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Zaiem F, Bedi M, Kheil M, Abujamea A, Jain D, Rosen D, Alkaram W, Kim S, Ali-Fehmi R, Gogoi R. Correlation between steroid receptor expression and response to progestational therapy in patients with atypical endometrial hyperplasia or cancer. Gynecol Oncol Rep 2024; 53:101402. [PMID: 38699462 PMCID: PMC11063354 DOI: 10.1016/j.gore.2024.101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/05/2024] Open
Abstract
Background Conservative management of atypical endometrial hyperplasia (AEH) or endometrial cancer (EMCA) often relies on the treatment of synthetic progestins, which show varied success and response rates. We evaluate the correlation between steroid receptor expression and response to progestin therapy in patients with AEH and EMCA. Methods Retrospective cohort study collected data for patients with AEH or EMCA who had an endometrial sample after receiving conservative therapy utilizing either Megestrol acetate or Levonorgestrel Intrauterine device (IUD). Immunohistochemistry (IHC) was performed on pre- and post- treatment biopsy samples to assess androgen receptor (AR), estrogen receptor (ER), and progesterone receptor (PR) expression. IHC scores (1-12) were calculated based on staining intensity and percentage of positive cells. Results and analysis We identified 15 patients with AEH and EMCA between 2015 and 2023 with the majority of African American ethnicity (53 %). Fourteen patients (93 %) received Megestrol acetate, and 1 patient received Levonorgestrel IUD alone. Three patients ultimately underwent hysterectomy. Seven (46.6 %) endometrial samples had strong positivity for AR, PR and ER expression on pre-treatment biopsies, and only 3 (20 %) of them maintained strong positivity for the 3 receptors in the post-treatment. Patients who successfully responded to the treatment demonstrated a significantly greater decrease in IHC scores after the treatment compared to those who did not respond (p = 0.009). Conclusion Steroid receptor expression could be used as a possible biomarker for response to progestin therapy in patients undergoing conservative management for AEH and EMCA.
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Affiliation(s)
- Fadi Zaiem
- Department of Pathology, Wayne State University 48201 Detroit, MI, USA
| | - Mannat Bedi
- School of Medicine, Wayne State University, 48201 Detroit, MI, USA
| | - Mira Kheil
- Department of Obstetrics and Gynecology, Henry Ford Hospital, 48202 Detroit, MI, USA
| | - Asem Abujamea
- Department of Internal Medicine, Marshfield Medical Center, 54449 Marshfield, WI, USA
| | - Deepti Jain
- Department of Pathology, Wayne State University 48201 Detroit, MI, USA
| | - Dovid Rosen
- School of Medicine, Wayne State University, 48201 Detroit, MI, USA
| | - Waed Alkaram
- Department of Pathology, Wayne State University 48201 Detroit, MI, USA
| | - Seongo Kim
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Rouba Ali-Fehmi
- Department of Pathology University of Michigan 48109 Ann Arbor, MI, USA
| | - Radhika Gogoi
- Department of Gynecology Oncology, Karmanos Cancer Institute/ Wayne State University, Detroit, MI 48201, USA
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Stolnicu S, Praiss AM, Allison D, Tessier-Cloutier B, Flynn J, Iasonos A, Hoang L, Terinte C, Pesci A, Mateoiu C, Lastra RR, Kiyokawa T, Ali-Fehmi R, Kheil M, Oliva E, Devins K, Abu-Rustum N, Soslow RA. Proposal of Novel Binary Grading Systems for Cervical Squamous Cell Carcinoma. Int J Gynecol Pathol 2024; 43:203-214. [PMID: 38085957 PMCID: PMC11031322 DOI: 10.1097/pgp.0000000000000979] [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] [Indexed: 04/20/2024]
Abstract
We compared grading systems and examined associations with tumor stroma and survival in patients with cervical squamous cell carcinoma. Available tumor slides were collected from 10 international institutions. Broders tumor grade, Jesinghaus grade (informed by the pattern of tumor invasion), Silva pattern, and tumor stroma were retrospectively analyzed; associations with overall survival (OS), progression-free survival (PFS), and presence of lymph node metastases were examined. Binary grading systems incorporating tumor stromal changes into Broders and Jesinghaus grading systems were developed. Of 670 cases, 586 were reviewed for original Broders tumor grade, 587 for consensus Broders grade, 587 for Jesinghaus grade, 584 for Silva pattern, and 556 for tumor stroma. Reproducibility among grading systems was poor (κ = 0.365, original Broders/consensus Broders; κ = 0.215, consensus Broders/Jesinghaus). Median follow-up was 5.7 years (range, 0-27.8). PFS rates were 93%, 79%, and 71%, and OS rates were 98%, 86%, and 79% at 1, 5, and 10 years, respectively. On univariable analysis, original Broders ( P < 0.001), consensus Broders ( P < 0.034), and Jesinghaus ( P < 0.013) grades were significant for OS; original Broders grade was significant for PFS ( P = 0.038). Predictive accuracy for OS and PFS were 0.559 and 0.542 (original Broders), 0.542 and 0.525 (consensus Broders), 0.554 and 0.541 (Jesinghaus grade), and 0.512 and 0.515 (Silva pattern), respectively. Broders and Jesinghaus binary tumor grades were significant on univariable analysis for OS and PFS, and predictive value was improved. Jesinghaus tumor grade ( P < 0.001) and both binary systems (Broders, P = 0.007; Jesinghaus, P < 0.001) were associated with the presence of lymph node metastases. Histologic grade has poor reproducibility and limited predictive accuracy for squamous cell carcinoma. The proposed binary grading system offers improved predictive accuracy for survival and the presence of lymph none metastases.
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Affiliation(s)
- Simona Stolnicu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology “George E Palade” of Targu Mures, Targu Mures, Romania
| | - Aaron M. Praiss
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Douglas Allison
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lien Hoang
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Anna Pesci
- IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Claudia Mateoiu
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | - Mira Kheil
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | | | - Kyle Devins
- Massachusetts General Hospital, Boston, MA, USA
| | - Nadeem Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Robert A. Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abada E, Kim S, Jang H, Kheil M, Singh K, Bandyopadhyay S, Ali-Fehmi R, Quddus MR. Human epidermal growth factor receptor-2 (HER2) expression in FIGO3 high-grade endometrial endometrioid carcinoma: Clinicopathologic characteristics and future directions. Gynecol Oncol 2024; 185:25-32. [PMID: 38364692 DOI: 10.1016/j.ygyno.2024.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To study the expression of HER2 in high-grade FIGO3 endometrial endometroid carcinoma (EEC) and to correlate our findings with the clinicopathologic characteristics of this tumor. METHODS HER2 expression by immunohistochemistry (IHC) was performed on 10% formalin-fixed paraffin embedded tissue on cases diagnosed as FIGO3 EEC. HER2 expression was interpreted as negative (0), low (1+ and 2+) or positive (3+) using similar criteria as in the breast. HER2 amplification by Fluorescence in situ hybridization (FISH) was performed on cases interpreted as 2+ and 3+ by IHC. RESULTS One hundred and forty-three FIGO3 EEC were identified. Of these, 70 (49%) cases were HER2 negative (IHC 0), and 73 (51%) cases expressed/amplified HER2 by IHC and/or FISH. Of the 73 cases expressing or amplifying HER2, 59 cases were IHC 1+, 12 cases were IHC 2+, and 2 cases were IHC 3+. FISH testing was performed in 12 cases. Only one of the two HER2 IHC 3+ cases showed HER2 gene amplification by FISH and the other 11 cases were not amplified. The 5-year overall survival (OS) rate for HER2 IHC 1+ cases was 92.20% (95% CI: 83.97-100.00), and the 5-year OS rate for HER2 IHC 2+/3+ cases was 89.50% (95% CI: 56.41-100.00). CONCLUSION Our findings indicate that about one half of FIGO3 EEC variably expresses HER2 and with the emerging concept of "HER2 low", anti-HER2 agents may be explored as potential therapeutic options in these patients, for possible survival benefits.
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Affiliation(s)
- Evi Abada
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, & The Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA.
| | - Seongho Kim
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, 4100 John R. Road, Detroit, MI 48201, USA
| | - Hyejeong Jang
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, 4100 John R. Road, Detroit, MI 48201, USA
| | - Mira Kheil
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Road, Detroit, MI 48201, USA
| | - Kamaljeet Singh
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, & The Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Road, Detroit, MI 48201, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R Road, Detroit, MI 48201, USA
| | - M Ruhul Quddus
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, & The Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA
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Wei S, Krause HB, Geynisman DM, Elliott A, Kutikov A, Uzzo RG, Pei J, Barata P, Carneiro B, Heath E, Ryan C, Farrell A, Nabhan C, Ali-Fehmi R, Naqash AR, Argani P, McKay RR. Molecular Characterization of TFE3-Rearranged Renal Cell Carcinoma: A Comparative Study With Papillary and Clear Cell Renal Cell Carcinomas. Mod Pathol 2024; 37:100404. [PMID: 38104891 DOI: 10.1016/j.modpat.2023.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
TFE3-rearranged renal cell carcinoma (rRCC) is a rare subtype of renal cell carcinomas belonging to the MiT family translocation RCC. To further elucidate the co-alterations that occur along with TFE3 fusions in rRCC, we characterized the genomic, transcriptional, and immune landscapes in comparison to clear cell (ccRCC) and papillary renal cell carcinoma (pRCC). Next-generation sequencing of RNA (whole transcriptome) and DNA (592-gene panel or whole exome) for rRCC (N = 20), pRCC (N = 20), and ccRCC samples (N = 392) was performed. Patients with rRCC were significantly younger and more frequently female (median 44.5 years, 75.0% female) as compared with patients with pRCC (68.5 years, 25.0% female; P < .05) and ccRCC (62.0 years, 27.8% female; P < .05). A total of 8 unique fusion partners were observed, including a novel fusion with SRRM2::TFE3 in 2 patients. ccRCC exhibited significantly higher mutation rates of VHL (0% rRCC, 0% pRCC, 78.7% ccRCC; P < .05) and PBMR1 (0% rRCC, 5.0% pRCC, 49.4% ccRCC; P < .05). The genomic landscapes of rRCC were sparse with no mutations occurring with a prevalence higher than 10% other than pTERT (18.2% rRCC, 0% pRCC, 9.2% ccRCC). rRCC were associated with significantly less M1 macrophages (0.8%) as compared with pRCC (1.4%) and ccRCC (2.7%) (P < .05), suggesting a cold tumor-immune microenvironment. However, rRCC were more commonly PD-L1+ (rRCC 50%, pRCC 19.0%, ccRCC 12.2%; P < .05). Gene set enrichment analysis showed that rRCC are enriched in genes related to oxidative phosphorylation when compared with both ccRCC and pRCC. Despite having a colder tumor-immune microenvironment than pRCC and ccRCC, increased PDL1+ rates in rRCC suggest a potential benefit from immune checkpoint inhibitor therapy.
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Affiliation(s)
- Shuanzeng Wei
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| | | | - Daniel M Geynisman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Alexander Kutikov
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Robert G Uzzo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jianming Pei
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Pedro Barata
- Division of Solid Tumor Oncology, Department of Medicine, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Benedito Carneiro
- Division of Hematology/Oncology, Department of Medicine, Lifespan Health System, Brown University, Providence, Rhode Islands
| | - Elisabeth Heath
- Department of Oncology, Karmanos Cancer Institute, Detroit, Michigan
| | - Charles Ryan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Rouba Ali-Fehmi
- Department of Pathology, Karmanos Cancer Institute, Detroit, Michigan
| | - Abdul Rafeh Naqash
- Medical Oncology, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma
| | - Pedram Argani
- Department of Pathology, The Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Rana R McKay
- Department of Medicine, University of California San Diego, San Diego, California
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5
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Stolnicu S, Allison D, Praiss AM, Tessier-Cloutier B, Momeni Boroujeni A, Flynn J, Iasonos A, Serrette R, Hoang L, Patrichi A, Terinte C, Pesci A, Mateoiu C, Lastra RR, Kiyokawa T, Ali-Fehmi R, Kheil M, Oliva E, Devins KM, Abu-Rustum NR, Soslow RA. Incidence and Clinicopathologic Characteristics of Human Papillomavirus-independent Invasive Squamous Cell Carcinomas of the Cervix: A Morphologic, Immunohistochemical, and Human Papilloma-Virologic Study of 670 Cases. Am J Surg Pathol 2023; 47:1376-1389. [PMID: 37702216 PMCID: PMC10840845 DOI: 10.1097/pas.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
We aimed to determine the frequency of human papillomavirus-independent (HPVI) cervical squamous cell carcinoma (SCC) and to describe clinicopathologic characteristics. Among 670 patients with surgically treated SCCs in an established multi-institutional cohort, 447 had available tissue. Tissue microarrays were constructed and studied by in situ hybridization (ISH) for high-risk and low-risk human papillomavirus (HPV) mRNA and immunohistochemistry for p16 and p53. Tumors were HPVI if negative by HPV ISH and they failed to show diffuse p16 positivity by immunohistochemistry, and human papillomavirus-associated (HPVA) if positive by HPV ISH. Ten HPVI SCCs and 435 HPVA SCCs were identified; 2 cases were equivocal and excluded from analysis. The overall rate of HPVI SCC was low (2%) but was higher among older patients (7% in patients above 60 y of age and 17% in patients above 70 y of age). Compared with HPVA, patients with HPVI SCC were significantly older (median age, 72 vs. 49, P <0.001) and diagnosed at a higher stage (40% vs. 18% with stage III/IV disease, P =0.055). p53 expression was varied; 2 cases (20%) had null expression and 8 (80%) had wild-type expression. HPVI SCCs were heterogenous, with keratinizing, nonkeratinizing, and warty morphologies observed. Several cases had a precursor lesion reminiscent of differentiated vulvar intraepithelial neoplasia, with prominent basal atypia and hypereosinophilia or a basaloid-like morphology. Two patients (20%) had distant recurrences within 12 months, and 3 (30%) died of disease during follow-up. HPVI SCCs are rare tumors that are more common among older patients with higher stage disease and have important clinical and histologic differences from HPVA SCCs.
