvant treatment of many patients, and the preference for neoadjuvant therapy in HER2 positive and triple-negative, stage II and III breast cancer. The Panel favored escalating radiation therapy with regional nodal irradiation in high-risk patients, while encouraging omission of boost in low-risk patients. The Panel endorsed gene expression signatures that permit avoidance of chemotherapy in many patients with ER positive breast cancer. For women with higher risk tumors, the Panel escalated recommendations for adjuvant endocrine treatment to include ovarian suppression in premenopausal women, and extended therapy for postmenopausal women. However, low-risk patients can avoid these treatments. Finally, the Panel recommended bisphosphonate use in postmenopausal women to prevent breast cancer recurrence. The Panel recognized that recommendations are not intended for all patients, but rather to address the clinical needs of the majority of common presentations. Individualization of adjuvant therapy means adjusting to the tumor characteristics, patient comorbidities and preferences, and managing constraints of treatment cost and access that may affect care in both the developed and developing world.
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Affiliation(s)
- G Curigliano
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - H J Burstein
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - E P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Gnant
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Klinik St. Anna, Luzern, Switzerland
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Colleoni
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - M M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Piccart-Gebhart
- Department of Medical Oncology, Institut Jules Bordet, UniversitÕ Libre de Bruxelles, Brussels, Belgium
| | - H-J Senn
- Tumor and Breast Center ZeTuP, St. Gallen
| | - B Thürlimann
- Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F André
- Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bergh
- Karolinska Institute and University Hospital, Stockholm, Sweden
| | - H Bonnefoi
- University of Bordeaux, Bordeaux, France
| | - S Y Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen, Germany
| | - F Cardoso
- Champalimaud Cancer Centre, Lisbon, Portugal
| | - L Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - E Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Denkert
- Institut für Pathologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Di Leo
- Azienda Usl Toscana Centro, Prato, Italy
| | | | - P Francis
- Peter McCallum Cancer Centre, Melbourne, Australia
| | - V Galimberti
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - J Garber
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - B Gulluoglu
- Marmara University School of Medicine, Istanbul, Turkey
| | - P Goodwin
- University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - N Harbeck
- University of Munich, München, Germany
| | - D F Hayes
- Comprehensive Cancer Center, University of Michigan, Ann-Arbor, USA
| | - C-S Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - H Khaled
- The National Cancer Institute, Cairo University, Cairo, Egypt
| | - J Jassem
- Medical University of Gdansk, Gdansk, Poland
| | - Z Jiang
- Hospital Affiliated to Military Medical Science, Beijing, China
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrensky University Hospital, Gothenburg, Sweden
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - R Orecchia
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | | | - O Pagani
- Institute of Oncology Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A H Partridge
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - K Pritchard
- Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Canada
| | - J Ro
- National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
| | - E J T Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F Sedlmayer
- LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - V Semiglazov
- N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | - Z Shao
- Fudan University Cancer Hospital, Shanghai, China
| | - I Smith
- The Royal Marsden, Sutton, Surrey, UK
| | - M Toi
- Graduate School of Medicine Kyoto University, Sakyo-ku, Kyoto City, Japan
| | - A Tutt
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - G Viale
- University of Milan, Milan, Italy
- Istituto Europeo di Oncologia, Milan, Italy
| | - T Watanabe
- Hamamatsu Oncology Center, Hamamatsu, Japan
| | | | - B Xu
- National Cancer Center, Chaoyang District, Beijing, China
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Karlsson P, Johnston C, Barker K. Stakeholders' views of the introduction of assistive technology in the classroom: How family-centred is Australian practice for students with cerebral palsy? Child Care Health Dev 2017; 43:598-607. [PMID: 28419501 DOI: 10.1111/cch.12468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/17/2016] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND With family-centred care widely recognized as a cornerstone for effective assistive technology service provision, the current study was undertaken to investigate to what extent such approaches were used by schools when assistive technology assessments and implementation occurred in the classroom. METHOD In this cross-sectional study, we compare survey results from parents (n = 76), school staff (n = 33) and allied health professionals (n = 65) with experience in the use of high-tech assistive technology. Demographic characteristics and the stakeholders' perceived helpfulness and frequency attending assessment and set-up sessions were captured. To evaluate how family-centred the assistive technology services were perceived to be, the parents filled out the Measure of Processes of Care for Caregivers, and the professionals completed the Measure of Processes of Care for Service Providers. Descriptive statistics and one-way analysis of variance were used to conduct the data analysis. RESULTS Findings show that parents are more involved during the assessment stage than during the implementation and that classroom teachers are often not involved in the initial stage. Speech pathologists in particular are seen to be to a great extent helpful when implementing assistive technology in the classroom. This study found that family-centred service is not yet fully achieved in schools despite being endorsed in early intervention and disability services for over 20 years. No statistically significant differences were found with respect to school staff and allied health professionals' roles, their years of experience working with students with cerebral palsy and the scales in the Measure of Processes of Care for Service Providers. CONCLUSION To enhance the way technology is matched to the student and successfully implemented, classroom teachers need to be fully involved in the whole assistive technology process. The findings also point to the significance of parents' involvement, with the support of allied health professionals, in the process of selecting and implementing assistive technology in the classroom.
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Affiliation(s)
- P Karlsson
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia
| | - C Johnston
- School of Education, Western Sydney University, Penrith, NSW, Australia
| | - K Barker
- School of Education, Western Sydney University, Penrith, NSW, Australia
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Schaldemose EL, Fontain FI, Karlsson P, Nyengaard JR. Improved sampling and analysis of images in corneal confocal microscopy. J Microsc 2017; 268:3-12. [PMID: 28548209 DOI: 10.1111/jmi.12581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 02/07/2017] [Revised: 04/06/2017] [Accepted: 04/21/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Corneal confocal microscopy (CCM) is a noninvasive clinical method to analyse and quantify corneal nerve fibres in vivo. Although the CCM technique is in constant progress, there are methodological limitations in terms of sampling of images and objectivity of the nerve quantification. The aim of this study was to present a randomized sampling method of the CCM images and to develop an adjusted area-dependent image analysis. Furthermore, a manual nerve fibre analysis method was compared to a fully automated method. METHODS 23 idiopathic small-fibre neuropathy patients were investigated using CCM. Corneal nerve fibre length density (CNFL) and corneal nerve fibre branch density (CNBD) were determined in both a manual and automatic manner. Differences in CNFL and CNBD between (1) the randomized and the most common sampling method, (2) the adjusted and the unadjusted area and (3) the manual and automated quantification method were investigated. RESULTS The CNFL values were significantly lower when using the randomized sampling method compared to the most common method (p = 0.01). There was not a statistical significant difference in the CNBD values between the randomized and the most common sampling method (p = 0.85). CNFL and CNBD values were increased when using the adjusted area compared to the standard area. Additionally, the study found a significant increase in the CNFL and CNBD values when using the manual method compared to the automatic method (p ≤ 0.001). CONCLUSION The study demonstrated a significant difference in the CNFL values between the randomized and common sampling method indicating the importance of clear guidelines for the image sampling. The increase in CNFL and CNBD values when using the adjusted cornea area is not surprising. The observed increases in both CNFL and CNBD values when using the manual method of nerve quantification compared to the automatic method are consistent with earlier findings. This study underlines the importance of improving the analysis of the CCM images in order to obtain more objective corneal nerve fibre measurements.
