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Henning JSL, Fernandez EJ, Nielsen T, Hazel S. Play and welfare in domestic cats: Current knowledge and future directions. Anim Welf 2022. [DOI: 10.7120/09627286.31.4.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Play and welfare have long been linked within animal research literature, with play considered as both a potential indicator and promoter of welfare. An indicator due to observations that play is exhibited most frequently in times when an animal's fitness is not under threat and when
immediate needs such as food, water and adequate space are met. And a promoter, because of observations that animals who play more also have better welfare outcomes. However, limited research has been undertaken to investigate this link, especially in companion animals. The domestic cat (
Felis catus) is one of the most popular companion animals in the world, yet little is known about the impact of play behaviour on cat welfare. We review the current literature on play and welfare in cats. This includes examining the role of cat play in mitigating negative welfare outcomes,
such as reducing problem behaviours, one of the leading reasons for guardian dissatisfaction and cat relinquishment to shelters. Play is also discussed as a potential tool to provide environmental enrichment and to improve cat-human relationships. Future areas for research are suggested. We
find that further research is needed that uses a multifaceted approach to assess how quantity, type and quality of play impact subsequent cat behaviour and welfare. Future research could also assess cat play needs and preferences as well as investigate the role of play in mitigating threats
to cat welfare such as reducing problem behaviour and improving human-cat relationships. If play is an indicator and promoter of welfare, studies into the impact of play may offer an accessible approach for monitoring and improving domestic cat welfare.
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Affiliation(s)
- JSL Henning
- University of Adelaide, School of Animal and Veterinary Sciences, South Australia, Australia
| | - EJ Fernandez
- University of Adelaide, School of Animal and Veterinary Sciences, South Australia, Australia
| | - T Nielsen
- University of Adelaide, School of Animal and Veterinary Sciences, South Australia, Australia
| | - S Hazel
- University of Adelaide, School of Animal and Veterinary Sciences, South Australia, Australia
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2
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Chan VWS, Keeley F, Lagerveld B, Breen D, King A, Nielsen T, van Strijen M, Garnon J, Alcorn D, Graumann O, de Kerviler E, Zondervan P, Walkden M, Lughezzani G, Wah TM. 455 The Changing Trends of Image Guided Biopsy of Small Renal Masses Before Intervention- an Analysis of European Multinational Prospective EuRECA Registry. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.502] [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: 11/07/2022]
Abstract
Abstract
Aim
To evaluate the use of pre-cryoablation biopsy for small renal masses (SRMs) and the effects of increasing up take on histological results of treated SMRs.
Method
From 2015 to 2019, patients with sporadic T1N0M0 SRMs undergoing percutaneous, laparoscopic or open cryoablation from 14 European institutions within the European Registry For Renal Cryoablation (EuRECA) were included for the retrospective analysis. Univariate and multivariate logistic models were used to evaluate the trends, histological results and the factors influencing use of pre-cryoablation biopsy.
Results
871 patients (Median [IQR] age, 69[14], 298 women) undergoing cryoablation were evaluated. The use of pre-cryoablation biopsy has significantly increased from 42% (65/156) in 2015 to 72% (88/122) in 2019 (p<0.001). Patients treated for a benign histology are significantly more likely to have presented later in the trend, where pre-cryoablation biopsy is more prevalent (OR: 0.64, 95% CI 0.51–0.81, p<0.001). Patients treated for undiagnosed histology are also significantly less likely to have presented in 2018 compared to 2016 (OR 0.31, 95% CI 0.10–0.97, p=0.044). Patients aged 70+ are less likely to be biopsies pre-cryoablation (p<0.05). R.E.N.A.L. nephrometry score of 10+ and a Charlson Comorbidity Index >1 are factors associated with lower likelihood to not have received a pre-cryoablation biopsy (p<0.05).
Conclusion
An increased use of pre-cryoablation biopsy was observed and cryoablation patients treated with a benign histology is more likely to have presented in periods where pre-cryoablation biopsy is not as prevalent. Comparative studies are needed to draw definitive conclusions on the effect of pre-cryoablation biopsy on SRM treatments.
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Affiliation(s)
- VWS Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds , Leeds , United Kingdom
- Department of Targeted Intervention, Division of Surgery and Interventional Science, University College London , London , United Kingdom
| | - F Keeley
- Bristol Urological Institute, North Bristol NHS Trust , Bristol , United Kingdom
| | - B Lagerveld
- Department of Urology, OLVG , Amsterdam , Netherlands
| | - D Breen
- Department of Radiology, Southampton University Hospitals , Southampton , United Kingdom
| | - A King
- Department of Radiology, Southampton University Hospitals , Southampton , United Kingdom
| | - T Nielsen
- Department of Urology, Aarhus University Hospital , Aarhus , Denmark
| | - M van Strijen
- Department of Radiology, St Antonius Hospital , Nieuwegein , Netherlands
| | - J Garnon
- Department of Interventional Radiology , Nouvel Hôpital Civil, 1 place de l’Hôpital 67000 Strasbourg , France
| | - D Alcorn
- Department of Interventional Radiology, Gartnavel General Hospital , Glasgow , United Kingdom
| | - O Graumann
- Department of Radiology, Odense University Hospital , Odense , Denmark
| | - E de Kerviler
- Radiology Department, Saint-Louis Hospital , Paris , France
| | - P Zondervan
- Department of Urology , 26066 Amsterdam UMC, , Amsterdam , Netherlands
- University of Amsterdam , 26066 Amsterdam UMC, , Amsterdam , Netherlands
| | - M Walkden
- Department of Imaging, University College London Hospitals NHS Foundation Trust , London , United Kingdom
| | - G Lughezzani
- Vita-Salute San Raffaele University, Department of Urology , Milan , Italy
| | - TM Wah
- Department of Diagnostic and Interventional Radiology, Institute of Oncology, Leeds Teaching Hospitals Trust, St James’s University Hospital , Leeds , United Kingdom
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Antoniotti C, Boccaccino A, Seitz R, Giordano M, Rossini D, Ambrosini M, Salvatore L, McGregor K, Bergamo F, Conca V, Leonetti S, Provenzano L, Tamberi S, Ramundo M, Tortora G, Rasola C, Ross D, Passardi A, Nielsen T, Varga M, Cremolini C. SO-36 An immune-related gene expression profile predicts the efficacy of adding atezolizumab to first-line FOLFOXIRI/bevacizumab in metastatic colorectal cancer: A translational analysis of the phase II randomized AtezoTRIBE study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.434] [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: 11/01/2022] Open
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4
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Varga M, Nielsen T, Vidal G, Hout D, Ross D, Seitz R, Schweitzer B. P60.10 A 27-Gene IO Assay to Capture the Tumor Immune Microenvironment Is Associated With Response in Metastatic and Primary Tumors. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.631] [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: 10/20/2022]
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5
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Hout D, Nielsen T, Schweitzer B, Seitz R, Vidal G. PR01.04 A Novel Immunomodulatory Signature Improves Prediction of Response to Immunotherapy Compared to PD-L1 IHC in NSCLC Patients. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Hout D, Seitz R, Bailey D, Schweitzer B, Nielsen T, Vidal G. PR01.03 A Novel 27-Gene Signature Associated with Better Outcomes for NSCLC Patients Treated with IO Therapies with PD-L1 Expression >50%. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.080] [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: 11/25/2022]
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7
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Jaafar R, Ødegård J, Mathiessen H, Karami AM, Marana MH, von Gersdorff Jørgensen L, Zuo S, Nielsen T, Kania PW, Buchmann K. Quantitative trait loci (QTL) associated with resistance of rainbow trout Oncorhynchus mykiss against the parasitic ciliate Ichthyophthirius multifiliis. J Fish Dis 2020; 43:1591-1602. [PMID: 32944955 PMCID: PMC7692903 DOI: 10.1111/jfd.13264] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
The parasitic ciliate Ichthyophthirius multifiliis has a low host specificity eliciting white spot disease (WSD) in a wide range of freshwater fishes worldwide. The parasite multiplies rapidly whereby the infection may reach problematic levels in a host population within a few days. The parasite targets both wild and cultured fish but the huge economic impact of the protozoan is associated with mortality, morbidity and treatment in aquacultural enterprises. We have investigated the potential for genetic selection of WSD-resistant strains of rainbow trout. Applying the DNA typing system Affymetrix® and characterizing the genome of the individual fish by use of 57,501 single nucleotide polymorphisms (SNP) and their location on the rainbow trout chromosomes, we have genetically characterized rainbow trout with different levels of natural resistance towards WSD. Quantitative trait loci (QTL) used for the selection of breeders with specific markers for resistance are reported. We found a significant association between resistance towards I. multifiliis infection and SNP markers located on the two specific rainbow trout chromosomes Omy 16 and Omy 17. Comparing the expression of immune-related genes in fish-with and without clinical signs-we recorded no significant difference. However, trout surviving the infection showed high expression levels of genes encoding IgT, T-cell receptor TCRβ, C3, cathelicidins 1 and 2 and SAA, suggesting these genes to be associated with protection.
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Affiliation(s)
- R Jaafar
- Laboratory of Aquatic PathobiologyDepartment of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg C.Denmark
| | | | - H Mathiessen
- Laboratory of Aquatic PathobiologyDepartment of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg C.Denmark
| | - A M Karami
- Laboratory of Aquatic PathobiologyDepartment of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg C.Denmark
| | - M H Marana
- Laboratory of Aquatic PathobiologyDepartment of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg C.Denmark
| | - L von Gersdorff Jørgensen
- Laboratory of Aquatic PathobiologyDepartment of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg C.Denmark
| | - S Zuo
- Laboratory of Aquatic PathobiologyDepartment of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg C.Denmark
| | | | - P W Kania
- Laboratory of Aquatic PathobiologyDepartment of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg C.Denmark
| | - K Buchmann
- Laboratory of Aquatic PathobiologyDepartment of Veterinary and Animal SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenFrederiksberg C.Denmark
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8
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Picard-Deland C, Pastor M, Solomonova E, Paquette T, Nielsen T. 0088 Gravity Dreams Following a Virtual Reality Flight Simulation. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.086] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Flying is a prevalent but infrequent experience in dreams. Despite a broad interest in such unique dream experiences, there is still no experimental procedure for reliably inducing them. Our study aimed 1) to induce flying dreams in the laboratory using virtual reality (VR), 2) to examine phenomenological correlates of flying dreams, such as lucidity and emotions and 3) to investigate the dynamics of dreamed gravity imagery in relation to participant state and trait factors.
Methods
A total of 137 healthy participants (24.01±4.03 y.o.; 85 F; 52 M) took part in a custom-built immersive VR task in which they learn how to ‘fly’ as precisely and quickly as possible, engaging vestibular, motor and visuo-spatial systems. Dreams were collected a) from home dream journals for 5 days before and 10 days after the laboratory VR task and b) after a 90-min morning nap in laboratory. Dream reports were scored by 2 independent judges for flying and other gravity-related imagery. Linear mixed models statistics were used to compare dreams from this cohort with a separate control cohort (N=52) that followed a similar protocol in the same lab but did not undertake a virtual flying task.
Results
The VR task successfully increased the likelihood of experiencing flying in dreams from both the laboratory nap (7.1%) and the following night (10.6%) compared to baseline (1.3%) and the control cohort on those days (Lab: 2.4%; following night: 0%). In contrast, the occurrence of other gravity imagery showed no differences. Flying dreams were altered qualitatively, exhibiting higher levels of lucid-control and emotional intensity after VR exposure. Moreover, various factors such as sex, prior dream experiences and sensory immersion in VR differentially modulated flying dream induction.
Conclusion
Our findings provide both quantitative and qualitative insights into flying dreams that may facilitate understanding of these typical dream experiences and future developments in dream flight-induction technologies.