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Affiliation(s)
- Simona Stolnicu
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology "George E Palade" of Targu Mures, Targu Mures
| | | | | | | | | | - Jessica Flynn
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Alexia Iasonos
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | | | - Lien Hoang
- Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Andrei Patrichi
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology "George E Palade" of Targu Mures, Targu Mures
| | | | - Anna Pesci
- Hospital "Sacro Cuore Don Calabria", Negrar, Italy
| | - Claudia Mateoiu
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Takako Kiyokawa
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University, Detroit, MI
| | - Mira Kheil
- Department of Pathology, Wayne State University, Detroit, MI
| | | | | | - Nadeem R Abu-Rustum
- Surgery
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY
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6
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Praiss AM, Allison D, Tessier-Cloutier B, Flynn J, Iasonos A, Hoang L, Patrichi A, Terinte C, Pesci A, Mateoiu C, Lastra RR, Puscasiu L, Kiyokawa T, Ali-Fehmi R, Kheil M, Oliva E, Devins KM, Abu-Rustum NR, Soslow RA, Stolnicu S. Extensive versus focal lymphovascular invasion in squamous cell carcinoma of the cervix: A comprehensive international, multicenter, retrospective clinicopathologic study. Gynecol Oncol 2023; 176:147-154. [PMID: 37541128 PMCID: PMC10809424 DOI: 10.1016/j.ygyno.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE We evaluated clinicopathologic parameters of patients with cervical squamous cell carcinoma (SCC) who were treated with initial surgical management and assessed their relation to survival outcomes. Specifically, we evaluated the relation between extent of lymphovascular invasion (LVI) and survival outcomes. METHODS All available tumor slides from patients with initially surgically treated cervical SCC were collected from 10 institutions and retrospectively analyzed. Standard clinicopathological parameters, tumor stroma, and extent of LVI were assessed (focal: <5 spaces, extensive: ≥5 spaces). PFS and OS were evaluated using Kaplan-Meier methodology. Univariable and multivariable Cox proportional hazards models were created to determine prognostic survival-related risk factors. RESULTS A total of 670 tumor samples were included in the analysis. Median age at diagnosis was 47 years (IQR: 38-60), 457 patients (72%) had a 2018 International Federation of Gynecology and Obstetrics (FIGO) stage I tumor, and 155 tumors (28%) were flat and/or ulcerated. There were 303 nonkeratinizing tumors (51%), 237 keratinizing tumors (40%), and 356 histologic grade 2 tumors (61%). Quantifiable LVI was present in 321 cases (51%; 23% focal and 33% extensive). On multivariable analysis for PFS, extensive and focal LVI had worse outcomes compared to negative LVI (HR: 2.38 [95% CI: 1.26-4.47] and HR: 1.54 [95% CI: 0.76-3.11], respectively; P = 0.02). The difference did not reach statistical significance for OS. CONCLUSION Presence of LVI is a prognostic marker for patients with cervical SCC. Quantification (extensive vs. focal vs. negative) of LVI may be an important biomarker for oncologic outcome.
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Affiliation(s)
- Aaron M Praiss
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Douglas Allison
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lien Hoang
- Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Andrei Patrichi
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology "George E Palade" of Targu Mures, Targu Mures, Romania
| | | | - Anna Pesci
- Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - Claudia Mateoiu
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Lucian Puscasiu
- Department of Gynecology, University of Medicine, Pharmacy, Sciences and Technology "George E Palade" of Targu Mures, Romania
| | | | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | - Mira Kheil
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | | | | | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA..
| | - Simona Stolnicu
- Department of Pathology, University of Medicine, Pharmacy, Science and Technology "George E Palade" of Targu Mures, Targu Mures, Romania
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7
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Corey L, Wallbillich JJ, Wu S, Farrell A, Hodges K, Xiu J, Nabhan C, Guastella A, Kheil M, Gogoi R, Winer I, Bandyopadhyay S, Huang M, Jones N, Wilhite A, Karnezis A, Thaker P, Herzog TJ, Oberley M, Korn WM, Vezina A, Morris R, Ali-Fehmi R. The Genomic Landscape of Vulvar Squamous Cell Carcinoma. Int J Gynecol Pathol 2023; 42:515-522. [PMID: 37131274 PMCID: PMC10417246 DOI: 10.1097/pgp.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Vulvar squamous cell cancer (VSC) accounts for 90% of vulvar cancers. Next-generation sequencing studies of VSC imply human papillomavirus (HPV) and p53 status play separate roles in carcinogenesis and prognosis. We sought to describe the genomic landscape and analyze the immunologic profiles of VSC with respect to HPV and p53 status. A total of 443 VSC tumors underwent tumor profiling. Next-generation sequencing was performed on genomic DNA isolated from formalin-fixed paraffin-embedded tumor samples. PD-L1, microsatellite instability were tested by fragment analysis, IHC, and next-generation sequencing. Tumor mutational burden-high was defined as >10 mutations per MB. HPV 16/18 positive (HPV+) status was determined using whole exome sequencing on 105 samples. Three cohorts were identified from 105 samples with known HPV: HPV+, HPV-/p53wt, and HPV-/p53mt. Where HPV and p53 status were examined, TP53 mutations were exclusive of HPV+ tumors. In all, 37% of samples were HPV+. Among the 66 HPV- tumors, 52 (78.8%) were HPV-/p53mt and 14 (21.2%) were HPV-/p53wt. The HPV-/p53wt cohort had a higher rate of mutations in the PI3KCA gene (42.9% HPV-/p53wt vs 26.3% HPV+ vs. 5.8% HPV-/p53mt, q =0.028) and alterations in the PI3K/AkT/mTOR pathway (57.1% HPV-/p53wt vs. 34.2% HPV+ vs. 7.7% HPV-/p53mt, q =0.0386) than the other 2 cohorts. Ninety-eight VSC tumors with HPV16/18 information underwent transcriptomic analysis and immune deconvolution method. No differences were observed in immune profiles. The HPV-/p53wt VSC tumors had significantly higher rates of mutations in the PI3KCA gene and alterations in the PI3K/AkT/mTOR pathway, a potential target that merits further investigation in this subgroup.
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Adzibolosu N, Alvero AB, Ali-Fehmi R, Gogoi R, Corey L, Tedja R, Chehade H, Gogoi V, Morris R, Anderson M, Vitko J, Lam C, Craig DB, Draghici S, Rutherford T, Mor G. Immunological modifications following chemotherapy are associated with delayed recurrence of ovarian cancer. Front Immunol 2023; 14:1204148. [PMID: 37435088 PMCID: PMC10331425 DOI: 10.3389/fimmu.2023.1204148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Ovarian cancer recurs in most High Grade Serous Ovarian Cancer (HGSOC) patients, including initial responders, after standard of care. To improve patient survival, we need to identify and understand the factors contributing to early or late recurrence and therapeutically target these mechanisms. We hypothesized that in HGSOC, the response to chemotherapy is associated with a specific gene expression signature determined by the tumor microenvironment. In this study, we sought to determine the differences in gene expression and the tumor immune microenvironment between patients who show early recurrence (within 6 months) compared to those who show late recurrence following chemotherapy. Methods Paired tumor samples were obtained before and after Carboplatin and Taxol chemotherapy from 24 patients with HGSOC. Bioinformatic transcriptomic analysis was performed on the tumor samples to determine the gene expression signature associated with differences in recurrence pattern. Gene Ontology and Pathway analysis was performed using AdvaitaBio's iPathwayGuide software. Tumor immune cell fractions were imputed using CIBERSORTx. Results were compared between late recurrence and early recurrence patients, and between paired pre-chemotherapy and post-chemotherapy samples. Results There was no statistically significant difference between early recurrence or late recurrence ovarian tumors pre-chemotherapy. However, chemotherapy induced significant immunological changes in tumors from late recurrence patients but had no impact on tumors from early recurrence patients. The key immunological change induced by chemotherapy in late recurrence patients was the reversal of pro-tumor immune signature. Discussion We report for the first time, the association between immunological modifications in response to chemotherapy and the time of recurrence. Our findings provide novel opportunities to ultimately improve ovarian cancer patient survival.
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Affiliation(s)
- Nicholas Adzibolosu
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Ayesha B. Alvero
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Rouba Ali-Fehmi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Radhika Gogoi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Logan Corey
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Roslyn Tedja
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Hussein Chehade
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Center of Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Vir Gogoi
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Robert Morris
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Matthew Anderson
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Julie Vitko
- Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Clarissa Lam
- Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Douglas B. Craig
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI, United States
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Sorin Draghici
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Computer Science, Wayne State University College of Engineering, Detroit, MI, United States
- Advaita Corporation, Ann Arbor, MI, United States
- Division of Information and Intelligent Systems, Directorate for Computer and Information Science and Engineering, National Science Foundation, Alexandria, VA, United States
| | - Thomas Rutherford
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Gil Mor
- C. S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, United States
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
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9
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LaFargue CJ, Amero P, Noh K, Mangala LS, Wen Y, Bayraktar E, Umamaheswaran S, Stur E, Dasari SK, Ivan C, Pradeep S, Yoo W, Lu C, Jennings NB, Vathipadiekal V, Hu W, Chelariu-Raicu A, Ku Z, Deng H, Xiong W, Choi HJ, Hu M, Kiyama T, Mao CA, Ali-Fehmi R, Birrer MJ, Liu J, Zhang N, Lopez-Berestein G, de Franciscis V, An Z, Sood AK. Overcoming adaptive resistance to anti-VEGF therapy by targeting CD5L. Nat Commun 2023; 14:2407. [PMID: 37100807 PMCID: PMC10133315 DOI: 10.1038/s41467-023-36910-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/22/2023] [Indexed: 04/28/2023] Open
Abstract
Antiangiogenic treatment targeting the vascular endothelial growth factor (VEGF) pathway is a powerful tool to combat tumor growth and progression; however, drug resistance frequently emerges. We identify CD5L (CD5 antigen-like precursor) as an important gene upregulated in response to antiangiogenic therapy leading to the emergence of adaptive resistance. By using both an RNA-aptamer and a monoclonal antibody targeting CD5L, we are able to abate the pro-angiogenic effects of CD5L overexpression in both in vitro and in vivo settings. In addition, we find that increased expression of vascular CD5L in cancer patients is associated with bevacizumab resistance and worse overall survival. These findings implicate CD5L as an important factor in adaptive resistance to antiangiogenic therapy and suggest that modalities to target CD5L have potentially important clinical utility.
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Affiliation(s)
- Christopher J LaFargue
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Paola Amero
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
- Istituto di Endocrinologia ed Oncologia Sperimentale, CNR, Naples, Italy
| | - Kyunghee Noh
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
- Laboratory of Disease Modeling and Therapeutics, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Lingegowda S Mangala
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Yunfei Wen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA.
| | - Emine Bayraktar
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Sujanitha Umamaheswaran
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Elaine Stur
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Santosh K Dasari
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Cristina Ivan
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sunila Pradeep
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Wonbeak Yoo
- Department of Molecular & Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chunhua Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Nicholas B Jennings
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Vinod Vathipadiekal
- Wave Life Sciences, 733 Concord Avenue, Cambridge, MA, 02138, USA
- Department of Genetic Medicines, Alloy Therapeutics, Waltham, USA
| | - Wei Hu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Anca Chelariu-Raicu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
- Department of Obstetrics and Gynecology, Ludwig Maximilians University of Munich, Munich, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center, Munich, Germany
| | - Zhiqiang Ku
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Hui Deng
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Wei Xiong
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Hyun-Jin Choi
- Department of Obstetrics and Gynecology, Chung-Ang University, College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Chung-Ang University Gwangmyeong Hospital, College of Medicine Chung-Ang University, Seoul, South Korea
| | - Min Hu
- CPRIT Single Core, Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Takae Kiyama
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 77030, USA
| | - Chai-An Mao
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 77030, USA
- The MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, TX, 77030, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University, Detroit, MI, 48201, USA
| | - Michael J Birrer
- Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jinsong Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ningyan Zhang
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Gabriel Lopez-Berestein
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Vittorio de Franciscis
- National Research Council (CNR), Institute of Genetic and Biomedical Research (IRGB)-UOS Milan via Rita Levi Montalcini, 20090, Pieve Emanuele, MI, Italy
- Harvard Medical School Initiative for RNA Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA.
- Center for RNA Interference and Non-Coding RNA, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
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Ali-Fehmi R, Oberley MJ, Kraus H, Herzog TJ, Karnezis A, Antonarakis ES, Kasi PM, Farrell AP, Xiu J, Swensen J, Spetzler D, Abraham J, Korn WM, Bryant D. Analysis of concordance between microsatellite instability by next generation sequencing (NGS-MSI) and mismatch repair deficiency by immunohistochemistry (IHC-MMR) in >28,000 colorectal tumors. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.30] [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: 01/25/2023] Open
Abstract
30 Background: The use of immune checkpoint inhibitors (ICI) in MSI-H/MMRd CRC patients has profoundly changed the treatment landscape in the metastatic setting; the most recent NICHE-2 trial showed 100% response rate in MSI-H/MMRd locally advanced CRC patients treated with neoadjuvant ICI, further highlighting the importance of identifying these patients accurately to enhance patient care. Here we report the concordance of NGS-MSI and IHC-MMR from a very large cohort of CRC tumors and study the molecular characteristics and clinical outcomes of these patients. Methods: A total of 28,105 CRC tumors were analyzed by NGS (592 genes, NextSeq or WES, NovaSeq) and IHC. MMRd was defined as complete loss of ≥1 IHC stains (MLH1, MSH2, MSH6, or PMS2) and proficient (MMRp) as any positive staining for all four proteins. MSI status was determined from over 7,000 target microsatellite loci covered by NGS. Central pathology review (CPR) of MMR IHC was done on 73 cases with discordant MMR/MSI results. Real-world overall survival was obtained from insurance claims and calculated from either tissue collection or treatment start to last contact; Kaplan-Meier estimates were calculated for molecularly defined patients. Results: For CRC tumors with NGS and IHC, 28031/28105 were concordant (99.74%), 0.09% were MMRd/MSS, and 0.2% were MMRp/MSI-H. After CPR, 23/24 (96%) of MMRd/MSS cases and 46/49 (94%) of MMRp/MSI-H were confirmed. Of the 46 post-CPR MMRp/MSI-H CRC samples, 52% had ≥1 pathogenic missense mutation in including MLH1/PMS2/MSH2/6 or MLH3, MSH3, PMS1 or POLE. Of the 23 post-CPR MMRd/MSS CRC samples, 38% had MLH1 loss, 91% PMS2 loss, no MSH2 loss and 9% MSH6 loss. When comparing clinical outcomes with concordant MSS/MMRp tumors, concordant MSI-H/MMRd patients had significantly longer OS (HR=1.131 [95% CI: 1.02-1.254], p<0.001) and post-ICI survival (HR= 2.695 [95% CI: 1.932-3.76], p<0.001). Compared to MSS/MMRd tumors (N=21), MSI-H/MMRp (N=29) trends to have longer OS (HR=2.163, [95% CI: 0.939-4.983], p=0.064) and insufficient ICI-treated patients were available for analysis. Conclusions: Here we report from >28,000 CRC tumors that the concordance of IHC-MMR/NGS-MSI is 99.74%. Clinical outcome from a large cohort of patients show NGS is not inferior compared to IHC in identifying patients with MSI-H/MMRd. The additional lens that NGS-MSI offers is of value in identifying CRC patients who may benefit from ICI therapy. [Table: see text]
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Affiliation(s)
| | | | | | - Thomas J Herzog
- Division of Gynecologic Oncology, The University of Cincinnati Cancer Institute, Cincinnati, OH
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11
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Klc TR, Wu S, Wilhite AM, Jones NL, Powell MA, Olawaiye A, Girda E, Brown J, Puechl A, Ali-Fehmi R, Winer IS, Herzog TJ, Korn WM, Erickson BK. HER2 in Uterine Serous Carcinoma: Testing platforms and implications for targeted therapy. Gynecol Oncol 2022; 167:289-294. [PMID: 36114027 DOI: 10.1016/j.ygyno.2022.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/20/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE HER2 is an important prognostic and therapeutic target in uterine serous carcinoma (USC). Optimal HER2 testing platforms have not been defined and guidelines for testing have changed over time. Our objective is to assess the concordance of HER2 positivity based on chromogenic in situ hybridization (CISH), immunohistochemistry (IHC), and next generation sequencing (NGS) and to determine the rate of downstream mutations that may affect response to HER2 directed therapy. METHODS Utilizing the Caris tumor registry, 2192 USC tumors were identified and analyzed using NGS (NextSeq, 592 Genes and WES, NovaSEQ), IHC, and CISH. PD-L1 expression was tested by IHC. Microsatellite instability was tested by fragment analysis, IHC, and NGS. Tumor mutational burden (TMB) was measured by totaling somatic mutations per tumor. HER2 positivity through IHC and CISH was determined based on 2007 and 2018 ASCO/CAP HER2 breast cancer guidelines. RESULTS There was a higher rate of HER2 positivity by IHC when using the 2018 guidelines compared to the 2007 guidelines (16.3% vs 12.3%). Concordance between IHC and CISH was 98.9%. ERBB2 amplification was identified by NGS in 10.5% of tumors. Compared to CISH results, this corresponds to a concordance rate of 91.6% and a positive predictive value (PPV) of 60.3%. Single gene alterations in HER2 amplified tumors that may implicate HER2 therapy resistance included PI3K (33.1%), KRAS (2.5%), and PTEN (1.3%). CONCLUSIONS There was high concordance between HER2 positivity based on CISH and IHC. Rate of HER2 positivity is the lowest by NGS. Ultimately these testing platforms need to be validated by response to targeted therapy.