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Affiliation(s)
- E L Schaldemose
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - F I Fontain
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - P Karlsson
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine - Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University Hospital, Aarhus, Denmark
| | - J R Nyengaard
- Department of Clinical Medicine - Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University Hospital, Aarhus, Denmark
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Sjöström M, Lundstedt D, Hartman L, Holmberg E, Kovács A, Malmström P, Niméus E, Werner Rönnerman E, Fernö M, Karlsson P. Abstract P1-09-03: Relative radioresistency in triple negative tumors in the SweBCG91-RT randomized clinical trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-03] [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: 11/16/2022]
Abstract
Abstract
Introduction: Breast-conserving surgery (BCS) with adjuvant whole breast radiation therapy (WBRT) is the standard treatment for a majority of early breast cancer patients. No predictive biomarkers for RT are in use and most patients are cured by surgery alone, and are thus over-treated. Further, some patients suffer a relapse despite WBRT, and may have benefited from mastectomy or more aggressive postoperative treatment. Gene expression tests can be used to predict risk of distant recurrence and effect of adjuvant systemic therapy, and can reveal the intrinsic subtype of the tumor. A surrogate method of determining intrinsic subtype based on high quality centralized immunohistochemistry (IHC) has been proposed with criteria set up by the St Gallen consensus group 2013. The intrinsic subtypes provide prognostic information and are treatment predictive for chemotherapy, but the predictive potential for WBRT has not been conclusively determined.
Aim: To evaluate the effect of WBRT on ipsilateral breast tumor recurrence (IBTR), in patients with tumors of different intrinsic subtypes.
Methods: Tumor tissue from FFPE blocks were collected from 1003 breast cancer patients with node negative, stage I-II disease, randomized to BCS with or without WBRT, in the randomized SweBCG RT-91 trial between 1991-1997. Systemic adjuvant treatment was administered according to regional guidelines, but was sparsely used. Median follow-up was 15.2 years. Tissue microarrays were constructed and stained for estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (Her2) and Ki-67. SISH was used to determine amplification of samples scored 2+ for Her2. Centralized evaluation was performed by two pathologists subspecialized in breast pathology. Endpoint IBTR within 10 years was considered with a cumulative incidence and competing risks approach. P-values were calculated with the cause-specific logrank test and hazard ratios (HR) with cause specific Cox regression. Multivariate models, with or without an interaction term between subtype and WBRT, were compared to formally test if the effect of RT differs between subtypes.
Results: We were able to stain and score 958 out of 1003 tumors. These were classified as Luminal A-like (n=554), Luminal B-like (Her2-negative, n=259), triple negative (n=81) and Her2-positive (any ER status, n=64). WBRT reduced the frequency of IBTR for Luminal A-like tumors (19% vs 9%, HR 0.46 (0.28-0.74), p=0.001), Luminal B-like tumors (24% vs 8%, HR 0.30 (0.14-0.61), p<0.001) and triple negative tumors (21% vs 6%, HR 0.25 (0.05-1.12), p=0.05), but not for Her2-positive tumors (15% vs 19%, HR 1.29 (0.38-4.4), p=0.69). However, the overall difference in WBRT effect between subtypes was not formally statistically validated (p=0.17).
Conclusions: We found that WBRT reduced IBTRs among the Luminal A, Luminal B, and the triple negative subgroups, but not in the Her2-positive subgroup. Thus, intrinsic subtyping by IHC may give information on how tumors respond to adjuvant WBRT. Additional studies are required and it remains to study the effect on breast cancer specific survival.
Citation Format: Sjöström M, Lundstedt D, Hartman L, Holmberg E, Kovács A, Malmström P, Niméus E, Werner Rönnerman E, Fernö M, Karlsson P. Relative radioresistency in triple negative tumors in the SweBCG91-RT randomized clinical trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-03.
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Affiliation(s)
- M Sjöström
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - D Lundstedt
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - L Hartman
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - E Holmberg
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - A Kovács
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - P Malmström
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - E Niméus
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - E Werner Rönnerman
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - M Fernö
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
| | - P Karlsson
- Lund University, Clinical Sciences Lund, Oncology and Pathology, Lund, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Regional Cancer Center WT, Gothenburg, Sweden; Lund University, Clincial Sciences Lund, Surgery, Lund, Sweden; University of Gothenburg, Sahlgrenska Academy, Institute of Clincial Sciences, Gothenburg, Sweden
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Killander F, Karlsson P, Anderson H, Mattsson J, Holmberg E, Lundstedt D, Holmberg L, Malmström P. No breast cancer subgroup can be spared postoperative radiotherapy after breast-conserving surgery. Fifteen-year results from the Swedish Breast Cancer Group randomised trial, SweBCG 91 RT. Eur J Cancer 2016; 67:57-65. [PMID: 27614164 DOI: 10.1016/j.ejca.2016.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 03/17/2016] [Revised: 07/29/2016] [Accepted: 08/01/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Breast-conserving surgery (BCS) followed by radiotherapy (RT) is an established treatment for women with T1-2N0 breast cancers. Since subgroups of patients have low ipsilateral breast tumour recurrence (IBTR) rates, it is important to study whether RT is necessary for all patients. PATIENTS AND METHODS A total of 1187 women with primary T1-2N0M0 breast cancer were randomised, after standardised sector resection, to postoperative whole breast RT or no local treatment. Adjuvant systemic therapy was offered to patients with stage II cancers. Patients were followed with clinical examinations and annual mammography for 10 years and thereafter referred to the Swedish mammography screening program. RESULTS After 15 years of follow-up, a higher cumulative incidence of IBTR was observed in control patients, 23.9%, versus irradiated patients, 11.5%, P<0.001. Recurrence-free survival was inferior, 51.7% versus 60.4%, P=0.0013. The main effect of RT was seen during the first 5 years. However, overall survival was not significantly lower 68.4% versus 71.1%, P=0.68, nor was breast cancer-specific mortality significantly higher. CONCLUSIONS RT after BCS significantly reduced the incidence of IBTR at 15 years of follow-up. We were unable to identify subgroups which could be spared RT. Breast cancer mortality was not significantly reduced after RT. Good predictive markers for radiation sensitivity and improved adjuvant systemic therapy are needed to omit RT after BCS.