Support
Natural Sciences and Engineering Research Council of Canada
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Affiliation(s)
- C Picard-Deland
- Université de Montréal, Neuroscience Department, Montreal, QC, CANADA
| | - M Pastor
- Dream & Nightmare Laboratory; Center for Advanced Research in Sleep Medicine, Montreal, QC, CANADA
| | - E Solomonova
- McGill University; Department of Psychiatry, Montreal, QC, CANADA
| | - T Paquette
- Dream & Nightmare Laboratory; Center for Advanced Research in Sleep Medicine, Montreal, QC, CANADA
| | - T Nielsen
- Dream & Nightmare Laboratory; Center for Advanced Research in Sleep Medicine, Montreal, QC, CANADA
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9
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Powell R, Nielsen T. The relationship of nightmares, insomnia, cataplexy, mirror behaviors, and psychological distress to suicidal ideation in undergraduate students. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.861] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Hinerfeld D, Chumsri S, Asleh K, Brauer H, Kachergus J, Lauttia S, Lindman H, Nielsen T, Joensuu H, Thompson A. Effects of immune architecture on response to adjuvant capecitabine in triple negative breast cancer (FinXX trial). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Morschhauser F, Ghosh N, Lossos I, Palomba M, Mehta A, Casasnovas O, Stevens D, Chitra S, Knapp A, Nielsen T, Oestergaard M, Wenger M, Salles G. EFFICACY AND SAFETY OF OBINUTUZUMAB + LENALIDOMIDE + ATEZOLIZUMAB IN PATIENTS WITH RELAPSED OR REFRACTORY FOLLICULAR LYMPHOMA: PRIMARY ANALYSIS OF A PHASE 1B/2 TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.74_2629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- F. Morschhauser
- Institute of Hematology-Transfusion; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - N. Ghosh
- Hematologic Oncology and Blood Disorders; Levine Cancer Institute/Atrium Health; Charlotte NC United States
| | - I. Lossos
- Division of Hematology; Department of Medicine, University of Miami; Miami FL United States
| | - M.L. Palomba
- Department of Medicine; Memorial Sloan Kettering Cancer Center; New York NY United States
| | - A. Mehta
- Division of Hematology and Oncology; University of Alabama School of Medicine; Birmingham Alabama United States
| | - O. Casasnovas
- Service d'Hématologie clinique; CHU Dijon Bourgogne - Hôpital François Mitterrand; Dijon France
| | - D. Stevens
- Norton Cancer Institute; Norton Healthcare; Louisville KY United States
| | - S. Chitra
- Product Development Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - A. Knapp
- Product Development Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - T. Nielsen
- Product Development Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - M. Oestergaard
- Oncology Biomarker Development; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - M. Wenger
- Product Development Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - G. Salles
- Haematology Department; Université Claude Bernard de Lyon, Lyon University Hospital; Villeurbanne France
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12
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Berry D, Broglio K, Ward C, Sahin D, Nielsen T, Mattiello F, McGlothlin A, Wendelberger B, Foster M, Nowakowski G, Kostakoglu L. PET-CR AS A SURROGATE FOR SURVIVAL OUTCOMES IN DLBCL: A LITERATURE BASED META-ANALYSIS. Hematol Oncol 2019. [DOI: 10.1002/hon.59_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- D.A. Berry
- Biostatistics; M.D. Anderson Cancer Center; Houston TX United States
| | - K.R. Broglio
- Biostatistics; Berry Consultants, LLC; Austin United States
| | - C. Ward
- PDBB; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - D. Sahin
- PDO; F. Hoffmann-La Roche Ltd., BASEL; Switzerland
| | - T. Nielsen
- PDO; F. Hoffmann-La Roche Ltd., BASEL; Switzerland
| | - F. Mattiello
- PDBB; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | | | | | - M. Foster
- Biostatistics; Berry Consultants, LLC; Austin United States
| | - G.S. Nowakowski
- Lymphoma Group; Mayo Clinic Rochester; Rochester United States
| | - L. Kostakoglu
- Radiology; Icahn School of Medicine at Mount Sinai; NY United States
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13
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Chauvie S, Dalmasso F, Pierce L, Vitolo U, Martelli M, Sehn L, Trněný M, Nielsen T, Sahin D, Lee C, Mattiello F, Berchialla P, Kinahan P, Kostakoglu L. RADIOMICS INCREASE THE PROGNOSTIC VALUE OF CLINICAL AND PET RISK FACTORS IN DLBCL: RESULTS FROM THE PHASE 3 GOYA STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.21_2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S. Chauvie
- Medical Physics Division; Santa Croce e Carle Hospital; Cuneo Italy
| | - F. Dalmasso
- Medical Physics Division; Santa Croce e Carle Hospital; Cuneo Italy
| | - L. Pierce
- Department of Radiology; University of Washington; Seattle WA United States
| | - U. Vitolo
- Department of Oncology and Haematology; Azienda Ospedaliera-Universitaria Città della Salute e della Scienza; Turin Italy
| | - M. Martelli
- Department of Translational and Precision Medicine; Sapienza University of Rome; Rome Italy
| | - L.H. Sehn
- Medical Oncology; University of British Columbia; Vancouver Canada
| | - M. Trněný
- 1st Department of Medicine - Department of Haematology; Charles University General Hospital; Prague Czech Republic
| | - T. Nielsen
- Product Development Oncology; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - D. Sahin
- Product Development Oncology; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - C. Lee
- Product Development Oncology; Genentech, Inc.; South San Francisco United States
| | - F. Mattiello
- Product Development Oncology; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - P. Berchialla
- Clinical and Biological Sciences; University of Turin; Turin Italy
| | - P.E. Kinahan
- Department of Radiology; University of Washington; Seattle WA United States
| | - L. Kostakoglu
- Department of Radiology; Icahn School of Medicine; New York United States
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Trněný M, Canales Ruiz I, Martelli M, Sehn L, Vitolo U, Brown H, Nielsen T, Sellam G, Kostakoglu L. BASELINE TOTAL METABOLIC TUMOUR VOLUME IS HIGHLY PROGNOSTIC FOR REFRACTORINESS TO IMMUNOCHEMOTHERAPY IN DLBCL: AN ANALYSIS OF THE PHASE 3 GOYA TRIAL. Hematol Oncol 2019. [DOI: 10.1002/hon.20_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- M. Trněný
- 1st Department of Medicine - Department of Haematology; Charles University, General Hospital; Prague Czech Republic
| | - I. Canales Ruiz
- Product Development Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - M. Martelli
- Department of Translational and Precision Medicine; Sapienza University of Rome; Rome Italy
| | - L.H. Sehn
- Medical Oncology; University of British Columbia; Vancouver Canada
| | - U. Vitolo
- Department of Oncology and Haematology; Azienda Ospedaliera-Universitaria Città della Salute e della Scienza; Turin Italy
| | - H. Brown
- on assignment to Roche Products Ltd; Welwyn Garden City; United Kingdom
| | - T. Nielsen
- Product Development Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - G. Sellam
- Product Development Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - L. Kostakoglu
- Department of Radiology; Icahn School of Medicine at Mount Sinai; New York United States
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15
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Acs B, Leung SC, Pelekanou V, Bai Y, Martinez-Morilla S, Toki M, Chang MC, Gholap A, Jadhav A, Hugh JC, Bigras G, Laurinavicius A, Augulis R, Levenson R, Todd A, Piper T, Virk S, van der Vegt B, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Abstract P4-02-01: Analytical validation of an automated digital scoring protocol for Ki67: International multicenter collaboration study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background/Goal: Ki67 expression has been a valuable prognostic marker in breast cancer, but has not seen broad adoption due to lack of standardization between institutions. Automation could represent a solution. Here we tested 3 automated digital image analysis (DIA) platforms including an open source platform to: (i) Investigate the reproducibility of Ki67 measurement across platforms with supervised classifiers performed by the same operator and by multiple operators. (ii) Compare accuracy of the 3 DIA platforms against outcome (prognostic potential). (iii) Assess inter-laboratory reproducibility of a calibrated DIA tool to evaluate Ki67 in breast cancer among 10 participating labs of the International Ki67 in Breast Cancer Working Group (IKWG).
Methods: The Mib-1 antibody (Dako) was used to detect Ki67 (dilution 1:100). HALO (H) (IndicaLabs), QuantCenter (QC) (3DHistech), QuPath (QP) (open-source software) digital image analysis (DIA) platforms were used to evaluate Ki67 expression. As a ground truth, we evaluated Ki67 LI with meticulous manual tissue segmentation using the Spectrum Webscope (SW) (Aperio). Calibration was performed using 30 ER+ breast cancer cases from phase 3 of the IKWG initiative where blocks were centrally cut and stained for Ki67. The inter-laboratory analysis was done with 10 participating laboratories divided into 2 groups where members within the same group were given the same set of images. The outcome cohort consisted of 149 breast cancer cases from the Yale Pathology archives in tissue microarray format. Intra-class correlation coefficient (ICC) was used to measure reproducibility with the pre-specified criterion for success being to exceed 0.80. Kaplan-Meier analysis supported with log-rank test was performed to assess prognostic potential.
Results: All 3 DIA platforms showed excellent inter-platform reproducibility (ICC: 0.933, CI: 0.879-0.966). Also, excellent reproducibility was found between all DIA platforms and the reference standard Ki67 values of SW (QP ICC: 0.970, CI: 0.936-0.986; H ICC: 0.968, CI: 0.933-0.985; QC ICC: 0.964, CI: 0.919-0.983). The intra-DIA reproducibility was also excellent for all platforms (QP ICC: 0.992, CI: 0.986-0.996; H ICC: 0.972, CI: 0.924-0.988; QC ICC: 0.978, CI: 0.932-0.991). Comparing each DIA against outcome, the hazard ratios were similar (QP=3.309, H=3.077, QC=3.731). The inter-operator reproducibility was particularly high (ICC: 0.962-0.995). As QP is open source software and also showed the lowest intra-DIA platform variability, we selected the QP platform to investigate inter-laboratory reproducibility among 10 IKWG labs. The different-section ICC across the 10 labs was 0.974 (CI: 0.954 - 0.986). The same-section ICC estimate was 0.984 (CI: 0.971-0.992) for group 1 and 0.978 (CI: 0.956-0.989) for group 2.
Conclusions: Our results showed outstanding reproducibility both within and between DIA platforms. We also found the platforms essentially indistinguishable with respect to prediction of breast cancer patient outcome. Automated Ki67 evaluation using a calibrated, open-source DIA platform (QuPath) met the pre-specified criterion of success in the multi-institutional setting. Assessment of clinical utility is planned.
Citation Format: Acs B, Leung SC, Pelekanou V, Bai Y, Martinez-Morilla S, Toki M, Chang MC, Gholap A, Jadhav A, Hugh JC, Bigras G, Laurinavicius A, Augulis R, Levenson R, Todd A, Piper T, Virk S, van der Vegt B, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Analytical validation of an automated digital scoring protocol for Ki67: International multicenter collaboration study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-01.
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Affiliation(s)
- B Acs
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - SC Leung
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - V Pelekanou
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - Y Bai
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - S Martinez-Morilla
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - M Toki
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - MC Chang
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - A Gholap
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - A Jadhav
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - JC Hugh
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - G Bigras
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - A Laurinavicius
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - R Augulis
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - R Levenson
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - A Todd
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - T Piper
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - S Virk
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - B van der Vegt
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - DF Hayes
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - M Dowsett
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - TO Nielsen
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
| | - DL Rimm
- Yale School of Medicine, New Haven, CT; Karolinska Institute, Stockholm, Sweden; University of British Columbia, Vancouver, BC, Canada; Sinai Health System and University of Toronto, Toronto, ON, Canada; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; University of Alberta, Edmonton, AB, Canada; Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, Kingston, ON, Canada; University of Groningen, University Medical Center Groningen, Groningen, Netherlands; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Institute of Cancer Research, London, United Kingdom
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Chumsri S, Asleh K, Brauer HA, Mashadi-Hossein A, Lauttia LS, Lindman H, Nielsen TO, Joensuu H, Thompson EA. Abstract P3-11-05: Predictive gene signatures of adjuvant capecitabine benefit in triple negative breast cancer in the FinXX trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-11-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent studies have demonstrated a benefit of adjuvant capecitabine in early stage breast cancer, particularly in patients with residual disease after neoadjuvant chemotherapy. Subset analyses suggest that patients with triple negative breast cancer (TNBC) may be more likely to benefit with capecitabine in this setting. However, more precise biomarkers to predict which patients are most likely to benefit from capecitabine are needed.
Methods: The NanoString Breast Cancer 360TM (BC360) panel was used to quantify mRNA expression in FFPE tissue samples from patients with TNBC in the FinXX trial. Gene signature scores were analyzed using prespecified algorithms developed by NanoString. 30 additional custom genes related to capecitabine metabolism and function were added. Patients in FinXX trial were randomized to receive either 3 cycles of docetaxel followed by 3 cycles of cyclophosphamide, epirubicin, and fluorouracil (T+CEF) or 3 cycles of docetaxel plus capecitabine followed by 3 cycles of cyclophosphamide, epirubicin, and capecitabine (TX+CEX). Cox proportional hazard ratio (HR) was used to determine the association of each gene signature with recurrence free survival (RFS).
Results: A total of 111 samples from patients with TNBC in the FinXX trial were available for gene expression analysis. 57 patients were treated with T+CEF and 54 patients were treated with TX+CEX. The median age was 52 years and median follow up was 10.2 years. Consistent with the previous analysis of the FinXX trial, patients with TNBC had nonsignificant but favorable RFS with capecitabine (HR 0.60, 95% CI 0.27-1.3, p 0.2). Among 39 individual genes and metagene signatures generated with the BC360 panel, there were 4 gene signatures significantly associated with improved RFS favoring an addition of capecitabine with TX+CEX compared to T+CEF. These were the cytotoxic cell signature (HR 0.37, 95%CI 0.15-0.92, p 0.03), endothelial signature (HR 0.18, 95%CI 0.04-0.83, p 0.03), mast cell signature (HR 0.43, 95%CI 0.21-0.88, p 0.02), and PDL2 gene (HR 0.29, 95%CI 0.09-0.99, p 0.05). PAM50 intrinsic subtype was not predictive of capecitabine benefit within this TNBC subset. Moreover, we identified additional individual 12 genes that were significantly associated with capecitabine benefit (p-FDR<0.05). Among these genes, high expression of CES1, which encodes an enzyme that activates capecitabine, was significantly associated with improved RFS when treated with capecitabine (HR 0.71, 95%CI 0.32-1.61 with p-interaction=0.04).