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Affiliation(s)
- Tenley R Klc
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology University of Minnesota, Minneapolis, MN, USA
| | - Sharon Wu
- Caris Life Sciences, Phoenix, AZ, United States of America
| | - Annelise M Wilhite
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, United States of America
| | - Nathaniel L Jones
- Mitchell Cancer Institute, University of South Alabama, Mobile, AL, United States of America
| | - Matthew A Powell
- Washington University in St. Louis, St. Louis, MO, United States of America
| | - Alex Olawaiye
- University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Eugenia Girda
- Rutgers Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, United States of America
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Allison Puechl
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States of America
| | - Rouba Ali-Fehmi
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States of America
| | - Ira S Winer
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States of America
| | - Thomas J Herzog
- University of Cincinnati Cancer Institute, Cincinnati, OH, United States of America
| | - W Michael Korn
- Caris Life Sciences, Phoenix, AZ, United States of America
| | - Britt K Erickson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology University of Minnesota, Minneapolis, MN, USA.
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12
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Abada E, Jang H, Kim S, Ali-Fehmi R, Bandyopadhyay S. A clinicopathologic and immunohistochemical study of primary and secondary breast angiosarcoma. J Pathol Transl Med 2022; 56:342-353. [DOI: 10.4132/jptm.2022.08.31] [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] [Received: 06/22/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
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13
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Wallbillich J, Wu S, Corey L, Kheil M, Gogoi R, Huang M, Jones N, Spetzler D, Thaker P, Herzog T, Korn WM, Morris R, Winer I, Ali-Fehmi R. Transcriptomic immune profiling for cervical squamous cell carcinoma: Does HPV type matter? (170). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01397-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: 11/04/2022]
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14
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Corey L, Wu S, Brodskiy P, Hodges K, Oberley MJ, Musallam R, Kheil M, Bandyopadhyay S, Wallbillich J, Winer IS, Morris R, Ali-Fehmi R. Molecular classification of endometrial carcinoma applied to endometrial atypical hyperplasia biopsy specimens. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17622] [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: 11/20/2022] Open
Abstract
e17622 Background: 50% of endometrial atypical hyperplasia (AH) cases on endometrial sampling have concurrent endometrial cancer (EC) on hysterectomy. Little data exists regarding molecular signatures that can predict the presence of concurrent endometrial cancer in patients with AH on biopsy. Therefore, we set to characterize molecular landscapes of endometrial samples diagnosed with AH with EC on the final hysterectomy specimen, using matched controls. Methods: Karmanos Cancer Institute pathology database was searched for patients with AH on endometrial curettage or biopsy who had a hysterectomy within 6 months. Only samples with adequate tissue for next generation sequencing were included. In total, 59 tissue samples from 34 patients were included: there were 15 AH endometrial biopsy samples, 18 AH final hysterectomy samples (13 matched pairs), 13 EC endometrial biopsies and 13 samples that were EC on final hysterectomy samples (12 matched pairs) that were analyzed using next-generation sequencing (WES) and/or whole transcriptome sequencing (WTS) (NovaSeq). TMB was measured by counting all somatic mutations found per tumor (TMB-high: >10 mutations per MB). Immune cell infiltrates were calculated by Quantiseq. Significance was determined using Fisher exact, Chi-square and Mann-Whitney U test and adjusted for multiple comparisons: p < 0.05 but q > 0.05 was considered a trend. Results: Clinical analysis demonstrated 15/34 patients with endometrial AH on initial sampling and EC on the final hysterectomy. 2 out of 15 patients were > stage II at time of surgery. Molecularly, fewer PTEN mutations were found between AH (2/8) and EC (14/17) on final hysterectomy (25% vs 82.4%, p = 0.01). Samples of EC origin were MSI-H by NGS-MSI (3/18) and had no mutations in PPP2R1A (0/16). Comparing hysterectomy samples, EC trended toward increased CTLA4 (FC: 6.97-fold) expression and immune cell infiltration of Macrophage M1 (+1.19%), NK cells (+2.13%), CD8+ T Cells (+1.27%), regulatory T cells (+2.17%) and Dendritic cells (+2.87%) compared to AH samples (all p < 0.05). Similarly, when comparing endometrial biopsies, EC samples trended toward increased expression of CTLA4 (12.6-fold), HAVCR2/TIM3 (FC: 2.59-fold) and IFNG (FC: 17.8-fold) immune checkpoint genes, as well as increased immune cell infiltration of Neutrophils (+11.7%), CD8+ T cells (+2.39%) and regulatory T cells (+2.43%) compared to AH samples (all p < 0.05). Conclusions: There are molecular and tumor microenvironment differences seen between AH endometrial biopsies that have concurrent EC compared to those that do not on the final hysterectomy specimens. These differences may lead to advances in identifying appropriate patients for fertility sparing treatments, versus those that can be managed surgically by a benign gynecologist or a gynecologic oncologist. Analyses with larger sample sizes are needed and are ongoing.
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Affiliation(s)
- Logan Corey
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | | | | | | | - Rami Musallam
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | - Mira Kheil
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
| | | | | | | | | | - Rouba Ali-Fehmi
- Wayne State University/Karmanos Cancer Institute, Detroit, MI
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Khan MYA, Bandyopadhyay S, Alrajjal A, Choudhury MSR, Ali-Fehmi R, Shidham VB. Atypical glandular cells (AGC): Cytology of glandular lesions of the uterine cervix. Cytojournal 2022; 19:31. [PMID: 35673694 PMCID: PMC9168395 DOI: 10.25259/cmas_03_11_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/06/2022] [Indexed: 11/08/2022] Open
Abstract
The Pap smear is a well-known screening tool for squamous lesions of the uterine cervix. However, its screening role in glandular lesions is less effective. The incidence of squamous cell carcinoma of the cervix has dramatically decreased with the advent of Pap smear and recent understanding related to HPV carcinogenesis of cervical cancers including the advent of HPV vaccines. However, in recent years, the incidence of glandular abnormalities, diagnosed on Pap smears, has increased with greater sensitivity and precision. The incidence of atypical glandular cells (AGC) is approximately 0.18–0.74% of all cervical smears with a reported prevalence of 2.5% among all Pap smears. A high degree of suspicion, good clinical history, and the presence of diagnostic cytomorphological findings are essential for the proper interpretation of glandular cell abnormalities. A methodical approach to evaluate Pap smear greatly helps interpretation and avoids the diagnostic pitfalls. The Bethesda System for reporting cervical cytology has categorized glandular cell abnormalities into various categories as follows: Endocervical adenocarcinoma in situ (AIS) Atypical glandular cells (AGCs) Endocervical cells: a1 NOS or specify in comments; a2 Favor neoplastic Endometrial cells: NOS or specify in comments
Adenocarcinoma (AdCa) Endocervical Endometrial Extrauterine NOS
Subtle differences in quantitative and qualitative cytologic features are essential for distinguishing one category from another. In this chapter, we highlight an organized approach for the interpretation of glandular abnormalities in Pap smear for our readers. This is an overview of the Bethesda categories, the reason for classification, and differential diagnosis with key characteristic features. An approach to the methodical evaluation of hyperchromatic crowded groups is discussed with key cytomorphologic differences. An algorithmic approach is suggested to facilitate the interpretation of various AGC categories.
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Ali-Fehmi R, Kheil M, Almohsen NA. TNM/FIGO Classification, Pathology of the Uterine Corpus. Encyclopedia of Pathology 2022:1-6. [DOI: 10.1007/978-3-319-28845-1_5623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 09/01/2023]
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17
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Shallal A, Abada E, Musallam R, Fehmi O, Kaljee L, Fehmi Z, Alzouhayli S, Ujayli D, Dankerlui D, Kim S, Cote ML, Kumar VA, Zervos M, Ali-Fehmi R. Evaluation of COVID-19 Vaccine Attitudes among Arab American Healthcare Professionals Living in the United States. Vaccines (Basel) 2021; 9:942. [PMID: 34579179 PMCID: PMC8471462 DOI: 10.3390/vaccines9090942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is the next great barrier for public health. Arab Americans are a rapidly growing demographic in the United States with limited information on the prevalence of vaccine hesitancy. We therefore sought to study the attitudes towards the coronavirus disease 2019 (COVID-19) vaccine amongst Arab American health professionals living in the United States. METHODS This was a cross sectional study utilizing an anonymous online survey. The survey was distributed via e-mail to National Arab American Medical Association members and Arab-American Center for Economic and Social Services healthcare employees. Respondents were considered vaccine hesitant if they selected responses other than a willingness to receive the COVID-19 vaccine. RESULTS A total of 4000 surveys were sent via e-mail from 28 December 2020 to 31 January 2021, and 513 responses were received. The highest group of respondents were between the ages of 18-29 years and physicians constituted 48% of the respondents. On multivariable analysis, we found that respondents who had declined an influenza vaccine in the preceding 5 years (p < 0.001) and allied health professionals (medical assistants, hospital administrators, case managers, researchers, scribes, pharmacists, dieticians and social workers) were more likely to be vaccine hesitant (p = 0.025). In addition, respondents earning over $150,000 US dollars annually were less likely to be vaccine hesitant and this finding was significant on multivariable analysis (p = 0.011). CONCLUSIONS Vaccine hesitancy among health care providers could have substantial impact on vaccine attitudes of the general population, and such data may help inform vaccine advocacy efforts.
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Affiliation(s)
- Anita Shallal
- Division of Infectious Disease, Henry Ford Hospital, 2799 W. Grand Blvd, CFP 303, Detroit, MI 48202, USA; (A.S.); (M.Z.)
| | - Evi Abada
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R. Rd, Detroit, MI 48201, USA;
| | - Rami Musallam
- Wayne State University School of Medicine, 4201 St Antoine, Detroit, MI 48201, USA; (R.M.); (S.A.)
| | - Omar Fehmi
- The University of Michigan College of Literature, Science, and the Arts, 101 N Main St, Ann Arbor, MI 48104, USA; (O.F.); (Z.F.)
| | - Linda Kaljee
- Global Health Initiative, Henry Ford Health System, One Ford Place, 1E, Detroit, MI 48202, USA; (L.K.); (D.D.)
| | - Ziad Fehmi
- The University of Michigan College of Literature, Science, and the Arts, 101 N Main St, Ann Arbor, MI 48104, USA; (O.F.); (Z.F.)
| | - Suma Alzouhayli
- Wayne State University School of Medicine, 4201 St Antoine, Detroit, MI 48201, USA; (R.M.); (S.A.)
| | - Deema Ujayli
- Michigan State University College of Human Medicine, 965 Fee Rd A110, East Lansing, MI 48824, USA;
| | - Doreen Dankerlui
- Global Health Initiative, Henry Ford Health System, One Ford Place, 1E, Detroit, MI 48202, USA; (L.K.); (D.D.)
| | - Seongho Kim
- Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, 4100 John R. St, Detroit, MI 48201, USA;
| | - Michele L. Cote
- Population Sciences and Disparities Research, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, 4100 John R. Rd, Detroit, MI 48201, USA;
| | - Vijaya Arun Kumar
- Department of Emergency Medicine, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R. Rd, Detroit, MI 48201, USA;
| | - Marcus Zervos
- Division of Infectious Disease, Henry Ford Hospital, 2799 W. Grand Blvd, CFP 303, Detroit, MI 48202, USA; (A.S.); (M.Z.)
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, 3990 John R. Rd, Detroit, MI 48201, USA;
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18
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Zaiem F, Deirawan H, Kherallah R, Fehmi O, Jang H, Kim S, Bandyopadhyay S, Ali-Fehmi R. Accuracy and Reproducibility of Frozen Section Diagnosis in Ovarian Tumors: A 10-Year Experience at a Tertiary Cancer Center. Arch Pathol Lab Med 2021; 146:626-631. [PMID: 34402886 DOI: 10.5858/arpa.2020-0686-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT.— Intraoperative consultation-frozen section diagnosis (FSD)-determines tumor pathology and guides the optimal surgical management of ovarian neoplasms intraoperatively. OBJECTIVE.— To evaluate the diagnostic accuracy of the FSD and analyze the discrepancy between the FSD and final diagnosis. DESIGN.— This is a retrospective study of 618 ovarian neoplasm FSDs from 2009 to 2018 at a tertiary health care center. The discrepant cases were reviewed and reevaluated by gynecologic and general surgical pathologists. The outcomes of interest were performing unnecessary procedure, returning for a second surgery, and 30-day postoperative mortality. RESULTS.— The sensitivity and the positive predictive value of the FSD were lower in borderline tumors than in benign and malignant epithelial ovarian tumors. Major and minor discrepancies were identified in 5.3% (33 of 618) and 12.3% of (76 of 618) cases, respectively. A root cause analysis of the major discrepant cases showed that sampling error accounted for 43% (14 of 33). The discrepancy distributions of gynecologic and general surgical pathologists were statistically similar in the overall cohort (P = .65). The overall κ for diagnostic agreement among gynecologic pathologists, general surgical pathologists, and final diagnosis was 0.18 (0.10-0.26, P < .001), implying only a slight overall agreement. Of the major discrepant cases, only 3 had a clinical implication. One overdiagnosed patient underwent unnecessary procedure and 2 underdiagnosed patients were recommended to return for a second surgery. No patient had 30-day postoperative mortality. CONCLUSIONS.— Frozen section diagnosis remains a definitive diagnostic tool in ovarian neoplasms and plays a crucial role in guiding intraoperative surgical management.