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Affiliation(s)
- F Killander
- Department of Clinical Sciences, Oncology, Lund University, Lund, Sweden; Skåne Department of Oncology, Skåne University Hospital, Lund, Sweden.
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden
| | - H Anderson
- Department of Clinical Sciences, Cancer Epidemiology, Lund, Sweden
| | - J Mattsson
- Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - E Holmberg
- Regional Oncologic Centre, Sahlgrenska University Hospital, Göteborg, Sweden
| | - D Lundstedt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden
| | - L Holmberg
- Regional Oncologic Centre, Uppsala University Hospital, Uppsala, Sweden; King's College London, Faculty of Life Sciences and Medicine, Division of Cancer Studies, London, UK
| | - P Malmström
- Department of Clinical Sciences, Oncology, Lund University, Lund, Sweden; Skåne Department of Oncology, Skåne University Hospital, Lund, Sweden
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Springer J, Karlsson P, Madsen C, Johnsen B, Finnerup N, Jensen T, Nikolajsen L. Functional and structural assessment of patients with and without persistent pain after thoracotomy. Eur J Pain 2016; 21:238-249. [DOI: 10.1002/ejp.919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 12/12/2022]
Affiliation(s)
- J.S. Springer
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
- Department of Neurology; Aarhus University Hospital; Denmark
| | - P. Karlsson
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
| | - C.S. Madsen
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
| | - B. Johnsen
- Department of Clinical Neurophysiology; Aarhus University Hospital; Denmark
| | - N.B. Finnerup
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
| | - T.S. Jensen
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
- Department of Neurology; Aarhus University Hospital; Denmark
| | - L. Nikolajsen
- Danish Pain Research Center; Department of Clinical Medicine; Aarhus University; Denmark
- Department of Anaesthesiology; Aarhus University Hospital; Denmark
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Ventura F, Sawatzky R, Öhlén J, Karlsson P, Koinberg I. Challenges of evaluating a computer-based educational programme for women diagnosed with early-stage breast cancer: a randomised controlled trial. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27339805 DOI: 10.1111/ecc.12534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Abstract
In a two-group, multi-centre, randomised controlled 9 months trial, we (1) evaluated the impact of a computer-based educational programme compared to standard care and (2) examined whether different patterns of programme usage could be explained by demographic, medical and psychosocial factors. We involved 226 Swedish-speaking women diagnosed with early-stage breast cancer and scheduled for surgery. Primary outcomes were health self-efficacy and health care participation measured by the Comprehensive Health Enhancement Supportive System instrument. Secondary outcomes were anxiety and depression levels measured by the Hospital Anxiety and Depression scale. The Functional Assessment of Cancer Therapy-Breast and Sense of Coherence scales measured psychosocial factors for the study's secondary aim. Multi-level modelling revealed no statistically significant impact of the computer-based educational programme over time on the outcomes. Subsequent exploratory regression analysis revealed that older women with axillary dissection and increased physical well-being were more likely to use the programme. Furthermore, receiving post-operative chemotherapy and increased meaningfulness decreased the likelihood of use. Providing reliable and evidence-based medical and rehabilitation information via a computer-based programme might not be enough to influence multi-dimensional outcomes in women diagnosed with breast cancer. The use of these programmes should be further explored to promote adherence to e-Health supportive interventions.
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Affiliation(s)
- F Ventura
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R Sawatzky
- Trinity Western University, Langley, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | - J Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Palliative Research Centre, Ersta Sköndal, University College, Stockholm, Sweden
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Koinberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Nordenskjöld AE, Fohlin H, Albertsson P, Arnesson LG, Chamalidou C, Einbeigi Z, Holmberg E, Nordenskjöld B, Karlsson P. No clear effect of postoperative radiotherapy on survival of breast cancer patients with one to three positive nodes: a population-based study. Ann Oncol 2015; 26:1149-1154. [PMID: 25839671 DOI: 10.1093/annonc/mdv159] [Citation(s) in RCA: 27] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/16/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In published radiotherapy trials, the failure rate in the control arm among patients with one to three positive nodes is high compared with that seen with modern adjuvant treatments. Therefore, the generalizability of the results has been questioned. The aim of the present study was to compare relative survival in breast cancer patients between two Swedish regions with screening mammography programs and adjuvant treatment guidelines similar with the exception of the indication of radiotherapy for patients with one to three positive nodes. PATIENTS AND METHODS Between 1989 and 2006, breast cancer patients were managed very similarly in the west and southeast regions, except for indication for postoperative radiotherapy. In patients with one to three positive nodes, postmastectomy radiotherapy was generally given in the southeast region (89% of all cases) and generally not given in the west region (15% of all cases). For patients with one to three positive nodes who underwent breast-conserving surgery, patients in the west region had breast radiotherapy only, while patients in the southeast region had both breast and lymph nodes irradiated. RESULTS The 10-year relative survival for patients with one to three positive lymph nodes was 78% in the west region and 77% in the southeast region (P = 0.12). Separate analyses depending on type of surgery, as well as number of examined nodes, also revealed similar relative survival. CONCLUSION Locoregional postoperative radiotherapy has well-known side-effects, but in this population-based study, there was little or no influence of this type of radiotherapy on survival when one to three lymph nodes were involved.
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Affiliation(s)
- A E Nordenskjöld
- Department of Medicine, Southern Älvsborg Hospital, Borås; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg
| | - H Fohlin
- Regional Cancer Center South East Sweden, Linköping; Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping
| | - P Albertsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg
| | - L G Arnesson
- Department of Surgery, University Hospital, Linkoping
| | - C Chamalidou
- Department of Medicine, Southern Älvsborg Hospital, Borås; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg
| | - Z Einbeigi
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg
| | - E Holmberg
- Regional Cancer Center, Gothenburg, Sweden
| | - B Nordenskjöld
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, Linköping
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg.