Conclusion: Our analyses demonstrated potential predictive individual genes and metagene signatures that may be used to identify TNBC patients who are more likely to benefit from adjuvant capecitabine. Interestingly, several gene signatures related to immune response and genes related to capecitabine activation were associated with improved outcome in TNBC patients treated with capecitabine in the FinXX trial. While these findings are compatible with basic science reports, future studies are needed to validate the significance of these gene signatures as predictive biomarkers for capecitabine benefit.
Citation Format: Chumsri S, Asleh K, Brauer HA, Mashadi-Hossein A, Lauttia LS, Lindman H, Nielsen TO, Joensuu H, Thompson EA. Predictive gene signatures of adjuvant capecitabine benefit in triple negative breast cancer in the FinXX trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-11-05.
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Affiliation(s)
- S Chumsri
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
| | - K Asleh
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
| | - HA Brauer
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
| | - A Mashadi-Hossein
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
| | - LS Lauttia
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
| | - H Lindman
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
| | - TO Nielsen
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
| | - H Joensuu
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
| | - EA Thompson
- Mayo Clinic, Jacksonville, FL; The University of British Columbia, Vancouver, BC, Canada; NanoString, Seattle, WA; University of Helsinki, Helsinki, Finland; Uppsala University Hospital, Uppsala, Sweden
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Cheng AS, Leung SC, Gao D, Anurag M, Nielsen T, Ellis MJ. Abstract P1-06-02: Mismatch repair protein loss in breast cancer: Clinicopathological associations in a large British Columbia cohort. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Alterations to mismatched repair (MMR) pathways are a known cause of cancer (particularly colorectal and endometrial). Recently, the FDA approved pembrolizumab for use in MMR-deficient (MMRD) cancers of any type, and the diagnosis can be made by immunohistochemistry (IHC) or genomic methods. In breast cancer, mutational process analyses indicate MMRD occurs in about 2% of breast cancer (Cancer Res; 77; 4755-62, 2017) and recent functional studies have shown associations with resistance to endocrine therapy and sensitivity to CDK4/6 inhibitors (Cancer Discov; 7; 1168-83, 2017). To date, insufficient cases have been assembled to power meaningful associative or survival studies. Herein, the strong correlation between IHC-determined loss of MLH1, PMS2, MSH2 or MSH6 and genomic evidence allowed the assessment of MMRD on a large tissue microarray (TMA) series linked to detailed biomarkers and long-term outcome data.
Methods: IHC markers MLH1, PMS2, MSH2 and MSH6 were optimized on the Ventana automated stainer for application to breast cancer TMAs. The patient cohort consists of females from British Columbia diagnosed with primary invasive breast carcinoma in 1986-1992, referred to the British Columbia Cancer Agency for treatment and follow-up. TMA blocks were sectioned and stained. Slides were scored by a pathologist and only nuclear positivity was evaluated positive. Loss of nuclear positivity for any one of the four tested marker defined MMRD. Clinicopathological associations were tested by Chi-square, and survival by Kaplan-Meier plot with log rank test.
Result: 1635 cases were interpretable for all MMR markers. 31 cases (1.9%) met criteria for MMRD. 6 cases had paired losses (4 MLH1-PMS2 loss, 2 MSH2-MSH6 loss) and the remaining 25 cases had singular MMR loss (11 PMS2 loss, 10 MLH1 loss, 3 MSH6 loss, 1 MSH2 loss). Deficiency of the the MutL complex (MLH1/PMS2) predominated over the MutS complex (MSH2/MSH6).
Among the demographic and pathological variables assessed – age, grade, tumour size, lymphovascular invasion, nodal and menstrual status – high grade is associated with MMRD (p=0.014). In terms of biomarker, MMRD is significantly associated with PR negativity (p=0.003) and PD-L1 expression (p=0.049), but not with ER, Her2, Ki67, or basal breast cancer IHC markers, nor does MMRD significantly correlate with any of the established major intrinsic subtypes of breast cancer. Tumor infiltrating lymphocyte (TIL) counts are higher in MMRD cases (p=0.009). Although statistically not significant (small numbers), Kaplan-Meier plots of survival analysis demonstrated a trend for MMR loss to be associated with decreased breast cancer disease-specific and overall survival.
Conclusion: This large series assessed by IHC corroborates findings from smaller genomic series that MMRD is present in about 2% of breast cancers. MMRD tumors are more likely to be high grade, low PR and immunologically active (higher PD-L1 expression and TIL counts). MMR deficiency is present across all major molecular subtypes (luminal, HER2, basal). Given the efficacy of PD1/PDL1 targeting agents in MMR deficient tumors of other types, evidence for the activity of these agents in MMR deficient breast cancers should be actively sought.
Citation Format: Cheng AS, Leung SC, Gao D, Anurag M, Nielsen T, Ellis MJ. Mismatch repair protein loss in breast cancer: Clinicopathological associations in a large British Columbia cohort [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-06-02.
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Affiliation(s)
- AS Cheng
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; Baylor College of Medicine, Houston, TX
| | - SC Leung
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; Baylor College of Medicine, Houston, TX
| | - D Gao
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; Baylor College of Medicine, Houston, TX
| | - M Anurag
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; Baylor College of Medicine, Houston, TX
| | - T Nielsen
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; Baylor College of Medicine, Houston, TX
| | - MJ Ellis
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; Baylor College of Medicine, Houston, TX
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Crusell M, Hansen T, Nielsen T, Allin K, Ruehlemann M, Damm P, Vestergaard H, Roerbye C, Joergensen N, Christiansen O, Heinsen FA, Franke A, Hansen T, Lauenborg J, Pedersen O. Gestational diabetes is associated with an aberrant gut microbiota during pregnancy and postpartum. J Reprod Immunol 2018. [DOI: 10.1016/j.jri.2018.05.040] [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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Burugu S, Gao D, Leung S, Chia SK, Nielsen TO. LAG-3+ tumor infiltrating lymphocytes in breast cancer: clinical correlates and association with PD-1/PD-L1+ tumors. Ann Oncol 2018; 28:2977-2984. [PMID: 29045526 DOI: 10.1093/annonc/mdx557] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Novel immune checkpoint blockade strategies are being evaluated in clinical trials and include targeting the lymphocyte activation gene 3 (LAG-3) checkpoint, alone or in combination with PD-1/PD-L1 blockade. We investigated LAG-3 expression and its prognostic value in a large series of breast cancer patients, and correlated LAG-3 expression with key biomarkers including PD-1 and PD-L1. Experimental design LAG-3 expression was evaluated by immunohistochemistry on two tissue microarray series incorporating 4322 breast cancer primary excision specimens (N = 330 in the training and N= 3992 in the validation set) linked to detailed clinicopathologic, biomarker and long-term clinical outcome data. PD-1 and PD-L1 expressions were also evaluated by immunohistochemistry. Stromal or intra-epithelial tumor infiltrating lymphocytes (sTILs or iTILs) expressing LAG-3 or PD-1 were assessed by absolute count. PD-L1 expression was evaluated as the percentage of positive carcinoma cells per core. Kaplan-Meier curves and Cox proportional hazard models were used for survival analyses. Results After locking down interpretation cut-offs on the training set, LAG-3+ iTILs were found in 11% of cases in the validation set. In both sets, LAG-3+ iTILs were significantly associated with negative prognostic factors: young age, large tumor size, high proliferation, HER2E and basal-like breast cancer subtypes. In multivariate analyses, breast cancer patients with LAG-3+ iTILs had a significantly improved breast cancer-specific survival [hazard ratio (HR): 0.71, 95% CI 0.56-0.90], particularly among estrogen receptor-negative patients (HR: 0.50, 95% CI 0.36-0.69). Furthermore, we found that 53% of PD-L1+ and 61% of PD-1+ cases were also positive for LAG-3+ iTILs. Concurrent infiltration of LAG-3+ and CD8+ iTILs was significantly associated with increased breast cancer-specific survival (HR: 0.49, 95% CI 0.32-0.74). Conclusion LAG-3+ iTILs are enriched in estrogen receptor-negative breast cancers and represent an independent favorable prognostic factor. In addition, a high proportion of PD-1/PD-L1+ tumors are co-infiltrated with LAG-3+ TILs, supporting potential immune checkpoint blockade combination strategies as a treatment option for breast cancer patients.
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Affiliation(s)
- S Burugu
- Genetic Pathology Evaluation Centre.,Pathology and Laboratory Medicine Department, University of British Columbia, Vancouver
| | - D Gao
- Genetic Pathology Evaluation Centre
| | - S Leung
- Genetic Pathology Evaluation Centre
| | - S K Chia
- British Columbia Cancer Agency, Vancouver, Canada
| | - T O Nielsen
- Genetic Pathology Evaluation Centre.,Pathology and Laboratory Medicine Department, University of British Columbia, Vancouver
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Schytte T, Nielsen T, Moeller D, Hoffmann L, Khalil A, Knap M, Lund M, Nyhus C, Hansen T, Ottosson W, Borissova S, Appelt A, Brimk C, Hansen O. PO-0754: Safe inhomogeneus RT dose escalation in locally advanced NSCLC, -interim results from NARLAL2. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Asleh-Aburaya K, Lyck Carstensen S, Burugu S, Gao D, Tykjær Jørgensen CL, Won JR, Jensen MB, Balslev E, Lænkholm AV, Nielsen DL, Ejlertsen B, Nielsen TO. Abstract P2-10-02: Basal biomarkers nestin and INPP4b predict gemcitabine benefit in metastatic breast cancer: Results from the phase III SBG0102 clinical trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-10-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A growing body of evidence is suggesting that basal-like and triple negative breast cancers may be particularly sensitive to nucleoside analogues (gemcitabine, capecitabine). In a prospective-retrospective analysis of the phase III SBG0102 clinical trial randomizing metastatic breast cancer patients to gemcitabine plus docetaxel (GD) or to higher-dose single agent docetaxel (D), patients with basal-like breast cancer by PAM50 gene expression had significantly better overall survival (OS) in the gemcitabine arm. By immunohistochemistry (IHC), triple negative status was not predictive, but is a poor surrogate for the basal-like intrinsic subtype. More accurate IHC biomarkers have since become available defining basal-like breast cancers by nestin positivity or by loss of inositol polyphosphate-4-phosphate (INPP4b).
Methods: Formalin-fixed paraffin embedded blocks of primary tumor tissue corresponding to 270 of the 337 patients participated in the SBG0102 trial were used to build tissue microarrays. IHC staining and interpretation for nestin and INPP4b by pathologists (who had no access to clinical data) followed published methods. A prespecified statistical plan was executed independently by Danish Breast Cancer Group statisticians, testing the primary hypothesis that patients with basal breast cancer – defined as positive for nestin or negative for INPP4b, regardless of ER/PR/HER2 status – would have superior OS on the GD treatment arm when compared to the D treatment arm by interaction test. Secondary outcomes included time to tumor progression (TTP) and response rate. Kaplan-Meier method with log-rank test of nestin and INPP4b status was used to measure OS and TTP. Forest plots were used to visualize predictive capacities relative to IHC markers and treatment effects.
Results: Two hundred fifty two cases were evaluable for this study, among which 38 (15%) had been classified as basal-like, 45 (18%) as HER2-Enriched, 74 (29%) as luminal A and 91 (36%) as luminal B by PAM50. Among 241 cases being evaluable for both IHC nestin and INPP4b markers, positive staining of nestin or loss of INPP4b was observed in 43 (17%) of the total cases and was significantly associated with PAM50 basal-like subtype (p<0.0001). Within a median follow up of 13 years, patients assigned as IHC-basal by virtue of being “nestin+ or INPP4b-” demonstrated a significantly lower OS when compared to non-basal cases defined as “nestin- and INPP4b+” (HR=2.45, 95% CI: 1.47-4.07) (p=0.0006). The IHC-basal patients did much better on the GD vs. the D arm (HR=0.36, 95% CI: 0.19-0.68) whereas there was no such difference in outcomes for other patients (HR=0.99). The interaction test was significant (p-interaction<0.005).
Conclusions: The nestin/INPP4b IHC panel offers a practical and inexpensive technology to identify basal-like patients. In the metastatic setting, women with IHC-basal breast cancers defined using these markers have superior overall survival when randomized to gemcitabine-containing chemotherapy compared to docetaxel alone.
Citation Format: Asleh-Aburaya K, Lyck Carstensen S, Burugu S, Gao D, Tykjær Jørgensen CL, Won JR, Jensen M-B, Balslev E, Lænkholm A-V, Nielsen DL, Ejlertsen B, Nielsen TO. Basal biomarkers nestin and INPP4b predict gemcitabine benefit in metastatic breast cancer: Results from the phase III SBG0102 clinical trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-10-02.