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Affiliation(s)
- Feras Zaiem
- From the Departments of Pathology and Gynecologic Oncology (Zaiem, Deirawan, Kherallah, Fehmi, Bandyopadhyay, Ali-Fehmi), Wayne State University School of Medicine, Detroit, Michigan
| | - Hany Deirawan
- From the Departments of Pathology and Gynecologic Oncology (Zaiem, Deirawan, Kherallah, Fehmi, Bandyopadhyay, Ali-Fehmi), Wayne State University School of Medicine, Detroit, Michigan
| | - Raghad Kherallah
- From the Departments of Pathology and Gynecologic Oncology (Zaiem, Deirawan, Kherallah, Fehmi, Bandyopadhyay, Ali-Fehmi), Wayne State University School of Medicine, Detroit, Michigan
| | - Omar Fehmi
- From the Departments of Pathology and Gynecologic Oncology (Zaiem, Deirawan, Kherallah, Fehmi, Bandyopadhyay, Ali-Fehmi), Wayne State University School of Medicine, Detroit, Michigan
| | - Hyejeong Jang
- The Biostatistics Core in the Department of Oncology (Jang, Kim), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Seongho Kim
- The Biostatistics Core in the Department of Oncology (Jang, Kim), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Sudeshna Bandyopadhyay
- From the Departments of Pathology and Gynecologic Oncology (Zaiem, Deirawan, Kherallah, Fehmi, Bandyopadhyay, Ali-Fehmi), Wayne State University School of Medicine, Detroit, Michigan
| | - Rouba Ali-Fehmi
- From the Departments of Pathology and Gynecologic Oncology (Zaiem, Deirawan, Kherallah, Fehmi, Bandyopadhyay, Ali-Fehmi), Wayne State University School of Medicine, Detroit, Michigan
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19
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Wallbillich J, Wu S, Xiu J, Ali-Fehmi R, Rubinsak L, Korn WM, Jones N, Herzog T, Holloway R, Powell M, Thaker P, Brown J, Poorman K, Winer I. Transcriptomic immune profiling: a precision path forward for immunotherapy in patients with cervical cancer? Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00673-9] [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: 11/17/2022]
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20
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Shallal A, Abada E, Fehmi Z, Kamatham S, Trak J, Fehmi O, Toma A, Farooqi S, Jang H, Kim S, Bandyopadhyay S, Zervos M, Ali-Fehmi R. Human Papillomavirus Infection and Cervical Dysplasia in a Subset of Arab American Women. Womens Health Rep (New Rochelle) 2021; 2:273-278. [PMID: 34318297 PMCID: PMC8310747 DOI: 10.1089/whr.2020.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
Background: With limited health data on Arab Americans (AAs), we sought to describe the health-seeking behaviors, prevalence of abnormal cervical cytology and high-risk human papillomavirus (HPV) serotypes, and the relationship with socioeconomic factors among a subset of AA women. Methods: Retrospective observational cohort study of women undergoing routine cancer screening at the Arab-American Center for Economic and Social Services clinic. Data collected included demographics, tobacco use, gross monthly income, prior Papanicolaou (Pap) smear history, and results of cervical cytology and high-risk HPV testing. Results: Of 430 women, 74 (17%) reported that they had never had a Pap smear. Three hundred eighty-eight (90%) women had cervical cytology interpreted as "negative for intraepithelial lesion," the remaining 42 (10%) women had abnormal results. Thirteen (3%) women reported prior abnormal Pap smear, which was significantly associated with additional abnormal Pap smear on multivariable analyses (odds ratio 65.46; 95% confidence interval [CI] 17.01-338.62; p < 0.001). One hundred twenty-five (29%) women were tested for high-risk HPV serotypes; 106 (91%) had negative results, 4 (3%) were positive for HPV-16, 7 (6%) were positive for other high-risk serotypes, and 8 results were not recorded. A negative HPV screen was significantly associated with a negative Pap smear (Fisher's exact test p = 0.006). There was no significant association between abnormal cervical cytology and evaluated socioeconomic factors. Conclusions: Additional population based-studies to determine cervical dysplasia/cancer and HPV prevalence in women of Middle Eastern descent are needed.
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Affiliation(s)
- Anita Shallal
- Division of Infectious Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Evi Abada
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan, USA
| | - Ziad Fehmi
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Joseph Trak
- Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
| | - Omar Fehmi
- University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Toma
- Oakland University, Rochester, Michigan, USA
| | - Sarah Farooqi
- Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
| | - Hyejeong Jang
- Department of Oncology, Biostatistics Core, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Seongho Kim
- Department of Oncology, Biostatistics Core, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan, USA
| | - Marcus Zervos
- Division of Infectious Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan, USA
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21
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Corey L, Fucinari J, Elshaikh M, Schultz D, Mussallam R, Zaiem F, Daaboul F, Fehmi O, Dyson G, Ruterbusch J, Morris R, Cote ML, Ali-Fehmi R, Bandyopadhyay S. Impact of positive cytology in uterine serous carcinoma: A reassessment. Gynecol Oncol Rep 2021; 37:100830. [PMID: 34345643 PMCID: PMC8319448 DOI: 10.1016/j.gore.2021.100830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/07/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
Prognostic implications of peritoneal cytology in uterine serous cancer are unclear. Positive cytology is not associated with FIGO stage or LVSI. Peritoneal cytology is an independent prognosticator in uterine serous cancer. Positive cytology is independently associated with worse overall survival and ECSS.
Objectives The aim of this study was to evaluate the prognostic value of peritoneal cytology status among other clinicopathological parameters in uterine serous carcinoma (USC). Methods A retrospective study of 148 patients diagnosed with uterine serous carcinoma from 1997 to 2016 at two academic medical centers in the Detroit metropolitan area was done. A central gynecologic pathologist reviewed all available slides and confirmed the histologic diagnosis of each case of USC. We assessed the prognostic impact of various clinicopathological parameters on overall survival (OS) and endometrial cancer-specific survival (ECSS). Those parameters included race, body mass index (BMI), stage at diagnosis, tumor size, lymphovascular invasion (LVSI), peritoneal cytology status, receipt of adjuvant treatment, and comorbidity count using the Charlson Comorbidity Index (CCI). We used Cox proportional hazards models and 95% confidence intervals for statistical analysis. Results Positive peritoneal cytology had a statistically significant effect on OS (HR: 2.09, 95% CI: [1.19, 3.68]) and on ECSS (HR: 2.02, 95% CI: [1.06 – 3.82]). LVSI had a statistically significant effect on both OS (HR: 2.27, 95% CI: [1.14, 4.53]) and ECSS (HR: 3.45, 95% CI: [1.49, 7.99]). Black or African American (AA) race was also found to have a significant effect on both OS (HR: 1.92, 95% CI: [1.07, 3.47]) and ECSS (HR: 2.01, 95% CI: [1.02, 3.98]). Other factors including BMI and tumor size > 1 cm did not show a statistically significant impact on OS or ECSS. Conclusions Peritoneal washings with positive cytology and LVSI are important prognostic tools that may have a significant impact on overall survival in USC and can be used as independent negative prognosticators to help guide adjuvant treatment.
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Affiliation(s)
- Logan Corey
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, Michigan
| | - Juliana Fucinari
- Karmanos Cancer Institute, Population Sciences and Disparities Research, Detroit, Michigan
| | | | | | - Rami Mussallam
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Feras Zaiem
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Fayez Daaboul
- Wayne State University, School of Medicine, Department of Pathology, Detroit, Michigan
| | - Omar Fehmi
- University of Michigan, Ann Arbor, Michigan
| | - Greg Dyson
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
| | - Julie Ruterbusch
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
| | - Robert Morris
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Department of Gynecologic Oncology, Detroit, Michigan
| | - Michelle L Cote
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan.,Karmanos Cancer Institute, Population Sciences and Disparities Research, Detroit, Michigan
| | - Rouba Ali-Fehmi
- Wayne State University, School of Medicine, Department of Oncology, Detroit, Michigan
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22
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Abada E, Daaboul F, Ebare K, Jang H, Fehmi Z, Kim S, Ali-Fehmi R, Bandyopadhyay S. Clinicopathologic Characteristics and Outcome Descriptors of Metaplastic Breast Carcinoma. Arch Pathol Lab Med 2021; 146:341-350. [PMID: 34237136 DOI: 10.5858/arpa.2020-0830-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Metaplastic breast carcinoma is an aggressive form of breast cancer that accounts for 0.5% to 3% of all breast cancers. OBJECTIVE.— To study the clinicopathologic characteristics and outcomes of this rare disease. DESIGN.— Retrospective study of patients with a diagnosis of metaplastic breast carcinoma between 2000 and 2019. Hematoxylin-eosin-stained slides were reviewed and additional clinical data were obtained from electronic medical records. Univariable and multivariable Cox proportional hazard regression analyses were used to determine associations between overall survival and several clinicopathologic variables. RESULTS.— Of the 125 patients with metaplastic breast carcinoma identified, only patients with high-grade disease (N = 115) were included in the data analysis. A total of 38 participants (33%) were white, 66 (57%) were African American, and 11 (10%) belonged to other ethnicities. The median age at diagnosis was 57 years. The median tumor size was 3 cm. Heterologous histology was seen in 30% of cases. Multivariable analyses showed that patients with a larger tumor size had worse overall survival (hazard ratio [HR], 1.25; 95% CI, 1.10-1.44; P < .001). Distant metastatic disease was also associated with worse overall survival on multivariable analysis (HR, 10.27; 95% CI, 2.03-55.54; P = .005). In addition to treatment with either partial or complete mastectomies, 84 patients (73%) received chemotherapy. Multivariable analyses showed that chemotherapy had no effect on overall survival (HR, 0.53; 95% CI, 0.09-6.05; P = .55). CONCLUSIONS.— A larger tumor size and distant metastatic disease are associated with worse overall survival in patients with metaplastic breast carcinoma. Additional studies are needed to further characterize our findings.
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Affiliation(s)
- Evi Abada
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Fayez Daaboul
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Kingsley Ebare
- the Department of Pathology, Baylor College of Medicine, Houston, Texas (Ebare)
| | - Hyejeong Jang
- the Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan (Jang, Kim)
| | - Ziad Fehmi
- the Department of Biomolecular Science, University of Michigan, Ann Arbor (Fehmi)
| | - Seongho Kim
- the Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan (Jang, Kim)
| | - Rouba Ali-Fehmi
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
| | - Sudeshna Bandyopadhyay
- From the Department of Pathology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan (Abada, Daaboul, Ali-Fehmi, Bandyopadhyay)
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23
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Fucinari J, Elshaikh MA, Ruterbusch JJ, Khalil R, Dyson G, Shultz D, Ali-Fehmi R, Cote ML. The impact of race, comorbid conditions and obesity on survival endpoints in women with high grade endometrial carcinoma. Gynecol Oncol 2021; 162:134-141. [PMID: 33985795 DOI: 10.1016/j.ygyno.2021.04.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate overall survival, disease-specific survival, and progression-free survival among high grade endometrial carcinoma cases and to determine factors impacting survival for non-Hispanic white and non-Hispanic black women. METHODS We identified high grade endometrial carcinoma cases among non-Hispanic white and non-Hispanic black women from ongoing institutional studies, and determined eligibility through medical record and pathologic review. We estimated effects of demographic and clinical variables on survival outcomes using Kaplan Meier methods and Cox proportional hazards modelling. RESULTS Non-Hispanic Black women with BMI <25.0 had poorest overall survival compared to non-Hispanic white women with BMI <25.0 (HR 3.03; 95% CI [1.35, 6.81]), followed by non-Hispanic black women with BMI 25.0+ (HR 2.43; 95% CI [1.28, 4.60]). A similar pattern emerged for disease-specific survival. Non-Hispanic black women also had poorer progression-free survival than non-Hispanic white women (HR 1.40; 95% CI [1.01, 1.93]). Other significant factors impacting survival outcomes included receipt of National Cancer Center Network (NCCN) guideline-concordant treatment (GCT), earlier stage at diagnosis, and fewer comorbid conditions. CONCLUSIONS BMI and race interact and modify the association with high grade endometrial carcinoma survival. Other potentially modifiable factors, such as reducing comorbidities and increasing access to GCT will potentially improve survival after diagnosis of high grade endometrial carcinomas. A better understanding of the molecular drivers of these high grade carcinomas may lead to targeted therapies that reduce morbidity and mortality associated with these aggressive tumors.
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Affiliation(s)
- Juliana Fucinari
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA
| | | | - Julie J Ruterbusch
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA
| | - Remonda Khalil
- Henry Ford Hospital, Department of Radiation Oncology, Detroit, MI, USA
| | - Gregory Dyson
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Population Studies and Disparities Research Program, Detroit, MI, USA
| | - Daniel Shultz
- Henry Ford Hospital, Department of Pathology, Detroit, MI, USA
| | - Rouba Ali-Fehmi
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA; Karmanos Cancer Institute, Tumor Biology and Microenvironment Program, Detroit, MI, USA
| | - Michele L Cote
- Wayne State University School of Medicine, Department of Oncology, Detroit, MI, USA; Karmanos Cancer Institute, Population Studies and Disparities Research Program, Detroit, MI, USA.