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Karlsson P, Nyengaard JR, Polydefkis M, Jensen TS. Structural and functional assessment of skin nerve fibres in small-fibre pathology. Eur J Pain 2014; 19:1059-70. [PMID: 25546653 DOI: 10.1002/ejp.645] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2014] [Indexed: 01/19/2023]
Abstract
Damage to nociceptor nerve fibres may give rise to peripheral neuropathies, some of which are pain free and some are painful. A hallmark of many peripheral neuropathies is the loss of small nerve fibres in the epidermis, a condition called small-fibre neuropathy (SFN) when it is predominantly the small nerve fibres that are damaged. Historically, SFN has been very difficult to diagnose as clinical examination and nerve conduction studies mainly detect large nerve fibres, and quantitative sensory testing is not sensitive enough to detect small changes in small nerve fibres. However, taking a 3-mm punch skin biopsy from the distal leg and quantification of the nerve fibre density has proven to be a useful method to diagnose SFN. However, the correlation between the nerve fibre loss and other test results varies greatly. Recent studies have shown that it is possible not only to extract information about the nerve fibre density from the biopsies but also to get an estimation of the nerve fibre length density using stereology, quantify sweat gland innervation and detect morphological changes such as axonal swelling, all of which may be additional parameters indicating diseased small fibres relating to symptoms reported by the patients. In this review, we focus on available tests to assess structure and function of the small nerve fibres, and summarize recent advances that have provided new possibilities to more specifically relate structural findings with symptoms and function in patients with SFN.
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Affiliation(s)
- P Karlsson
- Danish Pain Research Center and Stereology & EM Laboratory, Aarhus University Hospital, Denmark.,Stereology and Electron Microscopy Laboratory and Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University Hospital, Denmark
| | - J R Nyengaard
- Stereology and Electron Microscopy Laboratory and Centre for Stochastic Geometry and Advanced Bioimaging, Aarhus University Hospital, Denmark
| | - M Polydefkis
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - T S Jensen
- Danish Pain Research Center and Stereology & EM Laboratory, Aarhus University Hospital, Denmark.,Department of Neurology, Aarhus University Hospital, Denmark
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Karlsson P. Combining Systemic Treatment with Radiation Therapy: Quantifying the Therapeutic Gain. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu322.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Karin A, Hannesdottir K, Jaeger J, Annas P, Segerdahl M, Karlsson P, Sjögren N, von Rosen T, Miller F. Psychometric evaluation of ADAS-Cog and NTB for measuring drug response. Acta Neurol Scand 2014; 129:114-22. [PMID: 23763450 DOI: 10.1111/ane.12153] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/28/2022]
Abstract
AIMS To conduct a psychometric analysis to determine the adequacy of instruments that measure cognition in Alzheimer's disease trials. BACKGROUND Both the Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) and the Neuropsychological Test Battery (NTB) are validated outcome measures for clinical trials in Alzheimer's disease and are approved also for regulatory purposes. However, it is not clear how comparable they are in measuring cognitive function. In fact, many recent trials in Alzheimer's disease patients have failed and it has been questioned if ADAS-Cog still is a sensitive measure. MATERIALS AND METHODS The present paper examines the psychometric properties of ADAS-Cog and NTB, based on a post hoc analysis of data from a clinical trial (NCT01024660), which was conducted by AstraZeneca, in mild-to-moderate Alzheimer's disease (AD) patients, with a Mini Mental State Examination (MMSE) Total score 16-24. Acceptability, reliability, different types of validity and ability to detect change were assessed using relevant statistical methods. Total scores of both tests, as well as separate domains of both tests, including the Wechsler Memory Scale (WMS), Rey Auditory Verbal Learning Test (RAVLT) and Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency Condition, were analyzed. RESULTS Overall, NTB performed well, with acceptable reliability and ability to detect change, while ADAS-Cog had insufficient psychometric properties, including ceiling effects in 8 out of a total of 11 ADAS-Cog items in mild AD patients, as well as low test-retest reliability in some of the items. DISCUSSION Based on a direct comparison on the same patient sample, we see advantages of the NTB compared with the ADAS-Cog for the evaluation of cognitive function in the population of mild-to-moderate AD patients. The results suggest that not all of ADAS-Cog items are relevant for both mild and moderate AD population. CONCLUSIONS This validation study demonstrates satisfactory psychometric properties of the NTB, while ADAS-Cog was found to be psychometrically inadequate.
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Affiliation(s)
- A. Karin
- AstraZeneca R&D; Södertälje Sweden
| | | | - J. Jaeger
- AstraZeneca R&D; Wilmington DE USA
- CogState; New Haven CT USA
| | - P. Annas
- AstraZeneca R&D; Södertälje Sweden
| | | | | | | | - T. von Rosen
- Department of Statistics; Stockholm University; Stockholm Sweden
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Parris T, Kovács A, Aziz L, Hajizadeh S, Nemes S, Semaan M, Forssell-Aronsson E, Karlsson P, Helou K. Prognostic Value of a Four-Marker Panel Associated with Breast Cancer-Specific Survival. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt084.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Holmberg L, Wong YNS, Tabár L, Ringberg A, Karlsson P, Arnesson LG, Sandelin K, Anderson H, Garmo H, Emdin S. Mammography casting-type calcification and risk of local recurrence in DCIS: analyses from a randomised study. Br J Cancer 2013; 108:812-9. [PMID: 23370209 PMCID: PMC3590664 DOI: 10.1038/bjc.2013.26] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 11/09/2022] Open
Abstract
BACKGROUND We studied the association between mammographic calcifications and local recurrence in the ipsilateral breast. METHODS Case-cohort study within a randomised trial of radiotherapy in breast conservation for ductal cancer in situ of the breast (SweDCIS). We studied mammograms from cases with an ipsilateral breast event (IBE) and from a subcohort randomly sampled at baseline. Lesions were classified as a density without calcifications, architectural distortion, powdery, crushed stone-like or casting-type calcifications. RESULTS Calcifications representing necrosis were found predominantly in younger women. Women with crushed stone or casting-type microcalcifications had higher histopathological grade and more extensive disease. The relative risk (RR) of a new IBE comparing those with casting-type calcifications to those without calcifications was 2.10 (95% confidence interval (CI) 0.92-4.80). This risk was confined to in situ recurrences; the RR of an IBE associated with casting-type calcifications on the mammogram adjusted for age and disease extent was 16.4 (95% CI 2.20-140). CONCLUSION Mammographic appearance of ductal carcinoma in situ of the breast is prognostic for the risk of an in situ IBE and may also be an indicator of responsiveness to RT in younger women.
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Affiliation(s)
- L Holmberg
- King's College London, Medical School, Division of Cancer Studies, London SE1 9RT, UK.