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Affiliation(s)
- K Asleh-Aburaya
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - S Lyck Carstensen
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - S Burugu
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - D Gao
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - CL Tykjær Jørgensen
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - JR Won
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - M-B Jensen
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - E Balslev
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - A-V Lænkholm
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - DL Nielsen
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - B Ejlertsen
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
| | - TO Nielsen
- Genetic Pathology Evaluation Center, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Herlev and Gentofte Hospital, Herlev, Denmark; University of British Columbia, Vancouver, BC, Canada; Zealand University Hospital, Slagelse, Denmark
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Spears M, Kornaga E, Lyttle N, Liao L, Bayani J, Quintayo MA, Yao CQ, D'Costa A, Boutros PC, Twelves CJ, Pritchard KI, Levine MN, Nielsen TO, Shepherd L, Bartlett JMS. Abstract P2-10-01: Validation that a histone gene signature predicts anthracycline response in early breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-10-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The use of anthracycline-based chemotherapies has improved overall and disease free survival in breast cancer. However, anthracyclines can have significant toxicities including cardiotoxicity and leukemia. It is, therefore, imperative to identify those patients who will benefit from adjuvant anthracycline treatment and patients who could be spared unnecessary toxicities and be considered for alternative adjuvant therapy. Previous work performed by our laboratory identified a histone gene expression signature as a predictive marker of anthracycline benefit in the BR9601 clinical trial. In this study we validate the 18 histone gene signature in the MA.5 clinical trial and examine the role of the signature in individual intrinsic subtypes of breast cancer.
Methods We analysed the CCTG MA.5 clinical trial in a prospectively planned retrospective biomarker approach to validate this signature and tested the role of intrinsic subtyping as predictive markers of anthracycline benefit. RNA was extracted from patients in the MA.5 adjuvant trial evaluating the addition of epirubicin (E) to CMF and analysed using NanoString technology. Log-rank analyses validated the predictive values of the signature on distant relapse-free survival (DRFS). Cox-regression models tested independent predictive value on DRFS in the presence of treatment, age, tumour size, nodal status, HER2, ER status and grade, and treatment by marker interactions.
Results Analysis of the MA.5 clinical cohort revealed that patients whose tumour had low histone gene signature expression experienced increased DRFS (HR: 0.54, 95% CI 0.38-0.76, p=0.001) when treated with CEF compared with patients treated with CMF alone. Conversely, there was no apparent benefit of CEF vs CMF in patients with high histone gene expression signature (HR: 1.01, 95%CI 0.66-1.55, p=0.963). After multivariate analysis and adjustment for HER2, nodal status, age, grade and ER, the treatment by marker interaction for the gene signature was 0.54 (95%CI 0.31-0.94, p=0.030) for DRFS.
The predictive impact of the histone signature was independent of intrinsic subtype.
Conclusion The histone gene expression signature is an independent predictor of anthracycline benefit and could be a potential candidate diagnostic assay for patients with early breast cancer.
Citation Format: Spears M, Kornaga E, Lyttle N, Liao L, Bayani J, Quintayo M-A, Yao CQ, D'Costa A, Boutros PC, Twelves CJ, Pritchard KI, Levine MN, Nielsen TO, Shepherd L, Bartlett JMS. Validation that a histone gene signature predicts anthracycline response in early breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-10-01.
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Affiliation(s)
- M Spears
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - E Kornaga
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - N Lyttle
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - L Liao
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - J Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - M-A Quintayo
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - CQ Yao
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - A D'Costa
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - PC Boutros
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - CJ Twelves
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - KI Pritchard
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - MN Levine
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - TO Nielsen
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - L Shepherd
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - JMS Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Leeds Institute of Cancer and Pathology and Cancer Research UK Centre, Leeds, United Kingdom; Suunybrook Odette Cancer Centre, Toronto, ON, Canada; McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; University of British Columbia, Vancouver, BC, Canada; Canadian Clinical Trials Group, Kingston, ON, Canada; Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
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Nielsen TO, Leung SCY, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlet JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Lænkholm AV, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Abstract P2-03-01: Analytical validation of a standardized scoring protocol for Ki67 assessed on breast excision whole sections: An international multicenter collaboration. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-03-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aims: (i) Determine whether between-observer reproducibility for Ki67 when assessed on whole sections according to a standardized scoring protocol is adequate for clinical application. (ii) Compare between-observer reproducibility of Ki67 scores assessed on hot-spots to scores using a global method that averages across a tissue section.
Background: The nuclear proliferation biomarker Ki67 has multiple potential roles in breast cancer, including aiding decisions based on prognosis, but unacceptable levels of between-laboratory variability have been observed. The International Ki67 in Breast Cancer Working Group has undertaken a systematic program to determine whether Ki67 measurement can be analytically validated and standardized across labs. In phase 1, variability in visual interpretation was identified as an important source of variability. Phases 2 and 3a showed that adherence to defined scoring methods substantially improved reproducibility in scoring tissue microarrays and core-cut biopsies. We now assess whether acceptable reproducibility can be achieved on whole sections.
Methods: Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 to assemble 4 sets of 30 stained tumor sections, circulated around 23 labs in 12 countries. Ki67 was scored by 2 methods by all labs: (a) global: 4 fields of 100 tumor cells each were selected to reflect observed heterogeneity in nuclear staining (b) hot-spot: the field with highest Ki67 percentage of tumor cells with nuclear staining was selected and up to 500 cells scored. Ki67 scores were log2-transformed for statistical analyses and back-transformed for presentation. The primary objective was to assess whether either method could achieve an intraclass correlation coefficient (ICC) significantly greater than 0.8, considered substantial to almost-perfect reproducibility. Secondary objectives were to assess which method had highest observed ICC and to assess whether observers identified the same “hot-spots”.
Results: ICC for the global method was 0.87 (95%CI: 0.799-0.93), marginally meeting the prespecified success criterion. The ICC for the hot-spot method was 0.83 (95%CI: 0.74-0.90) and had a CI extending below the success criterion. Across the 23 labs, geometric mean value of the 30 scores ranged from 8.5 to 19.6 for the global method and from 12.8 to 30.3 for the hot-spot method. The overall mean (95% CI) of these values was 12.9 (11.9-14.0) and 20.9 (19.1-22.8), respectively. Visually, between-laboratory agreement in location of selected hot-spot varies between cases. The median times for scoring were 9 and 6 minutes for global and hot-spot methods respectively.
Conclusions: The global method marginally met the prespecified criterion of success; it should now be evaluated for clinical validity in appropriate cohorts of cases. The hot-spot method was observed to have slightly less reproducibility between labs. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between labs further.
(Supported by a grant from the Breast Cancer Research Foundation)
Citation Format: Nielsen TO, Leung SCY, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlet JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Lænkholm A-V, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Analytical validation of a standardized scoring protocol for Ki67 assessed on breast excision whole sections: An international multicenter collaboration [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-03-01.
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Affiliation(s)
- TO Nielsen
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - SCY Leung
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - LA Zabaglo
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - I Arun
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - SS Badve
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - AL Bane
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - JMS Bartlet
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Borgquist
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - MC Chang
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A Dodson
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A Ehinger
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Fineberg
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - CM Focke
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - D Gao
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - AM Gown
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - C Gutierrez
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - JC Hugh
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - Z Kos
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A-V Lænkholm
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - MG Mastropasqua
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Moriya
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Nofech-Mozes
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - CK Osborne
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - FM Penault-Llorca
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Piper
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Sakatani
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - R Salgado
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - J Starczynski
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Sugie
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - B van der Vegt
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - G Viale
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - DF Hayes
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - LM McShane
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - M Dowsett
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
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Burugu S, Gao D, Nielsen TO. Abstract P3-05-12: VISTA expression on tumor-infiltrating lymphocytes in breast cancer: Clinical correlates and association with PD-1. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-05-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The V-domain containing Ig Suppressor of T Cell Activation (VISTA) is a recently discovered immune checkpoint receptor with homology to PD-1. VISTA expression on tumor-infiltrating lymphocytes (TILs) blocks their proliferation and effector functions. Recent pre-clinical data in cancer mouse models treated with anti-VISTA and anti-PD-L1 combinations showed promising results and non-redundant functions of VISTA and PD-L1 blockade. However, the expression and prognostic value of VISTA+ TILs in primary breast tumors has not been investigated in detail. Here we assess expression, prognostic value, and associations of VISTA+TILs with other immune checkpoint markers (PD-1/PD-L1, LAG-3, and IDO-1) and with H&E TIL counts.
Methods: A tissue microarray consisting of breast carcinoma primary excision specimens (n=330) from the University of British Columbia hospital, linked to detailed clinicopathological data and outcomes, was used in this study. Patients from this cohort did not receive neoadjuvant treatment. A VISTA antibody (Clone D1L2G) was applied on a 4μm section of the tissue microarray by immunohistochemistry using a Ventana automated stainer. VISTA+TILs in direct contact with tumor nest were scored and reported as absolute count per 0.6mm core. Positive cases were defined as cases with VISTA+TILs≥1. All descriptive and survival analyses were conducted using SPSS software.
Results: VISTA+TILs were present in 30% of cases and were significantly (p<0.05) associated with younger age (<50 years old), larger tumors (>2cm), hormone receptor negativity (ER/PR) and high Ki67proliferation index (≥13.25%). Almost half (48%) of basal-like breast cancers were positive for VISTA expressing TILs. No significant prognostic associations were observed in this cohort. Among the immune checkpoint receptors analyzed, VISTA+TILs were highly associated with PD-1+ TILs: 79% of cases positive for PD-1+TILs were also infiltrated by VISTA+TILs. Interestingly, we found that VISTA+TILs and PD-1+TILs were enriched in cases with otherwise low levels (<10%) of H&E TILs.
Conclusions: Our study identifies the presence of VISTA+TILs in breast cancer patients and its strong association with PD-1+TILs. These results suggest that VISTA blockade could be a good candidate for combination therapy with other immune checkpoint inhibitors, a concept being tested in early phase clinical trials. Validation of these findings in a larger independent cohort powered for multivariate analysis is currently ongoing.
Citation Format: Burugu S, Gao D, Nielsen TO. VISTA expression on tumor-infiltrating lymphocytes in breast cancer: Clinical correlates and association with PD-1 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-05-12.