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24
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Udumula MP, Sakr S, Dar S, Alvero AB, Ali-Fehmi R, Abdulfatah E, Li J, Jiang J, Tang A, Buekers T, Morris R, Munkarah A, Giri S, Rattan R. Ovarian cancer modulates the immunosuppressive function of CD11b +Gr1 + myeloid cells via glutamine metabolism. Mol Metab 2021; 53:101272. [PMID: 34144215 PMCID: PMC8267600 DOI: 10.1016/j.molmet.2021.101272] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022] Open
Abstract
Objective Immature CD11b + Gr1+ myeloid cells that acquire immunosuppressive capability, also known as myeloid-derived suppressor cells (MDSCs), are a heterogeneous population of cells that regulate immune responses. Our study's objective was to elucidate the role of ovarian cancer microenvironment in regulating the immunosuppressive function of CD11b+Gr1+ myeloid cells. Methods All studies were performed using the intraperitoneal ID8 syngeneic epithelial ovarian cancer mouse model. Myeloid cell depletion and immunotherapy were carried out using anti-Gr1 mAb, gemcitabine treatments, and/or anti-PD1 mAb. The treatment effect was assessed by a survival curve, in situ luciferase-guided imaging, and histopathologic evaluation. Adoptive transfer assays were carried out between congenic CD45.2 and CD45.1 mice. Immune surface and intracellular markers were assessed by flow cytometry. ELISA, western blot, and RT-PCR techniques were employed to assess the protein and RNA expression of various markers. Bone marrow-derived myeloid cells were used for ex-vivo studies. Results The depletion of Gr1+ immunosuppressive myeloid cells alone and in combination with anti-PD1 immunotherapy inhibited ovarian cancer growth. In addition to the adoptive transfer studies, these findings validate the role of immunosuppressive CD11b+Gr1+ myeloid cells in promoting ovarian cancer. Mechanistic investigations showed that ID8 tumor cells and their microenvironments produced recruitment and regulatory factors for immunosuppressive CD11b+Gr1+ myeloid cells. CD11b+Gr1+ myeloid cells primed by ID8 tumors showed increased immunosuppressive marker expression and acquired an energetic metabolic phenotype promoted primarily by increased oxidative phosphorylation fueled by glutamine. Inhibiting the glutamine metabolic pathway reduced the increased oxidative phosphorylation and decreased immunosuppressive markers’ expression and function. Dihydrolipoamide succinyl transferase (DLST), a subunit of α-KGDC in the TCA cycle, was found to be the most significantly elevated gene in tumor-primed myeloid cells. The inhibition of DLST reduced oxidative phosphorylation, immunosuppressive marker expression and function in myeloid cells. Conclusion Our study shows that the ovarian cancer microenvironment can regulate the metabolism and function of immunosuppressive CD11b + Gr1+ myeloid cells and modulate its immune microenvironment. Targeting glutamine metabolism via DLST in immunosuppressive myeloid cells decreased their activity, leading to a reduction in the immunosuppressive tumor microenvironment. Thus, targeting glutamine metabolism has the potential to enhance the success of immunotherapy in ovarian cancer. Ovarian cancer microenvironment increases the immunosuppressive ability of myeloid cells. Ovarian cancer microenvironment can induce metabolic reprogramming in the immunosuppressive myeloid cells. Immunosuppressive myeloid cells upsurge their oxidative metabolism fueled by glutamine in ovarian cancer. DLST, a component of alpha-ketoglutarate dehydrogenase complex plays a key role in the immunometabolic regulation of immunosuppressive myeloid cells in ovarian cancer.
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Affiliation(s)
- Mary P Udumula
- Division of Gynecology Oncology, Department of Women's Health Services, Henry Ford Cancer Institute and Henry Ford Health System, Detroit, MI, USA
| | - Sharif Sakr
- Department of Gynecology Oncology, Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA
| | - Sajad Dar
- Division of Gynecology Oncology, Department of Women's Health Services, Henry Ford Cancer Institute and Henry Ford Health System, Detroit, MI, USA
| | - Ayesha B Alvero
- Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University and Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Eman Abdulfatah
- Department of Pathology, Wayne State University and Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Jing Li
- Metabolomics Core, Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA
| | - Jun Jiang
- Metabolomics Core, Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA
| | - Amy Tang
- Department of Public Health Services, Henry Ford Health System, Detroit, MI, USA
| | - Thomas Buekers
- Division of Gynecology Oncology, Department of Women's Health Services, Henry Ford Cancer Institute and Henry Ford Health System, Detroit, MI, USA; Department of Gynecology Oncology, Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA
| | - Robert Morris
- Department of Gynecology Oncology, Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, MI, USA
| | - Adnan Munkarah
- Division of Gynecology Oncology, Department of Women's Health Services, Henry Ford Cancer Institute and Henry Ford Health System, Detroit, MI, USA
| | - Shailendra Giri
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
| | - Ramandeep Rattan
- Division of Gynecology Oncology, Department of Women's Health Services, Henry Ford Cancer Institute and Henry Ford Health System, Detroit, MI, USA; Department of Oncology, Wayne State University, Detroit, MI, USA.
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25
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Klc T, Wu S, Wilhite AM, Jones NL, Powell MA, Olawaiye A, Simpkins F, Girda E, Brown J, Puechl A, Ali-Fehmi R, Winer IS, Herzog TJ, Korn WM, Erickson BK. HER2 in uterine serous carcinoma: Testing platforms and implications for targeted therapy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5580] [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: 11/20/2022] Open
Abstract
5580 Background: HER2 is an emerging prognostic and therapeutic target in uterine serous carcinoma (USC). Testing algorithms and platforms in breast and gastric cancers are well studied and validated, but optimal HER2 testing in uterine cancer is not yet established. We aimed to assess the concordance of chromogenic in situ hybridization (CISH), immunohistochemistry (IHC), and next generation sequencing (NGS) platforms to aid in the development of USC specific testing guidelines. We also evaluated the rate of downstream mutations that may affect response to HER2 directed therapy. Methods: A total of 2,192 USC tumors were analyzed using NGS (NextSeq, 592 Genes and WES, NovaSEQ), a subset of 1,423 tumors were also tested by IHC and CISH (Caris Life Sciences, Phoenix, AZ). HER2 positivity through IHC (4B5, Ventana) and CISH (INFORM DUAL HER2 ISH Assay, Ventana) was determined based on 2007 and 2018 ASCO/CAP HER2 breast cancer guidelines. PD-L1 expression was tested by IHC using SP142 (Spring Biosciences) (positive cut-off >1%). Microsatellite instability (MSI) was tested by fragment analysis (FA), IHC and NGS. Tumor mutational burden (TMB) was measured by totaling somatic mutations per tumor (TMB-high cut-off > 10 mutations per Mb). Statistical significance was determined using chi-square. Results: Rates of HER2 positivity were comparable using the 2018 and 2007 breast cancer guidelines (19.5% vs 17.5%; p=0.25). Based on 2018 guidelines, the concordance between IHC and CISH was 98.9%. Specifically, 229/1423 patients (16%) were IHC+/CISH+, 5 patients (0.4%) were IHC+/CISH- and 11 patients (0.8%) were IHC-/CISH+ (Table). Common pathway alterations in HER2+ USC include TP53, RTK RAS, PI3K, NOTCH, chromatin remodeling and cell cycle genes. Single gene alterations in HER2+ tumors that may implicate HER2 therapy resistance (based on pathway analyses in other tumor types) included PI3K (36%), KRAS (2.6%), and PTEN (2.1%). HER2+ tumors had low immunotherapy biomarker profiles (0.3% MSI-H, 0.8% TMB, 17.1% PD-L1). Conclusions: High concordance rates were observed between CISH and IHC. Ultimately these testing platforms need to be validated by response to HER2 targeted therapies in order to develop USC specific HER2 testing guidelines.[Table: see text]
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Affiliation(s)
- Tenley Klc
- University of Minnesota Physician's Oncology Clinic-Masonic Cancer Clinic, Minneapolis, MN
| | | | | | - Nathaniel L. Jones
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY
| | - Matthew A. Powell
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Fiona Simpkins
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Eugenia Girda
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Jubilee Brown
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Allison Puechl
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | | | - Thomas J Herzog
- Division of Gynecologic Oncology, The University of Cincinnati Cancer Institute, Cincinnati, OH
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Kamatham S, Trak J, Alzouhayli S, Fehmi Z, Rahoui N, Sulieman N, Khoury Z, Fehmi O, Rakine H, El-Masri D, Ujayli D, Elhagehassan H, Naaman J, Almsaddi F, Salloum M, Farooquee I, Syed N, Kim S, Lattouf O, Cote ML, Ali-Fehmi R. Characteristics and distribution of obesity in the Arab-American population of southeastern Michigan. BMC Public Health 2020; 20:1685. [PMID: 33172422 PMCID: PMC7653872 DOI: 10.1186/s12889-020-09782-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background Arab-Americans constitute ~ 5% of Michigan’s population. Estimates of obesity in Arab-Americans are not up-to-date. We aim to describe the distribution of and factors associated with obesity in an Arab-American population in Southeastern Michigan (SE MI). Methods Retrospective medical record review identified n = 2363 Arab-American patients seeking care at an Arab-American serving clinic in SE MI, located in a city which is home to a large proportion of Arab-Americans in the United States (US). Body mass index (BMI) was the primary outcome of interest. Distribution of BMI was described using percentages, and logistic regression models were constructed to examine the association between obesity, other comorbid conditions and health behaviors. This cohort was compared to Michigan’s Behavioral Risk Factor Surveillance System (BRFSS) data from 2018 (n = 9589) and to a cohort seeking care between 2013 and 2019 from a free clinic (FC) located in another city in SE MI (n = 1033). Results Of the 2363 Arab-American patients, those who were older or with HTN, DM or HLD had a higher prevalence of obesity than patients who were younger or without these comorbidities (all p-value < 0.001). Patients with HTN were 3 times as likely to be obese than those without HTN (95% CI: 2.41–3.93; p < 0.001). Similarly, the odds of being obese were 2.5 times higher if the patient was diabetic (95% CI: 1.92–3.16; p < 0.001) and 2.2 times higher if the patient had HLD (95% CI: 1.75–2.83; p < 0.001). There was no significant difference in obesity rates between Arab-Americans (31%) and the BRFSS population (32.6%). Compared to Arab-Americans, patients seen at the FC had a higher obesity rate (52.6%; p < 0.001) as well as significantly higher rates of HTN, DM and HLD (all p < 0.001). Conclusion Overall obesity rates in Arab-Americans were comparable to the population-based BRFSS rates, and lower than the patients seen at the FC. Further studies are required to understand the impact of obesity and the association of comorbidities in Arab-Americans.
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Affiliation(s)
- Saivaishnavi Kamatham
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Joseph Trak
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Ziad Fehmi
- University of Michigan, Ann Arbor, MI, USA
| | - Nabil Rahoui
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | - Omar Fehmi
- University of Michigan, Ann Arbor, MI, USA
| | | | - Dana El-Masri
- Wayne State University School of Medicine, Department of Family Medicine and Public Health Sciences, Detroit, MI, USA
| | | | | | - James Naaman
- Michigan State University, East Lansing, MI, USA
| | | | | | | | - Nadia Syed
- Arab Community Center for Economic and Social Services, Dearborn, MI, USA
| | - Seongho Kim
- Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Omar Lattouf
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michele L Cote
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
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Shaik AN, Kiavash K, Stark K, Boerner JL, Ruterbusch JJ, Deirawan H, Bandyopadhyay S, Ali-Fehmi R, Dyson G, Cote ML. Inflammation markers on benign breast biopsy are associated with risk of invasive breast cancer in African American women. Breast Cancer Res Treat 2020; 185:831-839. [PMID: 33113091 DOI: 10.1007/s10549-020-05983-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Markers of inflammation, including crown-like structures of the breast (CLS-B) and infiltrating lymphocytes (IL), have been identified in breast tissue and associated with increased risk of breast cancer (BrCa), however most of this work has been performed in primarily non-Hispanic white women. Here, we examined whether CLS-B and IL are associated with invasive BrCa in African American (AA) women. METHODS We assessed breast biopsies from three 5-year age-matched groups: BrCa-free AA women (50 Volunteer) from the Komen Normal Tissue Bank (KTB) and AA women with a clinically-indicated biopsy diagnosed with benign breast disease (BBD) from our Detroit cohort who developed BrCa (55 BBD-cancer) or did not develop BrCa (47 BBD only, year of biopsy matched to BBD-cancer). Mean adipocyte diameter and total adipose area were estimated from digital images using the Adiposoft plugin from ImageJ. Associations between CLS-B, IL, and BrCa among KTB and Detroit biopsies were assessed using multivariable multinomial and conditional logistic regression models. RESULTS Among all biopsies, Volunteer and BBD only biopsies did not harbor CLS-B or IL at significantly different rates after adjusting for logarithm of adipocyte area, adipocyte diameter, and BMI. Among clinically-indicated BBD biopsies, BBD-cancer biopsies were more likely to exhibit CLS-B (odds ratio (OR) = 3.36, 95% Confidence Interval (CI): 1.33-8.48) or IL (OR = 4.95, 95% CI 1.76-13.9) than BBD only biopsies after adjusting for total adipocyte area, adipocyte diameter, proliferative disease, and BMI. CONCLUSIONS CLS-B and IL may serve as histological markers of BrCa risk in benign breast biopsies from AA women.
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Affiliation(s)
- Asra N Shaik
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Katrin Kiavash
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Karri Stark
- Barbara Ann Karmanos Cancer Institute, 4100 John R. St, Mailstop: MM04EP, Detroit, MI, 48201, USA
| | - Julie L Boerner
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA.,Barbara Ann Karmanos Cancer Institute, 4100 John R. St, Mailstop: MM04EP, Detroit, MI, 48201, USA
| | - Julie J Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Hany Deirawan
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.,Barbara Ann Karmanos Cancer Institute, 4100 John R. St, Mailstop: MM04EP, Detroit, MI, 48201, USA
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.,Barbara Ann Karmanos Cancer Institute, 4100 John R. St, Mailstop: MM04EP, Detroit, MI, 48201, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.,Barbara Ann Karmanos Cancer Institute, 4100 John R. St, Mailstop: MM04EP, Detroit, MI, 48201, USA
| | - Gregory Dyson
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA.,Barbara Ann Karmanos Cancer Institute, 4100 John R. St, Mailstop: MM04EP, Detroit, MI, 48201, USA
| | - Michele L Cote
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA. .,Barbara Ann Karmanos Cancer Institute, 4100 John R. St, Mailstop: MM04EP, Detroit, MI, 48201, USA.
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Wallbillich J, Morris R, Ali-Fehmi R. Comparing mutation frequencies for homologous recombination genes in uterine serous and high-grade serous ovarian carcinomas: A case for homologous recombination deficiency testing in uterine serous carcinoma. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.096] [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: 11/15/2022]
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Wallbillich JJ, Morris RT, Ali-Fehmi R. Comparing mutation frequencies for homologous recombination genes in uterine serous and high-grade serous ovarian carcinomas: A case for homologous recombination deficiency testing in uterine serous carcinoma. Gynecol Oncol 2020; 159:381-386. [PMID: 32900500 DOI: 10.1016/j.ygyno.2020.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To compare the frequencies of somatic homologous recombination (HR) gene mutations identified in next-generation sequencing (NGS) genomic profiling of uterine serous carcinomas (USCs) and high-grade serous ovarian carcinomas (HGSOCs). METHODS Data for this analysis was obtained from AACR Project GENIE, a multi-institutional dataset of clinical-grade NGS genomic profiling results for many cancer sites and histologic subtypes, through cBioPortal. Patient/specimen groups used for analysis were USC and HGSOC. 14 HR genes were queried for each group with respect to mutation frequency. For each HR gene, the difference in mutation frequency between the two groups was evaluated using Fisher's exact test. The threshold for statistical significance was p-value < .05. RESULTS In the USC group, there were 457 samples from 451 patients. In the HGSOC group, there were 1537 samples from 1515 patients. The most frequently mutated HR gene for USC was BRCA2 (4.84%) and for HGSOC was BRCA1 (9.07%). Mutation frequency was significantly different between USC and HGSOC for BRCA 1 (p < .001) and BRCA2 (p = .0379). For the 12 non-BRCA HR genes, mutation frequency was not significantly different between USC and HGSOC. The rate of patients with at least one HR gene mutation in their profiled tumor was 16.85% for USC and 25.21% of HGSOC. Most USC patients with a somatic HR mutation had only one HR gene mutated. CONCLUSIONS Somatic HR gene mutations were commonly identified in NGS genomic profiling of USC. Mutation frequencies for non-BRCA HR genes were not significantly different between USC and HGSOC. These data add to the growing rationale for HR deficiency tumor testing and targeting (e.g., with PARP inhibitors) in future clinical trial development for women with USC.