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Karlsson P, Cole BF, Chua BH, Price KN, Lindtner J, Collins JP, Kovács A, Thürlimann B, Crivellari D, Castiglione-Gertsch M, Forbes JF, Gelber RD, Goldhirsch A, Gruber G. Patterns and risk factors for locoregional failures after mastectomy for breast cancer: an International Breast Cancer Study Group report. Ann Oncol 2012; 23:2852-2858. [PMID: 22776708 PMCID: PMC3477880 DOI: 10.1093/annonc/mds118] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [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: 08/04/2011] [Revised: 01/04/2012] [Accepted: 03/20/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Rates and risk factors of local, axillary and supraclavicular recurrences can guide patient selection and target for postmastectomy radiotherapy (PMRT). PATIENTS AND METHODS Local, axillary and supraclavicular recurrences were evaluated in 8106 patients enrolled in 13 randomized trials. Patients received chemotherapy and/or endocrine therapy and mastectomy without radiotherapy. Median follow-up was 15.2 years. RESULTS Ten-year cumulative incidence for chest wall recurrence of >15% was seen in patients aged <40 years (16.1%), with ≥4 positive nodes (16.5%) or 0-7 uninvolved nodes (15.1%); for supraclavicular failures >10%: ≥4 positive nodes (10.2%); for axillary failures of >5%: aged <40 years (5.1%), unknown primary tumor size (5.2%), 0-7 uninvolved nodes (5.2%). In patients with 1-3 positive nodes, 10-year cumulative incidence for chest wall recurrence of >15% were age <40, peritumoral vessel invasion or 0-7 uninvolved nodes. Age, number of positive nodes and number of uninvolved nodes were significant parameters for each locoregional relapse site. CONCLUSION PMRT to the chest wall and supraclavicular fossa is supported in patients with ≥4 positive nodes. With 1-3 positive nodes, chest wall PMRT may be considered in patients aged <40 years, with 0-7 uninvolved nodes or with vascular invasion. The findings do not support PMRT to the dissected axilla.
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Affiliation(s)
- P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - B F Cole
- Department of Mathematics and Statistics College of Engineering and Mathematical Sciences, University of Vermont, Burlington; IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA
| | - B H Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - K N Price
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA; Frontier Science and Technology Research Foundation, Boston, USA
| | - J Lindtner
- The Institute of Oncology, Ljubljana, Slovenia
| | - J P Collins
- Department of Surgery, Royal Melbourne Hospital, Victoria, Australia
| | - A Kovács
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - B Thürlimann
- The Breast Center, Kantonsspital, St Gallen, Switzerland and Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D Crivellari
- Department of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | | | - J F Forbes
- Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Calvary Mater Newcastle, Newcastle, Australia
| | - R D Gelber
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA; Frontier Science and Technology Research Foundation, Boston, USA; Harvard School of Public Health and Harvard Medical School, Boston, USA
| | - A Goldhirsch
- European Institute of Oncology, Milan, Italy; Swiss Center for Breast Health, Sant'Anna Clinics, Lugano-Sorengo
| | - G Gruber
- Institut fuer Radiotherapie, Klinik Hirslanden, Zürich, Switzerland
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Jakubowska A, Rozkrut D, Antoniou A, Hamann U, Scott RJ, McGuffog L, Healy S, Sinilnikova OM, Rennert G, Lejbkowicz F, Flugelman A, Andrulis IL, Glendon G, Ozcelik H, Thomassen M, Paligo M, Aretini P, Kantala J, Aroer B, von Wachenfeldt A, Liljegren A, Loman N, Herbst K, Kristoffersson U, Rosenquist R, Karlsson P, Stenmark-Askmalm M, Melin B, Nathanson KL, Domchek SM, Byrski T, Huzarski T, Gronwald J, Menkiszak J, Cybulski C, Serrano P, Osorio A, Cajal TR, Tsitlaidou M, Benítez J, Gilbert M, Rookus M, Aalfs CM, Kluijt I, Boessenkool-Pape JL, Meijers-Heijboer HEJ, Oosterwijk JC, van Asperen CJ, Blok MJ, Nelen MR, van den Ouweland AMW, Seynaeve C, van der Luijt RB, Devilee P, Easton DF, Peock S, Frost D, Platte R, Ellis SD, Fineberg E, Evans DG, Lalloo F, Eeles R, Jacobs C, Adlard J, Davidson R, Eccles D, Cole T, Cook J, Godwin A, Bove B, Stoppa-Lyonnet D, Caux-Moncoutier V, Belotti M, Tirapo C, Mazoyer S, Barjhoux L, Boutry-Kryza N, Pujol P, Coupier I, Peyrat JP, Vennin P, Muller D, Fricker JP, Venat-Bouvet L, Johannsson OT, Isaacs C, Schmutzler R, Wappenschmidt B, Meindl A, Arnold N, Varon-Mateeva R, Niederacher D, Sutter C, Deissler H, Preisler-Adams S, Simard J, Soucy P, Durocher F, Chenevix-Trench G, Beesley J, Chen X, Rebbeck T, Couch F, Wang X, Lindor N, Fredericksen Z, Pankratz VS, Peterlongo P, Bonanni B, Fortuzzi S, Peissel B, Szabo C, Mai PL, Loud JT, Lubinski J. Association of PHB 1630 C>T and MTHFR 677 C>T polymorphisms with breast and ovarian cancer risk in BRCA1/2 mutation carriers: results from a multicenter study. Br J Cancer 2012; 106:2016-24. [PMID: 22669161 PMCID: PMC3388557 DOI: 10.1038/bjc.2012.160] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/18/2012] [Accepted: 03/25/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The variable penetrance of breast cancer in BRCA1/2 mutation carriers suggests that other genetic or environmental factors modify breast cancer risk. Two genes of special interest are prohibitin (PHB) and methylene-tetrahydrofolate reductase (MTHFR), both of which are important either directly or indirectly in maintaining genomic integrity. METHODS To evaluate the potential role of genetic variants within PHB and MTHFR in breast and ovarian cancer risk, 4102 BRCA1 and 2093 BRCA2 mutation carriers, and 6211 BRCA1 and 2902 BRCA2 carriers from the Consortium of Investigators of Modifiers of BRCA1 and BRCA2 (CIMBA) were genotyped for the PHB 1630 C>T (rs6917) polymorphism and the MTHFR 677 C>T (rs1801133) polymorphism, respectively. RESULTS There was no evidence of association between the PHB 1630 C>T and MTHFR 677 C>T polymorphisms with either disease for BRCA1 or BRCA2 mutation carriers when breast and ovarian cancer associations were evaluated separately. Analysis that evaluated associations for breast and ovarian cancer simultaneously showed some evidence that BRCA1 mutation carriers who had the rare homozygote genotype (TT) of the PHB 1630 C>T polymorphism were at increased risk of both breast and ovarian cancer (HR 1.50, 95%CI 1.10-2.04 and HR 2.16, 95%CI 1.24-3.76, respectively). However, there was no evidence of association under a multiplicative model for the effect of each minor allele. CONCLUSION The PHB 1630TT genotype may modify breast and ovarian cancer risks in BRCA1 mutation carriers. This association need to be evaluated in larger series of BRCA1 mutation carriers.
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Affiliation(s)
- A Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland.