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Affiliation(s)
- S Burugu
- Department of Pathology and Laboratory Medicine, Vancouver, BC, Canada; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada
| | - D Gao
- Department of Pathology and Laboratory Medicine, Vancouver, BC, Canada; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada
| | - TO Nielsen
- Department of Pathology and Laboratory Medicine, Vancouver, BC, Canada; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada
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Hodges LD, Nielsen T, Baken D. Physiological measures in participants with chronic fatigue syndrome, multiple sclerosis and healthy controls following repeated exercise: a pilot study. Clin Physiol Funct Imaging 2017; 38:639-644. [DOI: 10.1111/cpf.12460] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/27/2017] [Indexed: 01/08/2023]
Affiliation(s)
- L. D. Hodges
- School of Sport and Exercise; Massey University; Palmerston North New Zealand
| | - T. Nielsen
- School of Sport and Exercise; Massey University; Palmerston North New Zealand
| | - D. Baken
- School of Psychology; Massey University; Palmerston North New Zealand
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Klanova M, Sehn L, Bence-Bruckler I, Cavallo F, Jin J, Martelli M, Stewart D, Vitolo U, Zaja F, Zhang Q, Mattiello F, Oestergaard M, Fingerle-Rowson G, Nielsen T, Trneny M. CELL OF ORIGIN COMBINED WITH CNS INTERNATIONAL PROGNOSTIC INDEX IMPROVES IDENTIFICATION OF DLBCL PATIENTS WITH HIGH CNS RELAPSE RISK AFTER INITIAL IMMUNOCHEMOTHERAPY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Klanova
- 1st Department of Medicine, Charles University General Hospital; Prague, Czech Republic and Pharma Development Clinical Oncology, F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - L.H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver Canada
| | - I. Bence-Bruckler
- Ottawa Hospital Research Institute; The Ottawa Hospital; Ottawa Canada
| | - F. Cavallo
- Ematologia 1; A.O. Universitaria S. Giovanni Battista-Molinette Di Torino; Torino Italy
| | - J. Jin
- The First Affiliated Hospital of College of Medicine; Zhejiang University; Wenzhou China
| | - M. Martelli
- Department of Cellular Biotechnologies and Hematology; Sapienza University; Rome Italy
| | - D. Stewart
- Department of Oncology; Tom Baker Cancer Centre; Calgary Canada
| | - U. Vitolo
- S.C. Ematologia; A.O.U. Citta' Della Salute e della Scienza P.O. Molinette; Turino Italy
| | - F. Zaja
- Oncologia; Clinica Ematologica, ASUI UD S.M. Misericordia di Udine; Udine Italy
| | - Q. Zhang
- Department of Medical Oncology; Harbin Medical University Cancer Hospital; Harbin China
| | - F. Mattiello
- Pharma Development Biometrics Biostatistics; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - M.Z. Oestergaard
- Oncology Biomarker Development; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - G.R. Fingerle-Rowson
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - T. Nielsen
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd.; Basel Switzerland
| | - M. Trneny
- 1st Department of Medicine; Charles University General Hospital; Prague Czech Republic
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Trotman J, Barrington S, Belada D, Meignan M, MacEwan R, Owen C, Ptáčník V, Rosta A, Fingerle-Rowson G, Mattiello F, Nielsen T, Sahin D, Hiddemann W, Marcus R, Davies A. PROGNOSTIC VALUE OF PET-CT AFTER FIRST-LINE IMMUNOCHEMOTHERAPY FOR FOLLICULAR LYMPHOMA IN THE PHASE III GALLIUM STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J. Trotman
- Haematology Department; Concord Repatriation General Hospital; Sydney Australia
| | - S. Barrington
- KCL and Guys' & St Thomas PET Imaging Centre, Division of Imaging and Biomedical Engineering; Kings College London; London UK
| | - D. Belada
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, and Charles University in Prague; Faculty of Medicine in Hradec Kralove; Hradec Kralove Czech Republic
| | - M. Meignan
- Service de Médecine Nucléaire; Hôpital Henri Mondor and Université Paris Est Créteil; Créteil France
| | - R. MacEwan
- Cross Cancer Institute; University of Alberta; Edmonton Canada
| | - C. Owen
- Division of Hematology and Hematological Malignancies; Foothills Medical Centre and Tom Baker Cancer Centre; Calgary Canada
| | - V. Ptáčník
- Department of Nuclear Medicine, First Faculty of Medicine; Charles University; Prague Czech Republic
| | - A. Rosta
- Department of Medicine; National Institute of Oncology; Budapest Hungary
| | - G. Fingerle-Rowson
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - F. Mattiello
- Pharma Development Biometrics Biostatistics; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - T. Nielsen
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - D. Sahin
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - W. Hiddemann
- Medical Department III; Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - R. Marcus
- Department of Haematology; Kings College Hospital; London UK
| | - A. Davies
- Cancer Research UK Centre; University of Southampton; Southampton UK
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Kostakoglu L, Martelli M, Belada D, Carella A, Chua N, Gonzalez-Barca E, Hong X, Pinto A, Sehn L, Shi Y, Tatsumi Y, Fingerle-Rowson G, Mattiello F, Nielsen T, Sahin D, Vitolo U, Trněný M. END OF TREATMENT PET-CT PREDICTS PROGRESSION-FREE SURVIVAL IN DLBCL AFTER FIRST-LINE TREATMENT: RESULTS FROM THE PHASE III GOYA STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L. Kostakoglu
- Department of Radiology; Icahn School of Medicine at Mount Sinai; New York USA
| | - M. Martelli
- Department of Cellular Biotechnologies and Hematology; Sapienza University; Rome Italy
| | - D. Belada
- 4th Department of Internal Medicine-Hematology; University Hospital Hradec Kralove, and Charles University in Prague, Faculty of Medicine in Hradec Kralove; Hradec Kralove Czech Republic
| | - A.M. Carella
- U.O. Hematology I; IRCCS AO University, San Martino-IST; Genoa Italy
| | - N. Chua
- Cross Cancer Institute; University of Alberta; Edmonton Canada
| | - E. Gonzalez-Barca
- Institut Catalá d'Oncologia Hospitalet, IDIBELL; University of Barcelona; Barcelona Spain
| | - X. Hong
- Department of Medical Oncology; Fudan University Shanghai Cancer Center; Shanghai China
| | - A. Pinto
- Istituto Nazionale Tumori, Fondazione G. Pascale; IRCCS; Naples Italy
| | - L.H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency and the University of British Columbia; Vancouver Canada
| | - Y. Shi
- National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs; Beijing China
| | - Y. Tatsumi
- Department of Hematology and Rheumatology, Faculty of Medicine; Kinki University Hospital; Osaka Japan
| | - G. Fingerle-Rowson
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - F. Mattiello
- Pharma Development Biometrics Biostatistics; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - T. Nielsen
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - D. Sahin
- Department of Hematology and Rheumatology, Faculty of Medicine; Kinki University Hospital; Osaka Japan
| | - U. Vitolo
- Department of Hematology; Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino; Turin Italy
| | - M. Trněný
- Department of Medicine-Department of Hematology; Charles University; Prague Czech Republic
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Sehn L, Oestergaard M, Trněný M, Bosi A, Egyed M, Illes A, Nakamae H, Opat S, Topp M, Zaja F, Fingerle-Rowson G, Lei G, Nielsen T, Punnoose E, Rahman M, Ray J, Zhang L, Martelli M, Vitolo U. PROGNOSTIC IMPACT OF BCL2 AND MYC EXPRESSION AND TRANSLOCATION IN UNTREATED DLBCL: RESULTS FROM THE PHASE III GOYA STUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- L.H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency and the University of British Columbia; Vancouver Canada
| | - M.Z. Oestergaard
- Oncology Biomarker Development; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - M. Trněný
- Charles University; General Hospital; Prague Czech Republic
| | - A. Bosi
- Department of Hematology; Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - M. Egyed
- Department of Hematology; Kaposi Mor Teaching Hospital; Kaposvár Hungary
| | - A. Illes
- Department of Hematology; University of Debrecen, Faculty of Medicine; Debrecen Hungary
| | - H. Nakamae
- Department of Hematology; Osaka City University Hospital; Osaka Japan
| | - S. Opat
- Department of Clinical Haematology; Monash Health and Monash University; Melbourne Australia
| | - M. Topp
- Department of Haematology, Medizinische Klinik und Poliklinik II; Universitätsklinikum Würzburg; Würzburg Germany
| | - F. Zaja
- Department of Hematology, ASUIUD S. M. Misericordia; Udine Italy
| | - G. Fingerle-Rowson
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - G. Lei
- Department of Biostatistics, Roche Products Ltd; Welwyn Garden City UK
| | - T. Nielsen
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - E.A. Punnoose
- Oncology Biomarker Development; Genentech Inc.; South San Francisco USA
| | - M. Rahman
- Department of Biostatistics, Roche Products Ltd; Welwyn Garden City UK
| | - J. Ray
- Oncology Biomarker Development; Genentech Inc.; South San Francisco USA
| | - L. Zhang
- Department of Pathology; Ventana Medical Systems Inc.; Tucson USA
| | - M. Martelli
- Department of Cellular Biotechnologies and Haematology; Sapienza University; Rome Italy
| | - U. Vitolo
- Department of Hematology; Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino; Turin Italy
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Fornecker L, Ou F, Dixon J, Casulo C, Hoster E, Hiddemann W, Sebban C, Morschhauser F, Marcus R, Hochster H, Rummel M, Hagenbeeck A, Kimby E, Herold M, Peterson B, Gyan E, Ladetto M, Zucca E, Nielsen T, Foon K, Vitolo U, Flowers C, Shi Q, Salles G. CLINICAL CHARACTERISTICS AND TREATMENT OUTCOMES FOR YOUNG PATIENTS WITH FIRST-LINE FOLLICULAR LYMPHOMA: A POOLED ANALYSIS OF 4249 PATIENTS FROM THE FLASH DATABASE. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- L. Fornecker
- Department of Hematology; University Hospital of Strasbourg; Strasbourg France
| | - F. Ou
- Division of Biomedical Statistics and Informatics, Mayo Clinic; Rochester USA
| | - J.G. Dixon
- Division of Biomedical Statistics and Informatics, Mayo Clinic; Rochester USA
| | - C. Casulo
- School of Medicine and Dentistry; University of Rochester Medical Center; Rochester USA
| | - E. Hoster
- Department of Internal Medicine III; Ludwig-Maximilians University Hospital, Campus Großhadern; Munich Germany
| | - W. Hiddemann
- Department of Internal Medicine III; Ludwig-Maximilians University Hospital, Campus Großhadern; Munich Germany
| | - C. Sebban
- Onco-Hematology, Centre Leon Berard; University Claude Bernard Lyon 1; Lyon France
| | - F. Morschhauser
- Department of Clinical Hematology; Centre Hospitalier Universitaire, Université de Lille; Lille France
| | - R. Marcus
- Department of Haematology; Addenbrookes Hospital; Cambridge UK
| | - H. Hochster
- Yale Cancer Center; Department of Medicine; New Haven USA
| | - M. Rummel
- Medizinische Klinik IV; University Hospital; Gießen Germany
| | - A. Hagenbeeck
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - E. Kimby
- Hematology Centre at Karolinska University Hospital; Karolinska Institutet; Stockholm Sweden
| | - M. Herold
- Department of Hematology and Oncology, HELIOS Klinikum; Erfurt Germany
| | - B.A. Peterson
- Division of Hematology, Oncology and Transplantation; University of Minnesota; Minneapolis USA
| | - E. Gyan
- Department of Hematology and Cell Therapy; University Hospital; Tours France
| | - M. Ladetto
- Department of Hematology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo; Alessandria Italy
| | - E. Zucca
- Department of Hematology, Oncology Institute of Southern Switzerland (IOSI); Bellinzona Switzerland
| | - T. Nielsen
- Department of Medical Affairs; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - K. Foon
- Department of Medical Affairs, Celgene Corporation; Summit USA
| | - U. Vitolo
- Department of Hematology; Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino; Torino Italy
| | - C.R. Flowers
- Department of Bone Marrow and Stem Cell Transplantation; Winship Cancer Institute of Emory University; Atlanta USA
| | - Q. Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic; Rochester USA
| | - G. Salles
- Department of Hematology; Centre Hospitalier Lyon-Sud; Pierre-Benite France
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Hiddemann W, Barbui A, Canales Albendea M, Cannell P, Collins G, Dürig J, Forstpointner R, Herold M, Hertzberg M, Klanova M, Radford J, Tobinai K, Burciu A, Fingerle-Rowson G, Nielsen T, Wolbers M, Marcus R. IMMUNOCHEMOTHERAPY WITH OBINUTUZUMAB OR RITUXIMAB IN PREVIOUSLY UNTREATED FOLLICULAR LYMPHOMA IN THE RANDOMISED PHASE III GALLIUM STUDY: ANALYSIS BY CHEMOTHERAPY REGIMEN. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- W. Hiddemann
- Department of Medicine III; Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - A.M. Barbui
- Department of Hematology; Azienda Ospedaliera Papa Giovanni XXIII; Bergamo Italy
| | | | - P.K. Cannell
- Haematology Department; Fiona Stanley Hospital; Murdoch Australia
| | - G.P. Collins
- Department of Clinical Haematology; Oxford Cancer and Haematology Centre, Churchill Hospital; Oxford UK
| | - J. Dürig
- Medical Faculty (Haematology), Universitaetsklinikum Essen; Essen Germany
| | - R. Forstpointner
- Department of Medicine III; Ludwig-Maximilians-University Hospital Munich; Munich Germany
| | - M. Herold
- Oncology Center; HELIOS-Klinikum Erfurt; Erfurt Germany
| | - M. Hertzberg
- Department of Haematology; Prince of Wales Hospital; Sydney Australia
| | - M. Klanova
- 1st Department of Medicine; Charles University General Hospital, Prague, Czech Republic and Pharma Development Clinical Oncology, F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - J.A. Radford
- Manchester Academic Health Science Centre; The University of Manchester and The Christie NHS Foundation Trust; Manchester UK
| | - K. Tobinai
- Department of Hematology; National Cancer Center Hospital; Tokyo Japan
| | - A. Burciu
- Pharma Development Safety and Risk Management; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - G.R. Fingerle-Rowson
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - T. Nielsen
- Pharma Development Clinical Oncology; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - M. Wolbers
- Pharma Development Biometrics Biostatistics; F. Hoffmann-La Roche Ltd; Basel Switzerland
| | - R. Marcus
- Department of Haematology; Kings College Hospital; London UK
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Iversen A, Busk M, Bertelsen L, Laustsen C, Munch O, Nielsen T, Wittenborn T, Bussink J, Lok J, Stødkilde-Jørgensen H, Horsman M. PV-0369: The potential of hyperpolarized 13 C MRS to monitor the effect of vascular disrupting agents. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marquis L, Julien S, Blanchette-Carrière C, Baril A, Desjardins M, Carr M, Paquette T, Soucy J, Montplaisir J, Nielsen T. 0732 NIGHTMARE DISTRESS IS NEGATIVELY CORRELATED WITH REGIONAL CEREBRAL BLOOD FLOW IN FRONTAL AREAS DURING AN IAPS PICTURE-VIEWING TASK. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.731] [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: 11/12/2022] Open
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Rimm DL, McShane LM, Leung SCY, Bai Y, Bane AL, Bartlett JMS, Bayani J, Chang MC, Dean M, Denkert C, Enwere E, Galderisi C, Gholap A, Hugh JC, Jadhav A, Kornaga E, Laurinavicius A, Levenson R, Lima J, Miller K, Pantanowitz L, Piper T, Ruan J, Srinivasan M, Virk S, Wu Y, Yang H, Hayes DF, Nielsen TO, Dowsett M. Abstract P1-03-01: An international multicenter study to evaluate reproducibility of automated scoring methods for assessment of Ki67 in breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-03-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The nuclear proliferation biomarker Ki67 has multiple potential roles in breast cancer, including prognosis-based decisions, but unacceptable between-laboratory variability has limited its clinical value. The International Ki67 Working Group (IKWG) has undertaken a systematic program to determine whether Ki67 immunohistochemistry can be analytically validated and standardized across laboratories. Technological advances and broader availability of devices for automated assessment of stained slides raise the possibility that these machines may improve on reproducibility of traditional pathologist-based visual Ki67 assessment.