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Affiliation(s)
- John J Wallbillich
- Division of Gynecologic Oncology, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States of America.
| | - Robert T Morris
- Division of Gynecologic Oncology, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Rouba Ali-Fehmi
- Department of Pathology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States of America
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Cote ML, Ruterbusch JJ, Rangarajan T, Khalil R, Elshaikh M, Ali-Fehmi R. Abstract C120: High-grade endometrial cancers: Persistent racial differences in survival. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c120] [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] Open
Abstract
Abstract
Introduction: Endometrial cancer (EC) is the most common gynecologic cancer diagnosed in the United States, and high-grade cancers account for approximately 1/5 of the ECs diagnosed in non-Hispanic white (NHW) women, Hispanic women, and Asian women, but nearly 1/3 of those diagnosed in African American (AA) women. These high-grade cancers are associated with poorer outcomes, and AAs are consistently at highest risk of mortality in studies that fail to adjust adequately for potentially important treatment or comorbidity variables. Here we present survival analyses from a study of AA and NHW women with high grade EC at two academic hospitals.
Methods: High-grade cancers were identified through registries at each hospital and representative slides were re-reviewed by a single gynecologic pathologist to confirm high-grade disease and subtype. The following subtypes were included: clear cell, endometrioid, mixed, and serous. We identified 258 women (n=86 NHW, n=169 AA) who were diagnosed with high-grade cancers between 1998 and 2010. Utilizing medical records and the Surveillance, Epidemiology and End Results (SEER) registry, the following data were abstracted: height, weight, comorbid conditions, type of radiation, dose and fractions, type(s) of chemotherapy, number of cycles, recurrence, and vital status. Descriptive analyses utilized chi-square and t-tests to determine differences in clinical characteristics between AA and NHW women. Kaplan Meier survival analysis was performed to test for differences by race and subtype. To compare survival while considering competing risks of death, cause-specific hazard and cumulative incidence functions were compared using Gray's test.
Results: The majority of the women had ECs classified as serous carcinomas (46.1%), followed by endometrioid (39.5%), clear cell carcinomas (9.7%) and mixed cell types (4.7%). AA women with endometrial cancer had slightly higher mean body mass index (BMI) compared to NHW women (34.6 and 32.2, respectively, p-value=0.06). NHW survived significantly longer after diagnosis compared to AA women (173 months versus 87 months, respectively, log-rank p-value=0.006). This difference remained after stratification by subtype, with similar findings for endometrioid cancers (log-rank p-value=0.06) and serous cancers (log-rank p-value=0.03). When examining survival considering competing risks (death due to EC versus other causes), AA women had a greater risk of death (HR: 1.84, 95% CI: 1.10-3.03) compared to their NHW counterparts; however, no difference was seen by race for other causes of death (HR: 1.29, 95% CI: 0.71-2.32). Further analyses, showing survival differences persist despite adjustments for BMI, comorbidities, and detailed treatment, will be presented.
Conclusions: AA women continue to experience greater mortality from high-grade EC despite adjustments for demographic, clinical and treatment data, warranting continued efforts to identify molecular and social factors associated with poorer survival.
Citation Format: Michele L. Cote, Julie J. Ruterbusch, Tara Rangarajan, Remonda Khalil, Mohamed Elshaikh, Rouba Ali-Fehmi. High-grade endometrial cancers: Persistent racial differences in survival [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C120.
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Affiliation(s)
- Michele L. Cote
- 1Wayne State University and Karmanos Cancer Institute, Detroit, MI,
| | | | | | | | | | - Rouba Ali-Fehmi
- 1Wayne State University and Karmanos Cancer Institute, Detroit, MI,
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Purrington KS, Knight J, Dyson G, Ali-Fehmi R, Schwartz AG, Boerner JL, Bandyopadhyay S. CLCA2 expression is associated with survival among African American women with triple negative breast cancer. PLoS One 2020; 15:e0231712. [PMID: 32298355 PMCID: PMC7161959 DOI: 10.1371/journal.pone.0231712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/30/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose Black/African American (AA) women are twice as likely to be diagnosed with triple negative breast cancer (TNBC) compared to whites, an aggressive breast cancer subtype associated with poor prognosis. There are no routinely used targeted clinical therapies for TNBC; thus there is a clear need to identify prognostic markers and potential therapeutic targets. Methods We evaluated expression of 27,016 genes in 155 treatment-naïve TN tumors from AA women in Detroit. Associations with survival were evaluated using Cox proportional hazards models adjusting for stage and age at diagnosis, and p-values were corrected using a false discovery rate. Our validation sample consisted of 494 TN tumors using four publically available data sets. Meta-analyses were performed using summary statistics from the four validation results. Results In the Detroit AA cohort, CLCA2 [Hazard ratio (HR) = 1.56, 95% confidence interval (CI) 1.31–1.86, nominal p = 5.1x10-7, FDR p = 0.014], SPIC [HR = 1.47, 95%CI 1.26–1.73, nominal p = 1.8x10-6, FDR p = 0.022], and MIR4311 [HR = 1.57, 95% CI 1.31–1.92, nominal p = 2.5x10-5, FDR p = 0.022] expression were associated with overall survival. Further adjustment for treatment and breast cancer specific survival analysis did not substantially alter effect estimates. CLCA2 was also associated with increased risk of death in the validation cohorts [HR = 1.14, 95% CI 1.05–1.24, p = 0.038, p-heterogeneity = 0.88]. Conclusions We identified CLCA2 as a potential prognostic marker for TNBC in AA women.
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Affiliation(s)
- Kristen S. Purrington
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States of America
- * E-mail:
| | - Jimmie Knight
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Gregory Dyson
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States of America
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Tumor Biology and Microenvironment Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States of America
| | - Ann G. Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States of America
| | - Julie L. Boerner
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Molecular Therapeutics Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States of America
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Tumor Biology and Microenvironment Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States of America
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Abdulfatah E, Wakeling E, Sakr S, Al-Obaidy K, Bandyopadhyay S, Morris R, Feldman G, Ali-Fehmi R. Molecular classification of endometrial carcinoma applied to endometrial biopsy specimens: Towards early personalized patient management. Gynecol Oncol 2019; 154:467-474. [PMID: 31248668 DOI: 10.1016/j.ygyno.2019.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The current risk stratification systems used to guide management of endometrial cancer are based on irreproducible post surgical pathological information, hence the need for more reliable classification systems. Using microarray and sequencing technologies, TCGA recently identified four prognostically significant endometrial carcinoma subtypes, which subsequently proved reproducible using clinically applicable surrogate tests. Using these tests, we sought to determine the level of concordance between endometrial biopsies and subsequent hysterectomy specimens in assessing the molecular classification of endometrial carcinoma. MATERIALS AND METHODS Fifty biopsies with corresponding hysterectomy specimens for endometrial carcinomas were collected. Additionally, 10 cases of biopsy proven atypical hyperplasia/EIN who were found to have endometrial carcinoma on resection were included. IHC for mismatch repair (MMR) proteins (MLH1, PMS2, MSH2 and MSH6) and P53 was performed. Microsatellite instability analysis was performed by PCR and Sanger sequencing was performed to detect mutations in exons 9 and 13 of the POLE gene. The level of concordance for tumor grade, histologic subtype, immunohistochemical and molecular profile in both specimens was determined using Cohen's kappa estimates. RESULTS A high level of concordance was achieved for MMR-loss, MSI-high, P53-wild and abnormal types. In contrast, grade and histologic subtype showed only moderate levels of agreement. POLE gene mutation was detected in two patients. For both cases, mutations were detected only in resection specimens. When comparing atypical hyperplasia/EIN with subsequent hysterectomy tumor, the profile was identical to that of endometrial carcinoma. CONCLUSION In our cohort of endometrial carcinoma, a high level of concordance was achieved between biopsy and hysterectomy specimens for MMR-loss, MSI-high, P53-wild and abnormal types, superior to that of grade and histologic subtype, providing earlier and more reliable prognostic information to inform management. Similar concordance could not be achieved for POLE mutation, given the low frequency of this mutation in our study.
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Affiliation(s)
- Eman Abdulfatah
- Department of Pathology, Wayne State University, Detroit, MI, United States of America.
| | - Erin Wakeling
- Molecular Genetic Laboratories, Detroit Medical Center, Detroit, MI, United States of America
| | - Sharif Sakr
- Department of Gynecologic Oncology, Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Khaleel Al-Obaidy
- Department of Pathology, Wayne State University, Detroit, MI, United States of America
| | | | - Robert Morris
- Department of Gynecologic Oncology, Karmanos Cancer Institute, Detroit, MI, United States of America
| | - Gerald Feldman
- Molecular Genetic Laboratories, Detroit Medical Center, Detroit, MI, United States of America
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University, Detroit, MI, United States of America.
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Fletcher N, Harper A, Fan R, Singh I, Deirawan H, Tsolakian I, Maclean J, Naaman J, Bandyopadhyay S, Ali-Fehmi R, Morris R, Saed G. Identification of a novel mechanism of survival in epithelial ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.209] [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: 10/26/2022]
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Ali-Fehmi R, Sakr S, Abdulfatah E, Wakeling E, Yerrapotu N, Tsolakian I, Ujayli D, Naaman J, Bandyopadhyay S, Morris R. Towards early personalized patient management: Molecular classification of endometrial carcinoma applied to endometrial biopsy specimens. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.417] [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: 10/26/2022]
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Radhakrishna U, Albayrak S, Zafra R, Baraa A, Vishweswaraiah S, Veerappa AM, Mahishi D, Saiyed N, Mishra NK, Guda C, Ali-Fehmi R, Bahado-Singh RO. Placental epigenetics for evaluation of fetal congenital heart defects: Ventricular Septal Defect (VSD). PLoS One 2019; 14:e0200229. [PMID: 30897084 PMCID: PMC6428297 DOI: 10.1371/journal.pone.0200229] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 03/11/2019] [Indexed: 12/19/2022] Open
Abstract
Ventricular Septal Defect (VSD), the most common congenital heart defect, is characterized by a hole in the septum between the right and left ventricles. The pathogenesis of VSD is unknown in most clinical cases. There is a paucity of data relevant to epigenetic changes in VSD. The placenta is a fetal tissue crucial in cardiac development and a potentially useful surrogate for evaluating the development of heart tissue. To understand epigenetic mechanisms that may play a role in the development of VSD, genome-wide DNA methylation assay on placentas of 8 term subjects with isolated VSD and no known or suspected genetic syndromes and 10 unaffected controls was performed using the Illumina HumanMethylation450 BeadChip assay. We identified a total of 80 highly accurate potential CpGs in 80 genes for detection of VSD; area under the receiver operating characteristic curve (AUC ROC) 1.0 with significant 95% CI (FDR) p-values < 0.05 for each individual locus. The biological processes and functions for many of these differentially methylated genes are previously known to be associated with heart development or disease, including cardiac ventricle development (HEY2, ISL1), heart looping (SRF), cardiac muscle cell differentiation (ACTC1, HEY2), cardiac septum development (ISL1), heart morphogenesis (SRF, HEY2, ISL1, HEYL), Notch signaling pathway (HEY2, HEYL), cardiac chamber development (ISL1), and cardiac muscle tissue development (ACTC1, ISL1). In addition, we identified 8 microRNAs that have the potential to be biomarkers for the detection of VSD including: miR-191, miR-548F1, miR-148A, miR-423, miR-92B, miR-611, miR-2110, and miR-548H4. To our knowledge this is the first report in which placental analysis has been used for determining the pathogenesis of and predicting VSD.
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Affiliation(s)
- Uppala Radhakrishna
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States of America
- * E-mail:
| | - Samet Albayrak
- Department of Obstetrics and Gynaecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Rita Zafra
- Department of Obstetrics and Gynaecology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Alosh Baraa
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Sangeetha Vishweswaraiah
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States of America
| | - Avinash M. Veerappa
- Department of Studies in Genetics and Genomics, Laboratory of Genomic Sciences, University of Mysore, Mysore, India
| | - Deepthi Mahishi
- Department of Studies in Genetics and Genomics, Laboratory of Genomic Sciences, University of Mysore, Mysore, India
| | - Nazia Saiyed
- Biotechnology, Nirma Institute of Science, Nirma University, Ahmedabad, India
| | - Nitish K. Mishra
- Department of Genetics, Cell Biology & Anatomy, College of Medicine, University of Nebraska Medical Centre Omaha, Nebraska, United States of America
| | - Chittibabu Guda
- Department of Genetics, Cell Biology & Anatomy, College of Medicine, University of Nebraska Medical Centre Omaha, Nebraska, United States of America
| | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Ray O. Bahado-Singh
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States of America
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Ueberroth BE, Lawhorn-Crews JM, Heilbrun LK, Smith DW, Akoury J, Ali-Fehmi R, Eiseler NT, Shields AF. The use of 3'-deoxy-3'- 18F-fluorothymidine (FLT) PET in the assessment of long-term survival in breast cancer patients treated with neoadjuvant chemotherapy. Ann Nucl Med 2019; 33:383-393. [PMID: 30810980 DOI: 10.1007/s12149-019-01345-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/08/2018] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the role of serial FLT-PET scans during early neoadjuvant treatment as a prognostic marker of response to treatment and survival. METHODS This study is a prospective cohort study which draws from a larger original study which examined the utility of FLT-PET imaging across multiple cancers. Our cohort consisted of patients who had biopsy-confirmed breast cancer amenable to surgical resection. These patients underwent serial FLT-PET scans: the first scan prior to starting neoadjuvant chemotherapy (NAC), and a second scan shortly after starting NAC. SUVmean was derived using an isocontour ROI drawn approximately half way between the SUVmax and background on three planes for each scan. The change in mean standardized uptake value (SUVmean) for the primary tumor between these two scans was then calculated, and patients were stratified into "responder" and "non-responder" groups based on a cut-off of 20% arithmetic decrease in SUVmean between the two scans. The rates of pathologic complete response (pCR) on subsequent surgical excision, overall survival (OS), and progression-free survival (PFS) were then compared between the two groups to assess for significant difference between responders and non-responders. RESULTS 16 patients (n = 16) met criteria for inclusion and successfully underwent FLT-PET scans in the prescribed sequence of events. Seven of these patients had a decrease of 20% or larger between the two serial PET scans, making them "responders". The remaining nine patients were "non-responders" to NAC based on PET imaging. Between responders and non-responders, there was no significant difference in median PFS (7.9 years versus 3.7 years; p = 0.425) and median OS (7.5 years versus 5.0 years; p = 0.944). In the 14 patients who underwent surgical resection (n = 14), there was no significant difference in the rate of achieving pCR (33% vs. 14%; p = 0.5846) between responders and non-responders. CONCLUSION Further study of a larger sample size is needed to examine the potential role for FLT-PET in predicting response to neoadjuvant treatment, particularly in correlating with long-term overall and progression-free survival. Our study is limited by small sample size, but does suggest that FLT-PET has a role in the long-term prognosis of breast cancer treated with NAC and surgical resection which is worthy of further study.