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Lundstedt D, Gustafsson M, Steineck G, Alsadius D, Sundberg A, Wilderäng U, Holmberg E, Johansson KA, Karlsson P. P3-13-03: Long-Term Symptoms after Radiotherapy of Supraclavicular Lymph Nodes in Breast Cancer Patients. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-13-03] [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: 11/16/2022]
Abstract
Abstract
Background and Purpose: Irradiation of the supraclavicular lymph nodes has historically been shown to increase the risk of brachial plexopathy with neurological problems in the upper limb. The purpose of this study was to compare long-term symptoms after modern radiotherapy (based on 3D dose planning) in breast cancer patients with or without irradiation of the supraclavicular lymph nodes.
Material and Methods: We collected information from 814 recurrence free women consecutively treated with adjuvant radiotherapy for breast cancer at the Sahlgrenska University Hospital in Gothenburg, Sweden, 1999 to 2004. The women had breast conserving surgery or mastectomy with axillary dissection or sentinel node biopsy. The breast area was irradiated to 50 Gy in 2.0 Gy fractions. Women with more than three lymph node metastases had regional radiotherapy to the supraclavicular lymph nodes delivered in 2.0 Gy fractions up to 50 Gy. Systemic treatments were given according to regional guidelines. In this study the women were classified into three groups depending on if they had axillary dissection and regional radiotherapy. The first group had both axillary dissection and regional radiotherapy, the second group had axillary dissection without regional radiotherapy, and the third group had sentinel node biopsy (i.e. no axillary dissection) without regional radiotherapy. Three to eight years after radiotherapy, the women received a questionnaire asking about paresthesia, pain and strength in the upper limb.
Results: Among women with axillary dissection and regional radiotherapy 38/192 (19.8%) reported paresthesia in the hand compared to 68/505 (13.5%) among women with axillary dissection without regional radiotherapy; relative risk (RR) 1.47; 95% confidence interval (95% CI) 1.02 - 2.11, and compared to 9/112 (8.0%) among women with sentinel node biopsy without regional radiotherapy; RR 2.46 (95% CI 1.24−4.90). Type of breast surgery, number of examined axillary lymph nodes, and chemotherapy had no impact on the occurrence of paresthesia. Age was an effect modifier among the women with axillary dissection and regional radiotherapy; up to 49 years of age 26.8% reported paresthesia (RR 2.45; 95% CI 1.05−5.73), between 50 and 59 years of age 19.7% reported paresthesia (RR 1.81; 95% CI 0.73−4.44), and above 59 years of age 10.9% reported paresthesia (RR 1.00 Reference). We found no statistically significant differences between the groups regarding pain or decreased strength.
Conclusions: Radiotherapy to the supraclavicular lymph nodes increases the occurrence of paresthesia in the hand. The effect was mainly seen among younger women. Dose/volume-response analysis regarding paresthesia will be presented at the meeting.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-03.
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Affiliation(s)
- D Lundstedt
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
| | - M Gustafsson
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
| | - G Steineck
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
| | - D Alsadius
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
| | - A Sundberg
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
| | - U Wilderäng
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
| | - E Holmberg
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
| | - K-A Johansson
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
| | - P Karlsson
- 1Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Gothenburg, Sweden; Karolinska Institute, Stockholm, Sweden
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Karlsson P, Sun Z, Braun D, Price KN, Castiglione-Gertsch M, Rabaglio M, Gelber RD, Crivellari D, Collins J, Murray E, Zaman K, Colleoni M, Gusterson BA, Viale G, Regan MM, Coates AS, Goldhirsch A. Long-term results of International Breast Cancer Study Group Trial VIII: adjuvant chemotherapy plus goserelin compared with either therapy alone for premenopausal patients with node-negative breast cancer. Ann Oncol 2011; 22:2216-26. [PMID: 21325445 DOI: 10.1093/annonc/mdq735] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [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] Open
Abstract
BACKGROUND The International Breast Cancer Study Group Trial VIII compared long-term efficacy of endocrine therapy (goserelin), chemotherapy [cyclophosphamide, methotrexate and fluorouracil (CMF)], and chemoendocrine therapy (CMF followed by goserelin) for pre/perimenopausal women with lymph-node-negative breast cancer. PATIENTS AND METHODS From 1990 to 1999, 1063 patients were randomized to receive (i) goserelin for 24 months (n = 346), (ii) six courses of 'classical' CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy (n = 360), or (iii) six courses of CMF plus 18 months goserelin (CMF→ goserelin; n = 357). Tumors were classified as estrogen receptor (ER) negative (19%), ER positive (80%), or ER unknown (1%); 19% of patients were younger than 40. Median follow-up was 12.1 years. RESULTS For the ER-positive cohort, sequential therapy provided a statistically significant benefit in disease-free survival (DFS) (12-year DFS = 77%) compared with CMF alone (69%) and goserelin alone (68%) (P = 0.04 for each comparison), due largely to the effect in younger patients. Patients with ER-negative tumors whose treatment included CMF had similar DFS (12-year DFS CMF = 67%; 12-year DFS CMF→ goserelin = 69%) compared with goserelin alone (12-year DFS = 61%, P= NS). CONCLUSIONS For pre/perimenopausal women with lymph-node-negative ER-positive breast cancer, CMF followed by goserelin improved DFS in comparison with either modality alone. The improvement was the most pronounced in those aged below 40, suggesting an endocrine effect of prolonged CMF-induced amenorrhea.
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Affiliation(s)
- P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Aebi S, Sun Z, Braun D, Price KN, Castiglione-Gertsch M, Rabaglio M, Gelber RD, Crivellari D, Lindtner J, Snyder R, Karlsson P, Simoncini E, Gusterson BA, Viale G, Regan MM, Coates AS, Goldhirsch A. Differential efficacy of three cycles of CMF followed by tamoxifen in patients with ER-positive and ER-negative tumors: long-term follow up on IBCSG Trial IX. Ann Oncol 2011; 22:1981-1987. [PMID: 21282282 DOI: 10.1093/annonc/mdq754] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The benefit of adjuvant chemotherapy in postmenopausal patients with estrogen receptor (ER)-positive lymph node-negative breast cancer is being reassessed. PATIENTS AND METHODS After stratification by ER status, 1669 postmenopausal patients with operable lymph node-negative breast cancer were randomly assigned to three 28-day courses of 'classical' CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy followed by tamoxifen for 57 months (CMF→tamoxifen) or to tamoxifen alone for 5 years. RESULTS ERs were positive in 81% of tumors. At a median follow-up of 13.1 years, patients with ER-positive breast cancers did not benefit from CMF [13-year disease-free survival (DFS) 64% CMF→tamoxifen, 66% tamoxifen; P = 0.99], whereas CMF substantially improved the prognosis of patients with ER-negative breast cancer (13-year DFS 73% versus 57%, P = 0.001). Similarly, breast cancer-free interval (BCFI) was identical in the ER-positive cohort but significantly improved by chemotherapy in the ER-negative cohort (13-year BCFI 80% versus 63%, P = 0.001). CMF had no influence on second nonbreast malignancies or deaths from other causes. CONCLUSION CMF is not beneficial in postmenopausal patients with node-negative ER-positive breast cancer but is highly effective within the ER-negative cohort. In the future, other markers of chemotherapy response may define a subset of patients with ER-positive tumors who may benefit from adjuvant chemotherapy.