Aims: To characterize reproducibility of automated machine-measured Ki67 expression using slides previously analyzed in the IKWG phase 3 study that evaluated reproducibility of visual Ki67 assessment.
Methods: Two sets of 30 previously stained slides containing core-cut biopsy sections of breast tumors were circulated to 14 laboratories for scanning and automated assessment of Ki67 expression. Sites were instructed to return average and maximum percentage of tumor cells positive for Ki67 for each slide, where maximum is designed to reflect “hot spot” analysis. Two laboratories returned scores from 2 operators; not all laboratories reported values for maximum Ki67 scores. Different operators were treated as distinct laboratories in analyses. Sixteen and 10 score sets were available for average and maximum Ki67 analyses, respectively, encompassing 7 unique scanner and 10 software platforms. Pre-specified analyses included evaluation of reproducibility across all laboratories as well as within a subgroup limited to those using Aperio scanners. The primary reproducibility metric was intraclass correlation coefficient between laboratories (ICC), regardless of device platform or software.
Results: Geometric means across 30 cases for 16 operators ranged from 11.06% to 38.11% with overall mean 16.75% (95% CI:14.45-19.42) for average scores. Geometric means for 10 operators ranged from 16.44% to 68.73% with overall mean 25.16% (95% CI: 18.71-33.84) for maximum scores. ICC for automated average scores across 16 operators was 0.83 (95% CI: 0.73-0.91) and ICC for maximum scores across 10 operators was 0.63 (95% CI: 0.44-0.80) although one outlier lab dramatically affected results. For the laboratories using the Aperio platform (8 score sets), ICC for automated average scores was 0.89 (95% CI; 0.81-0.96). These results are similar to ICC of 0.87 (95%CI; 0.81-0.93) reported using these same slides in the Phase 3 visual assessment reproducibility study in which observers counted 500 cells per slide (Leung et al, NPJBrCancer, in press).
Conclusions: Between-laboratory reproducibility for automated machine assessment of average Ki67 is similar to that for pathologist-based visual assessment of Ki67. However, the observed ICC was markedly numerically lower for the maximum score method compared to the average method, suggesting that the maximum score may not be useful as a reproducible measure of proliferation. Automated average scoring methods show promise for standardization of Ki67 scoring, supporting future studies to clinically validate Ki67.
Citation Format: Rimm DL, McShane LM, Leung SCY, Bai Y, Bane AL, Bartlett JMS, Bayani J, Chang MC, Dean M, Denkert C, Enwere E, Galderisi C, Gholap A, Hugh JC, Jadhav A, Kornaga E, Laurinavicius A, Levenson R, Lima J, Miller K, Pantanowitz L, Piper T, Ruan J, Srinivasan M, Virk S, Wu Y, Yang H, Hayes DF, Nielsen TO, Dowsett M. An international multicenter study to evaluate reproducibility of automated scoring methods for assessment of Ki67 in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-03-01.
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Affiliation(s)
- DL Rimm
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - LM McShane
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - SCY Leung
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - Y Bai
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - AL Bane
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - JMS Bartlett
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - J Bayani
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - MC Chang
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - M Dean
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - C Denkert
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - E Enwere
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - C Galderisi
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - A Gholap
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - JC Hugh
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - A Jadhav
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - E Kornaga
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - A Laurinavicius
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - R Levenson
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - J Lima
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - K Miller
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - L Pantanowitz
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - T Piper
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - J Ruan
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - M Srinivasan
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - S Virk
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - Y Wu
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - H Yang
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - DF Hayes
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - TO Nielsen
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
| | - M Dowsett
- Yale University School of Medicine, New Haven, CT; Biometric Research Branch, National Cancer Institute, Bethesda, MD; University of British Columbia, Vancouver, BC, Canada; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Transformative Pathology, Ontario Institute for Cancer Research, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; University of Alberta, Edmonton, AB, Canada; Institut für Pathologie, Charité Campus Mitte, Berlin, Germany; MolecularMD, Portland, OR; Optra Technologies, NeoPro SEZ, BlueRidge, Hinjewadi, India; National Center of Pathology, Vilnius University Hospital Santariskes Clinics, Vilnius, Lithuania; University of California Davis Medical Center, Sacramento, CA; Cancer Diagnostic Quality Assurance Services CIC, Poundbury Cancer Institute, Poundbury, Dorset, United Kingdom; University of Pittsburgh, Pittsburgh, PA; Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Edinburgh, United Kingdom; Queen's University, K
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Burugu S, Gao D, Nielsen TO. Abstract PD5-08: Expression of LAG-3 in breast cancer, and its association with subtype and outcome. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd5-08] [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
Aim: To investigate the expression and clinical value of the immune checkpoint marker LAG-3 in breast cancer patients
Background: Lymphocyte-activation gene 3 (LAG-3) is a recently discovered immune checkpoint biomarker that is targeted by agents currently being evaluated in early phase clinical trials. LAG-3 functions as a cell surface receptor expressed following T cell activation and negatively impacts T cell functions. This biomarker has not yet been evaluated in large series of breast cancers with long term treatment and outcome data, in the context of subtype and other immune biomarkers.
Methods: Two tissue microarray series (a training set with N=330 and a validation set with N = 2203 patients) were constructed from breast carcinoma primary excision specimens from University of British Columbia hospitals, linked to detailed clinical and pathological data. None of these patients had received neoadjuvant treatment. 4µm sections were stained with an antibody to LAG-3 (clone 17B4) by immunohistochemistry using a Ventana Discovery Ultra automated slide stainer. LAG-3+ stromal and intra-epithelial tumor infiltrating lymphocytes (TILs) were reported as absolute counts per tissue microarray core. Stromal TILs (sTIL) were defined as lymphocytes present in the stroma not in direct contact with tumor nest whereas intra-epithelial TIL (iTIL) were lymphocytes in direct contact with carcinoma cells. All descriptive and survival analyses were conducted using SPSS software.
Results: LAG-3+ sTILs were found in 16% of breast cancer cases in both the training set and the validation set; LAG-3+iTILs were present in 14 and 11%, respectively. In both the training set and the validation set, the presence of LAG-3 (iTILs or sTILs) was significantly (p<0.001) associated with high grade tumors, estrogen and progesterone receptor negativity, high Ki67 index and with the HER2+ and basal-like subtypes. In survival analyses of ER negative patients, in both sets patients with LAG-3 T cells (iTILs or sTILs) had a significantly improved disease-specific survival (p<0.05). As with other lymphocyte biomarkers, this association was not observed among ER+ patients.
Conclusions: LAG-3+TILs are present in breast cancer and are associated with major risk factors and hormone receptor negative subtypes. ER negative breast cancer patients have a better outcome if they contain LAG-3+ TILs, consistent with published data showing better survival among ER- breast cancer patients with immune infiltrates. More than a quarter of ER negative breast cancers contain TILs expressing LAG3, and may represent the most relevant subset to target with emerging checkpoint inhibitors targeting this T cell surface receptor.
Citation Format: Burugu S, Gao D, Nielsen TO. Expression of LAG-3 in breast cancer, and its association with subtype and outcome [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD5-08.
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Affiliation(s)
- S Burugu
- Genetic Pathology Evaluation Centre, Vancouver, BC, Canada
| | - D Gao
- Genetic Pathology Evaluation Centre, Vancouver, BC, Canada
| | - TO Nielsen
- Genetic Pathology Evaluation Centre, Vancouver, BC, Canada
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Liu S, Chen B, Burugu S, Leung S, Gao D, Virk S, Kos Z, Parulekar WR, Shepherd L, Gelmon K, Nielsen TO. Abstract P1-09-08: Predictive effect of cytotoxic tumor infiltrating lymphocytes in HER2-positive metastatic breast cancer: A correlative study with CCTG MA.31. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and Objectives: The presence of tumor infiltrating lymphocytes (TILs), particularly CD8+ cytotoxic T-cells, has been associated with improved prognosis in patients with HER2+ breast cancer. Increasing levels of TILs also appear to predict response to adjuvant trastuzumab in early breast cancer, although they did not predict benefit of combined trastuzumab-lapatinib neoadjuvant dual therapy over monotherapy in NeoALLTO. CCTG MA.31 randomized 652 women with HER2+ metastatic breast cancer to treatment with trastuzumab (T) vs. lapatinib (L), in combination with taxane (Tax) chemotherapy for 24 weeks, followed by the same HER2-targeted monotherapy. Final results from MA.31 found trastuzumab was superior to lapatinib for the primary endpoint of progression free survival (PFS): the hazard ratio (HR) for lapatinib to trastuzumab was 1.37 (95% CI, 1.13-1.65). Although both agents block HER2 signaling, trastuzumab has additional mechanisms of action via the immune system. We hypothesized that TIL levels may predict response to HER2-targeted therapy (trastuzumab vs. lapatinib).
Methods: MA.31 included HER2+ metastatic breast cancer patients, median age 55 years, and median follow-up 21.5 months. Overall TILs were counted per published guidelines on the original H&E stained sections used for pathology review at study entry. Immunohistochemistry (IHC) was performed on unstained sections from tissue microarrays or individual formalin-fixed paraffin-embedded blocks to test expression of lymphocyte biomarkers CD8, FOXP3, CD56 and PD-1 on stromal and intra-tumoral TILs (sTILs, iTILs). Statistical analysis was conducted by CCTG for a total of 9 prespecified biomarker tests. Associations of TILs with PFS were evaluated by univariate stratified log-rank test with graphical Kaplan-Meier curves, and by stratified multivariate Cox proportional hazards regression analysis. Predictive effect was examined with a test of interaction between treatment allocation and biomarker classification (high vs. low, using pre-established cutpoints).
Results: Of the 652 cases, 614 had slides for overall TIL assessment and 427 for IHC biomarker assessments. In this correlative study set, superiority of trastuzumab over lapatinib for PFS was confirmed in multivariate analysis (LTax/T vs. TTax/L: HR = 2.55, 95% CI = 1.43-4.55, p = 0.001). TIL counts by H&E were neither prognostic nor predictive in this set of metastatic HER2+ breast cancers. Lymphocyte IHC markers were not prognostic. However, prespecified stratified univariate analysis detected a significantly higher risk for lapatinib over trastuzumab (HR = 2.94, 95% CI = 1.40-6.17, p = 0.003) in patients with low CD8+ sTIL (< 3) than was observed among those with high CD8+ sTIL (HR = 1.36, 95% CI = 1.05-1.75, p = 0.019). This differential effect was confirmed in multivariate analysis (interaction test p = 0.042). The other tested biomarkers did not demonstrate significant predictive effects.
Conclusions: In this correlative study of metastatic HER2+ breast cancer, a low level of pre-existing stromal cytotoxic T cell infiltration predicts women who benefit most from trastuzumab over lapatinib. Overall TIL counts were neither prognostic nor predictive.
Citation Format: Liu S, Chen B, Burugu S, Leung S, Gao D, Virk S, Kos Z, Parulekar WR, Shepherd L, Gelmon K, Nielsen TO. Predictive effect of cytotoxic tumor infiltrating lymphocytes in HER2-positive metastatic breast cancer: A correlative study with CCTG MA.31 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-08.
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Affiliation(s)
- S Liu
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - B Chen
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - S Burugu
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - S Leung
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - D Gao
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - S Virk
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - Z Kos
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - WR Parulekar
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - L Shepherd
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - K Gelmon
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
| | - TO Nielsen
- University of British Columbia and Vancouver Coastal Health Research Institute; Canadian Cancer Trials Group; University of Ottawa; British Columbia Cancer Agency
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Verger E, Nielsen T, Chakaroun R, Aron-Wisnewsky J, Delaere F, Gausserès N, Clément K, Holmes B. Évaluation de la validité relative du questionnaire de fréquence alimentaire développé pour les sujets français de l’étude MetaCardis. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2016.10.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pinós T, de Luna N, Brull A, Nielsen T, Krag T, Vissing J. New advances in McArdle disease: Characterization of the p.R50X knock-in mouse model and evaluation of new therapeutic approaches. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.409] [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: 10/21/2022]
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Nielsen TO, Jensen [lrm] MB, Gao D, Leung S, Burugu S, Liu S, Tykjær Jørgensen CL, Balslev E, Ejlertsen B. Abstract S1-08: High risk premenopausal luminal A breast cancer patients derive no benefit from adjuvant chemotherapy: Results from DBCG77B randomized trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s1-08] [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
Aim: To determine the predictive value of intrinsic subtypes for response to adjuvant chemotherapy using specimens from a randomized clinical trial.