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Affiliation(s)
- Benjamin E Ueberroth
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
| | | | - Lance K Heilbrun
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.,Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
| | - Daryn W Smith
- Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
| | - Janice Akoury
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Rouba Ali-Fehmi
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.,Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
| | - Nicole T Eiseler
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.,Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Anthony F Shields
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.,Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
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Abstract
Ovarian carcinoma continues to be a concern for woman and maintains significant morbidity and mortality. Emerging molecular markers are providing additional opportunities for effective diagnosis and prognosis of disease. An integrated clinicopathologic and molecular classification of gynecologic malignancies has the potential to refine the clinical risk prediction of patients with cancer and to provide more tailored treatment recommendations.
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Affiliation(s)
- Eman Abdulfatah
- Department of Pathology, Detroit Medical Center Harper University Hospital, Wayne State University, 3990 John R Detroit, MI 48201, USA
| | - Quratulain Ahmed
- Michigan Diagnostic pathologists, Providence Hospital, 16001 W Nine Mile Road, Southfield, MI 48075, USA
| | - Baraa Alosh
- Department of Pathology, Detroit Medical Center Harper University Hospital, Wayne State University, 3990 John R Detroit, MI 48201, USA
| | - Sudeshna Bandyopadhyay
- Department of Pathology, Detroit Medical Center Harper University Hospital, Wayne State University, 3990 John R Detroit, MI 48201, USA.
| | - Martin H Bluth
- Department of Pathology, Wayne State University, School of Medicine, 540 East Canfield Street, Detroit, MI 48201, USA; Pathology Laboratories, Michigan Surgical Hospital, 21230 Dequindre Road, Warren, MI 48091, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Detroit Medical Center Harper University Hospital, Wayne State University, 3990 John R Detroit, MI 48201, USA
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Abstract
The most significant contribution of molecular subtyping of breast carcinomas has been the identification of estrogen-positive and estrogen-negative tumor subtypes. Knowledge of genetic alterations in these tumors will help clinicians identify novel therapeutic targets. Understanding the progression pathways involved in the transition of in situ carcinoma to invasive carcinoma might lead to efficient risk stratification in these patients. The Cancer Genome Analysis Network has collected genomic and epigenomic data to provide comprehensive information regarding carcinogenesis and pathway interactions. Such information improves understanding of the disease process and also provides more accurate information toward identifying targetable mutations for treatment.
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Affiliation(s)
- Sudeshna Bandyopadhyay
- Department of Pathology, Detroit Medical Center, Harper University Hospital 3990 John R, Detroit, MI 48201, USA.
| | - Martin H Bluth
- Department of Pathology, Wayne State University, School of Medicine, 540 East Canfield Street, Detroit, MI 48201, USA; Pathology Laboratories, Michigan Surgical Hospital, 21230 Dequindre Road, Warren, MI 48091, USA
| | - Rouba Ali-Fehmi
- Department of Pathology, Detroit Medical Center, Harper University Hospital 3990 John R, Detroit, MI 48201, USA
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Shaik AN, Ruterbusch JJ, Abdulfatah E, Shrestha R, Daaboul MHDF, Pardeshi V, Visscher DW, Bandyopadhyay S, Ali-Fehmi R, Cote ML. Breast fibroadenomas are not associated with increased breast cancer risk in an African American contemporary cohort of women with benign breast disease. Breast Cancer Res 2018; 20:91. [PMID: 30092846 PMCID: PMC6085691 DOI: 10.1186/s13058-018-1027-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibroadenomas are common benign breast lesions, and studies of European American women indicate a persistent, increased risk of breast cancer after diagnosing a fibroadenoma on biopsy. This association has not been independently assessed in African American women, despite reports that these women are more likely to present with fibroadenomas. METHODS The study cohort included 3853 African American women with a breast biopsy completed between 1997 and 2010 in metropolitan Detroit. Biopsies were microscopically reviewed for benign breast lesions, including fibroadenoma, proliferative disease, and atypia. Risk of breast cancer within the cohort was estimated using relative risk ratios and 95% CIs calculated using multivariable log-binomial regression. Relative risk of breast cancer in this cohort compared with African American women in the broader metropolitan Detroit population was estimated using standardized incidence ratios (SIRs). RESULTS Fibroadenomas occurred more frequently in biopsies of younger women, and other types of benign breast lesions were less likely to occur when a fibroadenoma was present (p = 0.008 for lobular hyperplasia; all other p values < 0.01). Unlike women with other benign lesions (SIR, 1.41; 95% CI, 1.20, 1.66), women with fibroadenomas did not have an increased risk of developing breast cancer compared with the general population (SIR, 0.94; 95% CI, 0.75, 1.18). Biopsies that indicated a fibroadenoma were associated with a reduced risk of breast cancer after adjusting for age at biopsy, proliferation, and atypia (relative risk, 0.67; 95% CI, 0.48, 0.93) compared with biopsies without a fibroadenoma. CONCLUSIONS These findings have important implications for breast cancer risk models and clinical assessment, particularly among African American women, in whom fibroadenomas are common.
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Affiliation(s)
- Asra N Shaik
- Department of Oncology, Wayne State University School of Medicine, 4100 John R Street, MM04EP, Detroit, MI, 48201, USA
| | - Julie J Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, 4100 John R Street, MM04EP, Detroit, MI, 48201, USA
| | - Eman Abdulfatah
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Resha Shrestha
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - M H D Fayez Daaboul
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Visakha Pardeshi
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Rouba Ali-Fehmi
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Michele L Cote
- Department of Oncology, Wayne State University School of Medicine, 4100 John R Street, MM04EP, Detroit, MI, 48201, USA.
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.
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Shaik AN, Kiavash K, Stark K, Boerner JL, Ruterbusch JJ, Ali-Fehmi R, Cote ML. Abstract LB-337: Adipose inflammation and the risk of benign and malignant breast disease in African American women. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-lb-337] [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: Obesity is associated with an increased breast cancer (BrCa) incidence. Adipose inflammation, marked by crown-like lesions in the breast (CLS-B) or dying adipocytes surrounded by macrophages, has been previously associated with BMI, aromatase expression, and systemic inflammation - all BrCa risk correlates. However, CLS-B has not been well described in normal or pre-malignant tissue, nor ever described in African American women (AAW). Here we examined whether CLS-B is associated with risk of benign breast disease (BBD) and BrCa in AAW, who suffer a higher incidence of breast cancer, poorer breast cancer outcomes, and a higher prevalence of obesity than women of other ethnicities.
Methods: We assessed breast biopsies from three age-matched groups including 50 AAW with no history of BBD or BrCa from the Komen Normal Tissue Bank (KTB) and AAW with BBD from our Detroit cohort who developed cancer (55 BBD cases) or did not develop breast cancer (47 BBD controls). Slides were assessed by pathologists (KK, RAF) for CLS-B presence. Associations between tissue type and CLS-B presence among KTB and BBD samples were assessed using chi-square tests. Association between tissue types and CLS-B adjusting for BMI was assessed using the Mantel-Haenszel test.
Results: The KTB, BBD controls and BBD cases groups were matched for age, consisted of approximately 15% <45, 43% 45-55, and 42% 55+ year old AAW. Our study of KTB, BBD control and BBD case groups predominately consisted of overweight (22, 17, and 32%, respectively) and obese women (60, 57, and 47%, respectively). Our data show that CLS-B presence is associated with BBD: significantly more BBD biopsies (29/89=32.6%) were CLS-B positive than KTB biopsies (4/44=9.1%; p=0.006). Among BBD biopsies, fewer BBD controls (11/45=24.4%) were CLS-B positive than BBD cases (18/44=40.9%; p=0.159). After controlling for BMI, CLS-B presence showed an increasing trend among KTB, BBD control and BBD case biopsies (p=0.002, see Table).
CLS-B presence by study group and BMIKTBBBD controlsBBD casesN (%) with CLS-B presenceN=44N=44N=42BMI<250/8 (0%)1/10 (10.0%)4/9 (44.4%)BMI 25-291/9 (11.1%)1/8 (12.5%)4/13 (30.8%)BMI 30+3/27 (11.1%)9/26 (34.6%)9/20 (45.0%)
Conclusions: These findings suggest that CLS-B may serve as an important histological marker of BrCa risk in benign breast biopsies. Our study population exhibited higher rates of obesity than other BBD and CLS-B studies of European American women highlighting the need to include diverse populations in future studies examining BrCa risk. These findings have potential implications for modeling BrCa risk, particularly among AAW, for whom obesity is prevalent.
Citation Format: Asra N. Shaik, Katrin Kiavash, Karri Stark, Julie L. Boerner, Julie J. Ruterbusch, Rouba Ali-Fehmi, Michele L. Cote. Adipose inflammation and the risk of benign and malignant breast disease in African American women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-337.
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Affiliation(s)
- Asra N. Shaik
- 1Wayne State University School of Medicine, Detroit, MI
| | | | - Karri Stark
- 2Barbara Ann Karmanos Cancer Institute, Detroit, MI
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Rattan R, Sakr S, Ali-Fehmi R, Abdulfatah E, Hanna R, Giri S, Munkarah A. S-nitrosoglutathione, a physiologic nitric oxide carrier, reduces immunosupression in ovarian cancer. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sakr S, Abdulfatah E, Loehr A, Simmons A, Morris R, Ali-Fehmi R. Prognostic impact of loss of heterozygosity in uterine serous carcinoma. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guastella AR, Michelhaugh SK, Klinger NV, Fadel HA, Kiousis S, Ali-Fehmi R, Kupsky WJ, Juhász C, Mittal S. Investigation of the aryl hydrocarbon receptor and the intrinsic tumoral component of the kynurenine pathway of tryptophan metabolism in primary brain tumors. J Neurooncol 2018; 139:239-249. [PMID: 29667084 DOI: 10.1007/s11060-018-2869-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 01/04/2018] [Accepted: 04/11/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is mounting evidence supporting the role of tryptophan metabolism via the kynurenine pathway (KP) in the pathogenesis of primary brain tumors. Under normal physiological conditions, the KP is the major catabolic pathway for the essential amino acid tryptophan. However, in cancer cells, the KP becomes dysregulated, depletes local tryptophan, and contributes to an immunosuppressive tumor microenvironment. METHODS We examined the protein expression levels (in 73 gliomas and 48 meningiomas) of the KP rate-limiting enzymes indoleamine 2,3-dioxygenase (IDO) 1, IDO2, and tryptophan 2,3-dioxygenase (TDO2), as well as, the aryl hydrocarbon receptor (AhR), a carcinogenic transcription factor activated by KP metabolites. In addition, we utilized commercially available small-molecules to pharmacologically modulate IDO1, IDO2, TDO2, and AhR in patient-derived glioma and meningioma cell lines (n = 9 each). RESULTS We observed a positive trend between the grade of the tumor and the average immunohistochemical staining score for IDO1, IDO2, and TDO2, with TDO2 displaying the strongest immunostaining. AhR immunostaining was present in all grades of gliomas and meningiomas, with the greatest staining intensity noted in glioblastomas. Immunocytochemical staining showed a positive trend between nuclear localization of AhR and histologic grade in both gliomas and meningiomas, suggesting increased AhR activation with higher tumor grade. Unlike enzyme inhibition, AhR antagonism markedly diminished patient-derived tumor cell viability, regardless of tumor type or grade, following in vitro drug treatments. CONCLUSIONS Collectively, these results suggest that AhR may offer a novel and robust therapeutic target for a patient population with highly limited treatment options.
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Affiliation(s)
- Anthony R Guastella
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | | | - Neil V Klinger
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
| | - Hassan A Fadel
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
| | - Sam Kiousis
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
| | - Rouba Ali-Fehmi
- Department of Oncology, Wayne State University, Detroit, MI, USA
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | - William J Kupsky
- Department of Oncology, Wayne State University, Detroit, MI, USA
- Department of Pathology, Wayne State University, Detroit, MI, USA
| | - Csaba Juhász
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA
- Department of Neurology, Wayne State University, Detroit, MI, USA
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
- PET Center and Translational Imaging Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
- Karmanos Cancer Institute, Detroit, MI, USA
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Detroit, MI, USA.
- Department of Oncology, Wayne State University, Detroit, MI, USA.
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.
- Karmanos Cancer Institute, Detroit, MI, USA.