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Affiliation(s)
- S Aebi
- Division of Medical Oncology, Berne University Hospital and Swiss Group for Clinical Cancer research (SAKK), Berne, Switzerland.
| | - Z Sun
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard School of Public Health, Boston
| | - D Braun
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard School of Public Health, Boston
| | - K N Price
- IBCSG Statistical Center and Frontier Science and Technology Research Foundation, Boston, USA
| | - M Castiglione-Gertsch
- Medical Onco-Gynecology Unit, Department of Medicine, Geneva University Hospital, Geneva
| | - M Rabaglio
- IBCSG Coordinating Center and Inselspital, Berne, Switzerland
| | - R D Gelber
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Frontier Science and Technology Research Foundation, Harvard School of Public Health, Harvard Medical School, Boston, USA
| | - D Crivellari
- Department of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - J Lindtner
- Department of Surgical Oncology, Institute of Oncology, Ljulbljana, Slovenia
| | - R Snyder
- Department of Medical Oncology, St Vincent's Hospital, Melbourne, Australia
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Simoncini
- Department of Medical Oncology, Spedali Civili di Brescia, Brescia, Italy
| | - B A Gusterson
- IBCSG Pathology Review Office, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - G Viale
- IBCSG Pathology Office, Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy
| | - M M Regan
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard School of Public Health, Boston
| | - A S Coates
- International Breast Cancer Study Group, Berne, Switzerland; School of Public Health, University of Sydney, Australia
| | - A Goldhirsch
- Department of Medicine, European Institute of Oncology, Milan, Italy; Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Isaksson K, Arver B, Atterhem H, Baan A, Bergqvist L, Brandberg Y, Ehrencrona H, Emanuelsson M, Hellborg H, Henriksson K, Karlsson P, Loman N, Lundberg J, Ringberg A, Stenmark Askmalm M, Wickman M, Sandelin K. Abstract P6-10-03: Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer — A National Survey. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p6-10-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Prophylactic mastectomy is the most efficient risk-reducing strategy for women with hereditary increased risk of breast cancer. Usually it is combined with immediate breast reconstruction. Unpublished data show that about 60% of Swedish female BRCA1/2 mutation carriers undergo bilateral prophylactic mastectomy (BPM) within eight years after mutation status disclosure. This study attempted a national inventory of all bilateral prophylactic mastectomies performed between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, histopathological findings, complications, and regional differences. Methods: Geneticists, oncologists, and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region during 2006 and 2007 and the data were analyzed centrally. Information about cancer and death was recorded through 2008. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. Women with incidental cancer in the breast specimens and women treated for ovarian cancer were excluded from the calculation. Prophylactic salpingo-oophorectomy performed before BPM was considered to have reduced the risk of breast cancer by 50%.
Results: A total of 223 women operated on were identified. During a mean postoperative follow-up of 6.6 years (range 2.1-14.0), no primary breast cancer was observed. However, one woman succumbed nine years after BPM to widespread adenocarcinoma of uncertain origin. According to our risk calculation, based on 204 women and 1362 woman-years, approximately 12 breast cancers would have been expected, had BPM not been performed. Eight of these would have occurred in mutation carriers.
The operations had been performed in eight hospitals throughout the country. One hospital performing BPMs declined participation in the study. Median age at BPM was 40 years. A total of 58% were BRCA1/2 mutation carriers. Five women (2%) had a lifetime risk of breast cancer <30% but no woman had a risk below 20%. All but three women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small (≥8 mm), invasive cancers and four DCIS were found in the mastectomy specimens. Three of the women with invasive cancer did not have recent preoperative breast imaging. The incidence of non-breast related complications was low (3%). Implant loss due to infection/necrosis occurred in 10% of the implant-based reconstructions. Conclusions: As only one hospital performing BPMs declined participation, we estimate that the 223 identified women are representative of Swedish conditions. In accordance with previous international series, we conclude that BPM is efficacious in reducing future breast cancer risk in high-risk women. Preoperative imaging and careful histopathological examination of the breast specimens is important, as incidental breast cancers occur. Given the small numbers of operations performed, centralization of this patient group seems justified.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-10-03.
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Affiliation(s)
- K Isaksson
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - B Arver
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - H Atterhem
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - A Baan
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - L Bergqvist
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - Y Brandberg
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - H Ehrencrona
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - M Emanuelsson
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - H Hellborg
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - K Henriksson
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - P Karlsson
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - N Loman
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - J Lundberg
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - A Ringberg
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - M Stenmark Askmalm
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - M Wickman
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
| | - K. Sandelin
- Karolinska Institutet, Stockholm, Sweden; Umeå University Hospital, Sweden; Sahlgrenska University Hospital, Göteborg, Sweden; Central Hospital Västerås and Uppsala University, Västerås, Sweden; Uppsala University, Sweden; Karolinska University Hospital, Stockholm, Sweden; Skåne University Hospital, Lund, Sweden; Skåne University Hospital and Lund University, Lund, Sweden; Skåne University Hospital and Lund University, Malmö, Sweden; Linköping University, Sweden
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Jucaite A, Forssberg H, Karlsson P, Halldin C, Farde L. Age-related reduction in dopamine D1 receptors in the human brain: from late childhood to adulthood, a positron emission tomography study. Neuroscience 2010; 167:104-10. [DOI: 10.1016/j.neuroscience.2010.01.034] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/19/2010] [Accepted: 01/19/2010] [Indexed: 12/01/2022]
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Heath E, Kosjek T, Andersen HR, Holten Lützhøft HC, Adolfson Erici M, Coquery M, Düring RA, Gans O, Guignard C, Karlsson P, Manciot F, Moldovan Z, Patureau D, Cruceru L, Sacher F, Ledin A. Inter-laboratory exercise on steroid estrogens in aqueous samples. Environ Pollut 2010; 158:658-662. [PMID: 19906476 DOI: 10.1016/j.envpol.2009.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 10/20/2009] [Accepted: 10/21/2009] [Indexed: 05/28/2023]
Abstract
An inter-laboratory comparison exercise was organized among European laboratories, under the aegis of EU COST Action 636: "Xenobiotics in Urban Water Cycle". The objective was to evaluate the performance of testing laboratories determining "Endocrine Disrupting Compounds" (EDC) in various aqueous matrices. As the main task three steroid estrogens: 17alpha-ethinylestradiol, 17beta-estradiol and estrone were determined in four spiked aqueous matrices: tap water, river water and wastewater treatment plant influent and effluent using GC-MS and LC-MS/MS. Results were compared and discussed according to the analytical techniques applied, the accuracy and reproducibility of the analytical methods and the nature of the sample matrices. Overall, the results obtained in this inter-laboratory exercise reveal a high level of competence among the participating laboratories for the detection of steroid estrogens in water samples indicating that GC-MS as well as LC-MS/MS can equally be employed for the analysis of natural and synthetic hormones.