Background: Several studies have shown distinct clinical profiles of intrinsic breast cancer subtypes. The Luminal A subtype has a favorable prognosis with higher survival rate and lower recurrence in comparison to other breast cancer subtypes (luminal B, HER2 and basal-like). In addition, there is mounting evidence suggesting that intrinsic breast cancer subtypes differ in their responsiveness to adjuvant chemotherapy. Based on these data, we hypothesized that Luminal A breast cancer patients derive no benefit from adjuvant chemotherapy whereas other intrinsic subtypes do. Randomized breast cancer trials with a no chemotherapy arm and available tissues are rare, but represent the best materials to test for markers predicting chemotherapy benefit. The 77B clinical trial from the Danish Breast Cancer Cooperative Group (DBCG) offers a unique opportunity to test such hypotheses as it randomized 1146 premenopausal women, who had positive axillary lymph nodes or tumors >5 cm, to two chemotherapy arms (single-agent oral cyclophosphamide, or cyclophosphamide-methotrexate-fluorouracil (CMF)), and two no chemotherapy arms (levamisole, or no agent). All arms included radiotherapy but no endocrine therapy.
Methods: We performed a full intrinsic subtype analysis on the 709 breast cancers available from DBCG77B on tissue microarrays using previously published, locked-down immunohistochemical (IHC) methods and intrinsic subtype definitions based on ER, PR, HER2, Ki67 and basal markers (Prat et al. JCO 2014). Biomarker scoring was performed in Vancouver by researchers with no access to the clinical database. A full statistical plan was prespecified in the Material Transfer Agreement and executed accordingly by the DBCG Statistical Office. 10-year invasive disease-free survival (IDFS) was the primary end point in DBCG77B; overall survival was also a predefined endpoint. The primary hypothesis was to assess interaction between benefit of chemotherapy (chemotherapy yes vs no) and subtype (Luminal A vs non-luminal A). This was analyzed in multivariate Cox proportional hazards models using the Wald test for interaction.
Results: 709 patients had tissue available and completed IHC intrinsic subtyping. The effect of chemotherapy in this subset of patients was similar to the original trial: hazard ratio 0.56, favoring chemotherapy for 10-yr IDFS. IHC classified 165 as luminal A, 319 luminal B, 58 HER2E and 91 as triple negative (including 82 core basal). Patients with luminal A breast tumors did not benefit from chemotherapy (HR = 1.07, 95% CI = 0.53-2.14, p = 0.86), whereas patients with non-luminal A subtypes did (HR = 0.50, 95% CI = 0.38-0.66, p < 0.001). This heterogeneity was statistically significant (p=0.048). A similar trend for 25-yr OS was seen, although not significant.
Conclusions: In a formal prospective-retrospective analysis of the DBCG 77B study randomizing women to adjuvant cyclophosphamide-based chemotherapy vs. no chemotherapy arms, patients with non-luminal A breast tumors (defined by IHC), but not luminal A tumors, benefit from adjuvant chemotherapy.
Citation Format: Nielsen TO, Jensen [lrm] M-B, Gao D, Leung S, Burugu S, Liu S, Tykjær Jørgensen CL, Balslev E, Ejlertsen B. High risk premenopausal luminal A breast cancer patients derive no benefit from adjuvant chemotherapy: Results from DBCG77B randomized trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S1-08.
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Affiliation(s)
- TO Nielsen
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
| | - M-B Jensen [lrm]
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
| | - D Gao
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
| | - S Leung
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
| | - S Burugu
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
| | - S Liu
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
| | - CL Tykjær Jørgensen
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
| | - E Balslev
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
| | - B Ejlertsen
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Genetic Pathology Evaluation Centre, Vancouver, BC, Canada; Canadian Immunohistochemistry Quality Control, Vancouver, BC, Canada; University of Ottawa, Ottawa, ON, Canada
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Whitehouse MR, Endo M, Zachara S, Nielsen TO, Greidanus NV, Masri BA, Garbuz DS, Duncan CP. Adverse local tissue reactions in metal-on-polyethylene total hip arthroplasty due to trunnion corrosion: the risk of misdiagnosis. Bone Joint J 2015. [PMID: 26224816 DOI: 10.1302/0301-620x.97b8.34682] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adverse reaction to wear and corrosion debris is a cause for concern in total hip arthroplasty (THA). Modular junctions are a potential source of such wear products and are associated with secondary pseudotumour formation. We present a consecutive series of 17 patients treated at our unit for this complication following metal-on-highly cross-linked polyethylene (MoP) THA. We emphasise the risk of misdiagnosis as infection, and present the aggregate laboratory results and pathological findings in this series. The clinical presentation was pain, swelling or instability. Solid, cystic and mixed soft-tissue lesions were noted on imaging and confirmed intra-operatively. Corrosion at the head-neck junction was noted in all cases. No bacteria were isolated on multiple pre- and intra-operative samples yet the mean erythrocyte sedimentation rate was 49 (9 to 100) and C-reactive protein 32 (0.6 to 106) and stromal polymorphonuclear cell counts were noted in nine cases. Adverse soft-tissue reactions can occur in MoP THA owing to corrosion products released from the head-neck junction. The diagnosis should be carefully considered when investigating pain after THA. This may avoid the misdiagnosis of periprosthetic infection with an unidentified organism and mitigate the unnecessary management of these cases with complete single- or two-stage exchange.
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Affiliation(s)
| | - M Endo
- Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - S Zachara
- Vancouver General Hospital, 855 W 12th Ave, Vancouver, V5Z 1M9, Canada
| | - T O Nielsen
- Vancouver General Hospital, 855 W 12th Ave, Vancouver, V5Z 1M9, Canada
| | - N V Greidanus
- University of British Columbia, Third Floor, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
| | - B A Masri
- University of British Columbia, Third Floor, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
| | - D S Garbuz
- University of British Columbia, Third Floor, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
| | - C P Duncan
- University of British Columbia, Third Floor, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
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Nielsen T, Pinos T, Krag T, Vissing J. Effect of treatment with grow factors on muscle pathology in the mdx mouse model of Duchenne muscular dystrophy. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.377] [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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Krag T, Pinos T, Nielsen T, Brull A, Andreu A, Vissing J. Molecular, morphological and physiological studies in a mouse model of McArdle disease: Similarities to the human disease. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.127] [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: 10/23/2022]
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Gnant M, Sestak I, Filipits M, Dowsett M, Balic M, Lopez-Knowles E, Greil R, Dubsky P, Stoeger H, Rudas M, Jakesz R, Ferree S, Cowens JW, Nielsen T, Schaper C, Fesl C, Cuzick J. Identifying clinically relevant prognostic subgroups of postmenopausal women with node-positive hormone receptor-positive early-stage breast cancer treated with endocrine therapy: a combined analysis of ABCSG-8 and ATAC using the PAM50 risk of recurrence score and intrinsic subtype. Ann Oncol 2015; 26:1685-91. [PMID: 25935792 DOI: 10.1093/annonc/mdv215] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 11/19/2014] [Accepted: 04/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the adjuvant treatment of hormone receptor-positive (HR+) breast cancer, variables like tumour size, grade and nodal status have great impact on therapy decisions. As most node-positive patients with HR+ breast cancer currently receive adjuvant chemotherapy improved methods for characterization of individuals' metastasis risk are needed to reduce overtreatment. PATIENTS AND METHODS Tissue specimens from node-positive patients of the ABCSG-8 and ATAC trials who received adjuvant tamoxifen and/or anastrozole were included in this study. Analysing RNA from paraffin blocks using the PAM50 test, the primary objective was to evaluate the prognostic information of the risk of recurrence (ROR) score added to combined clinical standard variables in patients with one positive node (1N+) and in patients with two or three positive nodes (2-3N+), using log-likelihood ratio tests. RESULTS At a median follow-up of 9.6 years, distant metastases occurred in 97 (18%) of 543 node-positive patients. In a multivariate analysis, the PAM50-derived ROR score provided reliable prognostic information in addition to and beyond established clinical factors for 1N+ (P < 0.0001) and 2-3N+ patients (P = 0.0002). Ten-year distant recurrence risk was significantly increased in the high-risk compared with the low-risk group derived from ROR score for 1N+ [25.5%, 95% confidence interval (CI) 17.5% to 36.1%versus 6.6%, 95% CI 3.3% to 12.8%] and compared with the combined low/intermediate risk group for 2-3N+ patients (33.7%, 95% CI 25.5% to 43.8% versus 12.5%, 95% CI 6.6% to 22.8%). Additionally, the luminal A intrinsic subtype (IS) exhibited significantly lower risk of distant recurrence compared with the luminal B subtype in 1N+ and 2-3N+ patients. CONCLUSION PAM50 ROR score and IS can identify node-positive patient subgroups with limited risk of metastasis after endocrine therapy, for whom adjuvant chemotherapy can be spared. The PAM50 test is a valuable tool in determining treatment of node-positive early-stage breast cancer patients.
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Affiliation(s)
- M Gnant
- Department of Surgery and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - I Sestak
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - M Filipits
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - M Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital and Breakthrough Breast Cancer Centre, London, UK
| | - M Balic
- Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - E Lopez-Knowles
- Institute of Cancer Research, Royal Marsden Hospital and Breakthrough Breast Cancer Research Centre, London, UK
| | - R Greil
- Department of Internal Medicine III, Paracelsus Medical University Salzburg, Salzburg
| | - P Dubsky
- Department of Surgery and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - H Stoeger
- Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - M Rudas
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - R Jakesz
- Department of Surgery and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - S Ferree
- NanoString Technologies, Seattle, USA
| | | | - T Nielsen
- Department of Pathology, University of British Columbia, Vancouver, Canada
| | - C Schaper
- Independent Statistical Consultant New York, New York, USA
| | - C Fesl
- Department of Statistics, Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - J Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Kallehauge J, Nielsen T, Alber M, Haack S, Pedersen E, Lindegaard J, Ramlov A, Tanderup K. PD-0144: Classification of tumor sub-volumes based on Dynamic Contrast Enhanced MRI model hierarchy for cervical cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chu QSC, Nielsen TO, Alcindor T, Gupta A, Endo M, Goytain A, Xu H, Verma S, Tozer R, Knowling M, Bramwell VB, Powers J, Seymour LK, Eisenhauer EA. A phase II study of SB939, a novel pan-histone deacetylase inhibitor, in patients with translocation-associated recurrent/metastatic sarcomas-NCIC-CTG IND 200†. Ann Oncol 2015; 26:973-981. [PMID: 25632070 DOI: 10.1093/annonc/mdv033] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 01/09/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A subgroup of sarcomas is characterized by defining chromosomal translocations, creating fusion transcription factor oncogenes. Resultant fusion oncoproteins associate with chromatin-modifying complexes containing histone deacetylases (HDAC), and lead to epigenetic transcriptional dysregulation. HDAC inhibitors were shown to be effective in vitro, reversing gene repression by these complexes, restoring PTEN expression and apoptosis via the PI3K/Akt/mTOR pathway. PATIENTS AND METHODS SB939 is an oral inhibitor of classes 1 and 2 HDAC. Eligible patients with recurrent or metastatic translocation-associated sarcoma (TAS) by local pathology were treated with 60 mg/day every other day for 3 of 4 weeks. Central pathology review was conducted with fusion oncogenes characterized, and HDAC2 expression correlated with efficacy in pre-specified methods. RESULTS Twenty-two patients were treated with a median of 2 cycles. Fourteen patients were assessable for response with confirmed specific chromosomal translocations; 8 had a best response of stable disease (SD) (median duration 5.4 months) with no confirmed objective responses. The 3-month progression-free survival (PFS) rate was 49%. Among those with HDAC2 score ≥5, 7/10 had SD, versus 0/3 with HDAC2 score <5. SB939 was considered as well tolerated with <10% patients experienced ≥grade 3 toxicity. CONCLUSION This study was stopped prematurely due to prolonged unavailability of SB939. No objective responses were seen. Although the observed SD in HDAC2 high patients was interesting, due to the small sample size, no definitive conclusion can be drawn about the efficacy of SB939 in this patient population. CLINICAL TRIAL NCT01112384.