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Matsuo K, Wong KK, Fotopoulou C, Blake EA, Robertson SE, Pejovic T, Frimer M, Pardeshi V, Hu W, Choi JS, Sun CC, Richmond AM, Marcus JZ, Hilliard MAM, Mostofizadeh S, Mhawech-Fauceglia P, Abdulfatah E, Post MD, Saglam O, Shahzad MMK, Karabakhtsian RG, Ali-Fehmi R, Gabra H, Roman LD, Sood AK, Gershenson DM. Impact of lympho-vascular space invasion on tumor characteristics and survival outcome of women with low-grade serous ovarian carcinoma. J Surg Oncol 2017; 117:236-244. [PMID: 28787528 DOI: 10.1002/jso.24801] [Citation(s) in RCA: 8] [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] [Received: 05/18/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine association of lympho-vascular space invasion (LVSI) with clinico-pathological factors and to evaluate survival of women with low-grade serous ovarian carcinoma containing areas of LVSI. METHODS This is a multicenter retrospective study examining consecutive cases of surgically treated stage I-IV low-grade serous ovarian carcinoma (n = 178). Archived histopathology slides for the ovarian tumors were reviewed, and LVSI was scored as present or absent. LVSI status was correlated to clinico-pathological findings and survival outcome. RESULTS LVSI was seen in 79 cases (44.4%, 95% confidence interval [CI] 37.1-51.7). LVSI was associated with increased risk of omental metastasis (87.0% vs 64.9%, odds ratio [OR] 3.62, P = 0.001), high pelvic lymph node ratio (median 12.9% vs 0%, P = 0.012), and malignant ascites (49.3% vs 32.6%, OR 2.01, P = 0.035). On multivariable analysis, controlling for age, stage, and cytoreductive status, presence of LVSI in the ovarian tumor remained an independent predictor for decreased progression-free survival (5-year rates 21.0% vs 35.7%, adjusted-hazard ratio 1.57, 95%CI 1.06-2.34, P = 0.026). LVSI was significantly associated with increased risk of recurrence in lymph nodes (OR 2.62, 95%CI 1.08-6.35, P = 0.047). CONCLUSION LVSI in the ovarian tumor is associated with adverse clinico-pathological characteristics and decreased progression-free survival in women with low-grade serous ovarian carcinoma.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kwong-Kwok Wong
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Christina Fotopoulou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colarodo
| | - Erin A Blake
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Sharon E Robertson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Tanja Pejovic
- Department of Pathology, Wayne State University, Detroit, Michigan
| | - Marina Frimer
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vishakha Pardeshi
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Wei Hu
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jong-Sun Choi
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Charlotte C Sun
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Abby M Richmond
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Jenna Z Marcus
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maren A M Hilliard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Sayedamin Mostofizadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Paulette Mhawech-Fauceglia
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Eman Abdulfatah
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Miriam D Post
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Ozlen Saglam
- Department of Pathology, University of Southern California, Los Angeles, California
| | - Mian M K Shahzad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Rouzan G Karabakhtsian
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York
| | - Rouba Ali-Fehmi
- Clinical Discovery Unit, Early Clinical Development, AstraZeneca, Cambridge, UK
| | - Hani Gabra
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colarodo
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anil K Sood
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - David M Gershenson
- Ovarian Cancer Action Research Center, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Jung YS, Najy AJ, Huang W, Sethi S, Snyder M, Sakr W, Dyson G, Hüttemann M, Lee I, Ali-Fehmi R, Franceschi S, Struijk L, Kim HE, Kato I, Kim HRC. HPV-associated differential regulation of tumor metabolism in oropharyngeal head and neck cancer. Oncotarget 2017; 8:51530-51541. [PMID: 28881665 PMCID: PMC5584266 DOI: 10.18632/oncotarget.17887] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 11/04/2016] [Accepted: 04/05/2017] [Indexed: 11/25/2022] Open
Abstract
HPV-positive oropharyngeal cancer patients experience significantly lower locoregional recurrence and higher overall survival in comparison with HPV-negative patients, especially among those who received radiation therapy. The goal of the present study is to investigate the molecular mechanisms underlying the differential radiation sensitivity between HPV-negative and HPV-positive head and neck squamous cell carcinoma (HNSCC). Here, we show that HPV-negative HNSCC cells exhibit increased glucose metabolism as evidenced by increased production of lactate, while HPV-positive HNSCC cells effectively utilize mitochondrial respiration as evidenced by increased oxygen consumption. HPV-negative cells express HIF1α and its downstream mediators of glucose metabolism such as hexokinase II (HKII) and carbonic anhydrase IX (CAIX) at higher levels, while the expression level of cytochrome c oxidase (COX) was noticeably higher in HPV-positive HNSCC. In addition, the expression levels of pyruvate dehydrogenase kinases (PDKs), which inhibit pyruvate dehydrogenase activity, thereby preventing entry of pyruvate into the mitochondrial tricarboxylic acid (TCA) cycle, were much higher in HPV-negative HNSCC compared to those in HPV-positive cells. Importantly, a PDK inhibitor, dichloroacetate, effectively sensitized HPV-negative cells to irradiation. Lastly, we found positive interactions between tonsil location and HPV positivity for COX intensity and COX/HKII index ratio as determined by immunohistochemical analysis. Overall survival of patients with HNSCC at the tonsil was significantly improved with an increased COX expression. Taken together, the present study provides molecular insights into the mechanistic basis for the differential responses to radiotherapy between HPV-driven vs. spontaneous or chemically induced oropharyngeal cancer.
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Affiliation(s)
- Young-Suk Jung
- Department of Pathology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
- Current Address: Pusan National University College of Pharmacy, Geumjeong-gu, Busan, Republic of Korea
| | - Abdo J. Najy
- Department of Pathology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Wei Huang
- Department of Pathology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Seema Sethi
- Department of Pathology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael Snyder
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
- Division of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Wael Sakr
- Department of Pathology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gregory Dyson
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Maik Hüttemann
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Icksoo Lee
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
- Current Address: College of Medicine, Dankook University, Cheonan-si, Chungcheongnam-do, Republic of Korea
| | - Rouba Ali-Fehmi
- Department of Pathology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Linda Struijk
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Harold E. Kim
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
- Division of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ikuko Kato
- Department of Pathology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Hyeong-Reh Choi Kim
- Department of Pathology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
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Holowatyj AN, Ruterbusch JJ, Ali-Fehmi R, Bandyopadhyay S, Mehner C, Mann MS, Dyson G, Radisky D, Cote ML. Abstract 4253: Expression profiling of paired benign and breast cancer lesions in African American women. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4253] [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
Benign breast disease, a known risk factor for subsequent breast cancer, includes a histological spectrum of lesions that can be subdivided based on the overall impression into non-proliferative lesions, proliferative lesions without atypia, and atypical hyperplasia. Yet little is known about the molecular characteristics of benign breast tissue from African American women, who suffer from disproportionately high breast cancer mortality rates. 72 breast samples from African American women were obtained. RNA was extracted from archival formalin-fixed, paraffin-embedded (FFPE) blocks. Gene expression profiling was performed on these samples using the Affymetrix HTA2.0 exon array chip. A fit linear model using generalized least squares identified probe sets with differential expression in benign-in situ and benign-invasive breast cancer paired lesions. 36 benign and 36 breast cancer paired lesions were included in the study. In the benign-in situ set (n=20), 978 probe sets were differentially expressed (threshold: fold-change, 1.50; p < 0.05). Probe sets mapped to 125 annotated genes, of which 69 (55.2%) were involved in cancer. The benign-invasive set (n=52) identified 351 differentially expressed probe sets that mapped to 84 annotated genes, of which 61 (72.6%) had known cancer significance. Genes involved in cellular growth and proliferation were significantly over-expressed in both benign-in situ and benign-invasive lesions (p-values < 0.0104). In the population of 36 paired samples, differentially expressed genes were found to regulate the estrogen receptor (ESR1) through distinct network associations. Many genes are differentially expressed by benign and breast cancer lesions, and in situ/invasive histology contribute to the distinct molecular characteristics and pathways of breast malignancy. Our findings highlight the first study to assess expression profiling of paired benign and breast cancer lesions among African American women.
Citation Format: Andreana Natalie Holowatyj, Julie J. Ruterbusch, Rouba Ali-Fehmi, Sudeshna Bandyopadhyay, Christine Mehner, Melody Stallings Mann, Gregory Dyson, Derek Radisky, Michele L. Cote. Expression profiling of paired benign and breast cancer lesions in African American women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4253. doi:10.1158/1538-7445.AM2017-4253
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Affiliation(s)
| | | | | | | | | | | | - Gregory Dyson
- 1Wayne State University School of Medicine, Detroit, MI
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Rattan R, Dar S, Rasool N, Ali-Fehmi R, Giri S, Munkarah A. Depletion of immunosuppressive myeloid-derived suppressor cells impedes ovarian cancer growth. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abdulfatah E, Sakr S, Morris R, Munkarah A, Barbuto D, Euscher E, Frauenhoffer E, Montiel D, Malpica A, Silva E, Ali-Fehmi R. Mucinous differentiation is predictive of improved outcomes in low-grade endometrioid carcinoma. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.284] [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: 10/19/2022]
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Ruterbusch JJ, Cote ML, Boerner J, Abdulfatah E, Alosh B, Pardeshi V, Daaboul MHDF, Roquiz W, Ali-Fehmi R, Bandyopadhyay S. Abstract A15: Breast cancer subtype subsequent to a benign breast biopsy among African American women. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.carisk16-a15] [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] Open
Abstract
Abstract
Introduction: Most clinical models to estimate risk of invasive breast cancer include history of benign breast disease (BBD) as a covariate, as these women represent a higher risk group compared to the general population. A better understanding of the association between BBD and breast cancer is necessary to improve the utility of these risk models, particularly with respect to tumor subtype. This may be especially important for African American women who are more likely to present with aggressive cancers compared to white women. Here we present tumor subtypes from a higher risk cohort of African American women with a history of BBD.
Methods: Benign breast biopsies from 3,865 African American women with BBD diagnosed from 1997-2010 were examined for 14 benign features, and followed for subsequent breast cancers in metropolitan Detroit, Michigan using medical records and data from the Detroit Surveillance, Epidemiology and End Results (SEER) program. Immunohistochemistry analysis was performed for the following 6 markers: estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK 5/6) in order to categorize the subsequent breast cancers by subtype. Briefly, ER and PR were utilized to classify tumors as luminal or non-luminal, and then further classification was made based HER2. Luminal tumors were also classified by Ki-67 expression, and triple negative tumors (ER/PR/HER2 negative) were further classified based on expression of either CK5/6 or EGFR, resulting in 6 categories.
Results: 210 women (5.4% of the total cohort) with a subsequent breast cancer were identified over a median follow-up time of 12.3 years (range: 0.6 - 18.0). Analysis of all 6 markers is complete for half of the tumors (104). The majority of the subsequent cancers were invasive (n=72, 69.2%). Most of the invasive tumors were luminal B, HER2- (37.5%), followed by luminal A (31.9%), triple negative (19.4%), non-luminal, HER2+ (6.9%) and luminal B, HER2+ (4.2%). Of the 14 triple negative cancers (19.4%), 8 were negative for CK5/6 and EGFR (5 negative phenotype, 57.1%) and 6 were core basal (42.9%). Among the 32 in situ tumors, the majority were luminal A (n=26, 81.3%), followed by luminal B, HER2- (n=5, 15.6%) and there was a single tumor classified as 5 negative. Compared to population-based SEER data from 5,268 African American women with invasive breast cancer and available data on 3 markers (ER, PR, and HER2) diagnosed in 2010, our cohort is similar with respect to tumor subtype.
Conclusions: The women with a previous benign breast biopsy in our cohort who develop a subsequent breast cancer have subtypes that are similar to the general African American population in the United States. Thus, our BBD cohort represents the full spectrum of invasive breast cancers with respect to subtype, including triple negative tumors.
Citation Format: Julie J. Ruterbusch, Michele L. Cote, Julie Boerner, Eman Abdulfatah, Baraa Alosh, Vishakha Pardeshi, MHD Fayez Daaboul, Woodlyne Roquiz, Rouba Ali-Fehmi, Sudeshna Bandyopadhyay. Breast cancer subtype subsequent to a benign breast biopsy among African American women. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr A15.
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Cote ML, Chen W, Ruterbusch JJ, Abdulfatah E, Pardeshi V, Shaik AN, Ghanim MT, Daaboul MHDF, Visscher DW, Bandyopadhyay S, Ali-Fehmi R. Abstract A25: Benign breast disease and subsequent breast cancer risk: The Detroit cohort. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.carisk16-a25] [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] Open
Abstract
Abstract
Introduction: Atypical hyperplasia (also known as proliferative disease with atypia), while categorized as a benign finding, has been consistently associated with an increased risk of subsequent breast cancer that persists for decades after initial diagnosis. There are various other lesions that are classified as benign breast disease (BBD) that are routinely identified by pathologists that may also increase risk and be of use to inform breast cancer risk models. We sought to identify which BBD lesions were associated with increased risk of breast cancer in an African American (AA) cohort.
Methods: Benign breast biopsies from 3,895 AA women diagnosed with BBD between 1997 and 2010 in metropolitan Detroit were reviewed for 12 benign features including columnar alterations, ductal ectasia, ductal hyperplasia, fibrosis, apocrine metaplasia, lobular hyperplasia, calcifications, cysts, intraductal papilloma, radial scar, sclerosing adenosis, and fibroadenomas. Women were followed for subsequent breast cancer using the Metropolitan Detroit Cancer Surveillance System, part of the Surveillance, Epidemiology, and End Results (SEER) cancer registry. Associations between BBD features and subsequent breast cancer were examined using chi-square tests. Features that had a significant chi-square test result were also combined into scores describing the overall number of BBD features identified, termed busy breast score. Multivariable log-binomial regression with backward selection based on BIC criteria was performed to assess risk ratio and 95% confidence intervals of breast cancer on 12 candidate features. Multivariable log-binomial regression was performed for busy breast score as well. All regression models were adjusted for age at biopsy and overall impression for presence of proliferative disease with or without atypia using non-proliferative disease as the reference. Models were checked for multicollinearity using a variable inflation factor (VIF).
Results: Of the 3,895 AA women in the BBD cohort, 210 developed a subsequent breast cancer. The median age at biopsy among those without a subsequent cancer (controls) was 47 years of age, while cases were 53 years of age (p-value<0.001). In univariate analyses, ductal hyperplasia (p-value=0.001), lobular hyperplasia (p-value<0.001), calcifications (p-value<0.004), cysts (p-value=0.003), intra-ductal papilloma (p-value=0.005), sclerosing adenosis (p-value=0.002), columnar alterations (p-value<0.001) and radial scar (p-value=0.001) were associated with subsequent breast cancer. Fibroadenomas were inversely associated with subsequent breast cancer (p-value<0.001). In multivariable model after backwards selection, presence of columnar alterations was associated with increased risk of breast cancer, (RR=1.57, 95% CI: 1.16, 2.13). Combining the 9 BBD features associated with subsequent breast cancer in univariate analysis, those with a busy breast score of 5+ was associated with 2.5 times increased risk compared to those with none of these features (RR=2.52, 95% CI: 1.41, 4.49). As a continuous variable for busy breast score, each additional feature conferred a 20% increase in risk of breast cancer (RR=1.20, 95% CI: 1.10, 1.31).
Conclusions: Columnar alterations confer increased risk of breast cancer beyond the risks associated with atypical hyperplasia, as does the presence of multiple types of BBD lesions in a single biopsy. These estimates may help improve the current risk assessment models for African American women and highlight the need for additional research regarding the utility of closer surveillance and potentially chemoprevention for reduction of breast cancer in these women.
Citation Format: Michele L. Cote, Wei Chen, Julie J. Ruterbusch, Eman Abdulfatah, Visakha Pardeshi, Asra N. Shaik, Marcel T. Ghanim, MHD Fayez Daaboul, Daniel W. Visscher, Sudeshna Bandyopadhyay, Rouba Ali-Fehmi. Benign breast disease and subsequent breast cancer risk: The Detroit cohort. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr A25.
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Affiliation(s)
| | - Wei Chen
- 1Barbara Ann Karmanos Cancer Institute, Detroit, MI,
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