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Affiliation(s)
- E Heath
- Department of Environmental Sciences, Jozef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia.
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Browall M, Ahlberg K, Karlsson P, Danielson E, Persson L, Gaston-Johansson F. 4272 Health related quality of life during adjuvant treatment of breast cancer among postmenopausal women. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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47
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Viale G, Giobbie-Hurder A, Gusterson BA, Maiorano E, Mastropasqua MG, Sonzogni A, Mallon E, Colleoni M, Castiglione-Gertsch M, Regan MM, Price KN, Brown RW, Golouh R, Crivellari D, Karlsson P, Öhlschlegel C, Gelber RD, Goldhirsch A, Coates AS. Adverse prognostic value of peritumoral vascular invasion: is it abrogated by adequate endocrine adjuvant therapy? Results from two International Breast Cancer Study Group randomized trials of chemoendocrine adjuvant therapy for early breast cancer. Ann Oncol 2009; 21:245-254. [PMID: 19633051 DOI: 10.1093/annonc/mdp317] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Peritumoral vascular invasion (PVI) may assist in assigning optimal adjuvant systemic therapy for women with early breast cancer. PATIENTS AND METHODS Patients participated in two International Breast Cancer Study Group randomized trials testing chemoendocrine adjuvant therapies in premenopausal (trial VIII) or postmenopausal (trial IX) node-negative breast cancer. PVI was assessed by institutional pathologists and/or central review on hematoxylin-eosin-stained slides in 99% of patients (analysis cohort 2754 patients, median follow-up >9 years). RESULTS PVI, present in 23% of the tumors, was associated with higher grade tumors and larger tumor size (trial IX only). Presence of PVI increased locoregional and distant recurrence and was significantly associated with poorer disease-free survival. The adverse prognostic impact of PVI in trial VIII was limited to premenopausal patients with endocrine-responsive tumors randomized to therapies not containing goserelin, and conversely the beneficial effect of goserelin was limited to patients whose tumors showed PVI. In trial IX, all patients received tamoxifen: the adverse prognostic impact of PVI was limited to patients with receptor-negative tumors regardless of chemotherapy. CONCLUSION Adequate endocrine adjuvant therapy appears to abrogate the adverse impact of PVI in node-negative disease, while PVI may identify patients who will benefit particularly from adjuvant therapy.
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Affiliation(s)
- G Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy.
| | - A Giobbie-Hurder
- International Breast Cancer Study Group, Statistical Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - B A Gusterson
- Division of Cancer Sciences and Molecular Pathology, Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - E Maiorano
- Department of Pathological Anatomy, University of Bari, Bari, Italy
| | - M G Mastropasqua
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy
| | - A Sonzogni
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy
| | - E Mallon
- Division of Cancer Sciences and Molecular Pathology, Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - M Colleoni
- Department of Medicine, Research Unit in Medical Senology, European Institute of Oncology, Milan, Italy
| | | | - M M Regan
- International Breast Cancer Study Group, Statistical Center, Dana-Farber Cancer Institute, Harvard School of Public Health, Boston, MA, USA
| | - K N Price
- International Breast Cancer Study Group, Statistical Center, Frontier Science and Technology Research Foundation, Boston, MA, USA
| | - R W Brown
- Melbourne Pathology, Collingwood, Victoria, Australia
| | - R Golouh
- Department of Pathology, Institute of Oncology, Ljubljana, Slovenia
| | - D Crivellari
- Department of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - P Karlsson
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - C Öhlschlegel
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R D Gelber
- International Breast Cancer Study Group, Statistical Center, Dana-Farber Cancer Institute, Frontier Science and Technology Research Foundation, Harvard School of Public Health, Boston, MA, USA
| | - A Goldhirsch
- European Institute of Oncology, Milan, Italy; Department of Medicine, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - A S Coates
- Scientific Committee, International Breast Cancer Study Group, Bern, Switzerland; School of Public Health, University of Sydney, Sydney, Australia
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Browall M, Persson LO, Ahlberg K, Karlsson P, Danielson E. Daily assessment of stressful events and coping among post-menopausal women with breast cancer treated with adjuvant chemotherapy. Eur J Cancer Care (Engl) 2009; 18:507-16. [PMID: 19490004 DOI: 10.1111/j.1365-2354.2008.00994.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of the study was twofold: to examine what type of daily stressful events post-menopausal woman with breast cancer experience during adjuvant chemotherapy and how bothersome these are and to identify coping strategies used by these women used to manage such stressful events. The patient group comprised 75 consecutively invited women (>or=55 years of age) at two university hospitals and one county hospital in Sweden. The Daily Coping Assessment was used to collect data over time. Data were analysed both qualitatively and quantitatively. Six categories of stressful events were identified: 'nausea and vomiting', 'fatigue', 'other symptoms', 'isolation and alienation', 'fear of the unknown' and 'being controlled by the treatment'. The first three categories were subsumed under the domain physical problems and the latter three under psychosocial problems. Almost 30% of the diary entries recorded no stressful event. Physical problems were three times as frequent as psychosocial problems. 'Nausea/vomiting' was the most frequently observed stressful event (21.6%). 'Isolation and alienation' and 'fear of the unknown' were less frequent, but when they occurred they were rated as the most distressing. Several coping strategies were used to manage each stressful event. The most common strategies were acceptance, relaxation and distraction. Religion was rarely used as a coping strategy.
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Affiliation(s)
- Maria Browall
- The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
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Karlsson P, Cole B, Colleoni M, Roncadin M, Chua B, Gruber G. 0110 Timing of radiotherapy and outcome in patients receiving adjuvant endocrine therapy. Breast 2009. [DOI: 10.1016/s0960-9776(09)70151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Margolin S, Carlsson L, Hellstrom M, Karlsson P, Lidbrink E, Linderholm B, Lindman H, Malmstrom P, Skold Pettersson D, Bergh J. A randomized feasibility/phase II study (SBG 2004-1) with dose-dense/tailored epirubicin, cyclophoshamide (EC) followed by docetaxel (T) or fixed dosed dose-dense EC/T versus T, doxorubicin and C (TAC) in node-positive breast cancer. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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