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Affiliation(s)
- Q S-C Chu
- Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton.
| | - T O Nielsen
- Department of Pathology, British Columbia Cancer Agency, Vancouver
| | - T Alcindor
- Division of Medical Oncology, Department of Oncology, McGill University, Montreal
| | - A Gupta
- Division of Medical Oncology, Department of Oncology, Mount Sinai Hospital/Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - M Endo
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - A Goytain
- Department of Pathology, British Columbia Cancer Agency, Vancouver
| | - H Xu
- Investigational New Drug Program, NCIC-Clinical Trials Group, Kingston
| | - S Verma
- Department of Medical Oncology, Ottawa Cancer Centre, University of Ottawa, Ottawa
| | - R Tozer
- Division of Medical Oncology, Department of Oncology, Jurvinski Cancer Centre, McMaster University, Hamilton
| | - M Knowling
- Department of Pathology, British Columbia Cancer Agency, Vancouver
| | - V B Bramwell
- Division of Medical Oncology, Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - J Powers
- Investigational New Drug Program, NCIC-Clinical Trials Group, Kingston
| | - L K Seymour
- Investigational New Drug Program, NCIC-Clinical Trials Group, Kingston
| | - E A Eisenhauer
- Investigational New Drug Program, NCIC-Clinical Trials Group, Kingston
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Salgado R, Denkert C, Demaria S, Sirtaine N, Klauschen F, Pruneri G, Wienert S, Van den Eynden G, Baehner FL, Penault-Llorca F, Perez EA, Thompson EA, Symmans WF, Richardson AL, Brock J, Criscitiello C, Bailey H, Ignatiadis M, Floris G, Sparano J, Kos Z, Nielsen T, Rimm DL, Allison KH, Reis-Filho JS, Loibl S, Sotiriou C, Viale G, Badve S, Adams S, Willard-Gallo K, Loi S. The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs Working Group 2014. Ann Oncol 2014; 26:259-71. [PMID: 25214542 DOI: 10.1093/annonc/mdu450] [Citation(s) in RCA: 1856] [Impact Index Per Article: 185.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The morphological evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer (BC) is gaining momentum as evidence strengthens for the clinical relevance of this immunological biomarker. Accumulating evidence suggests that the extent of lymphocytic infiltration in tumor tissue can be assessed as a major parameter by evaluation of hematoxylin and eosin (H&E)-stained tumor sections. TILs have been shown to provide prognostic and potentially predictive value, particularly in triple-negative and human epidermal growth factor receptor 2-overexpressing BC. DESIGN A standardized methodology for evaluating TILs is now needed as a prerequisite for integrating this parameter in standard histopathological practice, in a research setting as well as in clinical trials. This article reviews current data on the clinical validity and utility of TILs in BC in an effort to foster better knowledge and insight in this rapidly evolving field, and to develop a standardized methodology for visual assessment on H&E sections, acknowledging the future potential of molecular/multiplexed approaches. CONCLUSIONS The methodology provided is sufficiently detailed to offer a uniformly applied, pragmatic starting point and improve consistency and reproducibility in the measurement of TILs for future studies.
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Affiliation(s)
- R Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - C Denkert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - S Demaria
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - N Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Klauschen
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Pruneri
- European Institute of Oncology (IEO) and University of Milan, Milan, Italy
| | - S Wienert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Van den Eynden
- Department of Pathology GZA, TCRU Hospitals and CORE Antwerp University, Antwerp, Belgium
| | - F L Baehner
- Genomic Health, Inc., Redwood City, USA University of California San Francisco, San Francisco, USA
| | - F Penault-Llorca
- Clermont-Ferrand Biopathology, University of Auvergne, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - E A Perez
- Division of Haematology/Medical Oncology and
| | - E A Thompson
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville
| | - W F Symmans
- Department of Pathology, The UT M.D. Anderson Cancer Center, Boston
| | - A L Richardson
- Department of Pathology, Brigham and Women's Hospital, Boston Department of Cancer Biology, Dana Farber Cancer Institute, Boston
| | - J Brock
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston Department of Cancer Biology, Harvard Medical School, Boston, USA
| | | | - H Bailey
- Genomic Health, Inc., Redwood City, USA
| | - M Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - J Sparano
- Department of Medicine, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein Medical Center, Bronx, USA
| | - Z Kos
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - T Nielsen
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - D L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven
| | - K H Allison
- Department of Pathology, Stanford University Medical Centre, Stanford
| | - J S Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - C Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - S Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - S Adams
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - K Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Loi
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
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Ali HR, Provenzano E, Dawson SJ, Blows FM, Liu B, Shah M, Earl HM, Poole CJ, Hiller L, Dunn JA, Bowden SJ, Twelves C, Bartlett JMS, Mahmoud SMA, Rakha E, Ellis IO, Liu S, Gao D, Nielsen TO, Pharoah PDP, Caldas C. Association between CD8+ T-cell infiltration and breast cancer survival in 12,439 patients. Ann Oncol 2014; 25:1536-43. [PMID: 24915873 DOI: 10.1093/annonc/mdu191] [Citation(s) in RCA: 521] [Impact Index Per Article: 52.1] [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: 02/11/2024] Open
Abstract
BACKGROUND T-cell infiltration in estrogen receptor (ER)-negative breast tumours has been associated with longer survival. To investigate this association and the potential of tumour T-cell infiltration as a prognostic and predictive marker, we have conducted the largest study of T cells in breast cancer to date. PATIENTS AND METHODS Four studies totalling 12 439 patients were used for this work. Cytotoxic (CD8+) and regulatory (forkhead box protein 3, FOXP3+) T cells were quantified using immunohistochemistry (IHC). IHC for CD8 was conducted using available material from all four studies (8978 samples) and for FOXP3 from three studies (5239 samples)-multiple imputation was used to resolve missing data from the remaining patients. Cox regression was used to test for associations with breast cancer-specific survival. RESULTS In ER-negative tumours [triple-negative breast cancer and human epidermal growth factor receptor 2 (human epidermal growth factor receptor 2 (HER2) positive)], presence of CD8+ T cells within the tumour was associated with a 28% [95% confidence interval (CI) 16% to 38%] reduction in the hazard of breast cancer-specific mortality, and CD8+ T cells within the stroma with a 21% (95% CI 7% to 33%) reduction in hazard. In ER-positive HER2-positive tumours, CD8+ T cells within the tumour were associated with a 27% (95% CI 4% to 44%) reduction in hazard. In ER-negative disease, there was evidence for greater benefit from anthracyclines in the National Epirubicin Adjuvant Trial in patients with CD8+ tumours [hazard ratio (HR) = 0.54; 95% CI 0.37-0.79] versus CD8-negative tumours (HR = 0.87; 95% CI 0.55-1.38). The difference in effect between these subgroups was significant when limited to cases with complete data (P heterogeneity = 0.04) and approached significance in imputed data (P heterogeneity = 0.1). CONCLUSIONS The presence of CD8+ T cells in breast cancer is associated with a significant reduction in the relative risk of death from disease in both the ER-negative [supplementary Figure S1, available at Annals of Oncology online] and the ER-positive HER2-positive subtypes. Tumour lymphocytic infiltration may improve risk stratification in breast cancer patients classified into these subtypes. NEAT ClinicalTrials.gov: NCT00003577.
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Affiliation(s)
- H R Ali
- Cancer Research UK Cambridge Institute Departments of Pathology Oncology, University of Cambridge, Cambridge
| | - E Provenzano
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge
| | - S-J Dawson
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - F M Blows
- Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - B Liu
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - M Shah
- Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge Strangeways Research Laboratory, Cambridge
| | - H M Earl
- Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
| | - C J Poole
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - L Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - S J Bowden
- Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, The University of Birmingham, Birmingham
| | - C Twelves
- University of Leeds and Leeds Cancer Research UK Centre, St James' Institute of Oncology, Leeds, UK
| | - J M S Bartlett
- Ontario Institute for Cancer Research, Toronto, Canada and Biomarker and Companion Diagnostics, Edinburgh Cancer Research Centre, Edinburgh Department of Histopathology and School of Molecular Medical Sciences, The University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S M A Mahmoud
- Department of Pathology and Laboratory Medicine, University of British Columbia; Integrative Oncology Department, British Columbia Cancer Agency, Vancouver
| | - E Rakha
- Department of Pathology and Laboratory Medicine, University of British Columbia; Integrative Oncology Department, British Columbia Cancer Agency, Vancouver
| | - I O Ellis
- Department of Pathology and Laboratory Medicine, University of British Columbia; Integrative Oncology Department, British Columbia Cancer Agency, Vancouver
| | - S Liu
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - D Gao
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - T O Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - P D P Pharoah
- Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge Strangeways Research Laboratory, Cambridge
| | - C Caldas
- Cancer Research UK Cambridge Institute Oncology, University of Cambridge, Cambridge Cambridge Experimental Cancer Medicine Centre and NIHR Cambridge Biomedical Research Centre, Cambridge
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Kallehauge J, Haack S, Tanderup K, Lindegaard J, Mohamed S, Pedersen E, Fokdal L, Nielsen T. PD-0414: Tracer kinetic model selection for dynamic contrast-enhanced MRI of locally advanced cervical cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30519-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gnant M, Filipits M, Greil R, Stoeger H, Rudas M, Bago-Horvath Z, Mlineritsch B, Kwasny W, Knauer M, Singer C, Jakesz R, Dubsky P, Fitzal F, Bartsch R, Steger G, Balic M, Ressler S, Cowens JW, Storhoff J, Ferree S, Schaper C, Liu S, Fesl C, Nielsen TO. Predicting distant recurrence in receptor-positive breast cancer patients with limited clinicopathological risk: using the PAM50 Risk of Recurrence score in 1478 postmenopausal patients of the ABCSG-8 trial treated with adjuvant endocrine therapy alone. Ann Oncol 2013; 25:339-45. [PMID: 24347518 DOI: 10.1093/annonc/mdt494] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND PAM50 is a 50-gene test that is designed to identify intrinsic breast cancer subtypes and generate a Risk of Recurrence (ROR) score. It has been developed to be carried out in qualified routine hospital pathology laboratories. PATIENTS AND METHODS One thousand four hundred seventy-eight postmenopausal women with estrogen receptor (ER)+ early breast cancer (EBC) treated with tamoxifen or tamoxifen followed by anastrozole from the prospective randomized ABCSG-8 trial were entered into this study. Patients did not receive adjuvant chemotherapy. RNA was extracted from paraffin blocks and analyzed using the PAM50 test. Both intrinsic subtype (luminal A/B, HER2-enriched, basal-like) and ROR score were calculated. The primary analysis was designed to test whether the continuous ROR score adds prognostic value in predicting distant recurrence (DR) over and above standard clinical variables. RESULTS In all tested subgroups, ROR score significantly adds prognostic information to the clinical predictor (P<0.0001). PAM50 assigns an intrinsic subtype to all cases, and the luminal A cohort had a significantly lower ROR at 10 years compared with Luminal B (P<0.0001). Significant and clinically relevant discrimination between low- and high-risk groups occurred also within all tested subgroups. CONCLUSION(S) The results of the primary analysis, in combination with recently published results from the ATAC trial, constitute Level 1 evidence for clinical validity of the PAM50 test for predicting the risk of DR in postmenopausal women with ER+ EBC. A 10-year metastasis risk of <3.5% in the ROR low category makes it unlikely that additional chemotherapy would improve this outcome-this finding could help to avoid unwarranted overtreatment. CLINICAL TRIAL NUMBER ABCSG 8: NCT00291759.
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Affiliation(s)
- M Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Nielsen TO, Polley MYC. Abstract S2-07: An international Ki67 reproducibility study: Harmonizing scoring methodology. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s2-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Ki67 is an important biomarker for breast cancer but lack of scoring standardization has limited its clinical use. A previous International Ki67 in Breast Cancer Working Group reproducibility study (phase 1) found problematic inter-laboratory variability when labs employed their own scoring methods. This follow-up study (phase 2) devised and tested strategies to harmonize Ki67 scoring.
Methods:
Web-based Calibration: 17 labs were sent simple instructions prescribing a scoring pattern with supporting sample images and asked to score web images of 9 “training” and 9 “test” breast cancer cases representing a range of Ki67 values. Cases were selected from centrally MIB-1 stained TMA cores used in phase 1. Labs yielding consistent scores served as reference labs. Software tracked object selection and scoring. After scoring the training cases, labs were asked to learn from discrepancies by comparing their scored images with scored reference images. “Passing” the training was required for proceeding to testing. The study allowed multiple attempts in training but only 1 attempt on the test cases. Statistical criteria for success, reflecting deviation from reference scores (RMSE < 0.6, MAXDEV < 1.0), were pre-specified.
Phase 2 on glass: Scoring instructions similar to those used in the calibration were provided to 16 of the calibration study labs. They were asked to apply the same standardized method to glass TMA slides (50 cases from the phase 1 TMA, none used in the calibration). Three sections from the TMA were circulated among 3 groups. Labs’ Ki67 scores were log2-transformed to approximate a normal distribution. Sources of variation (e.g., patient, lab) were analyzed using 2-way crossed random effects models with quantification of reproducibility via intraclass correlation coefficient (ICC; range of 0-1, 1 = highest agreement). The pre-specified benchmark of success was a scoring ICC consistent with a true value of 0.9 and significantly greater than the observed overall ICC from phase 1 (0.7).
Results:
Web-based Calibration: Lab performance through the calibration exercise, from training to testing, showed trends of improvement (average across labs: RMSE decreased from 0.6 to 0.4, MAXDEV decreased from 1.6 to 0.9), although not statistically significant, possibly due to limited number of labs (paired t-test: p = 0.07 for RMSE, 0.06 for MAXDEV).
Phase 2 on glass: Whereas inter-laboratory reproducibility in phase 1 was only moderate overall, standardizing the scoring method resulted in achieving a scoring ICC of 0.92 (0.79-0.95), 0.96 (0.78-0.97), and 0.94 (0.77-0.97) in phase 2 for the three groups receiving a given section of the TMA, respectively. Substantial discrepancies persisted among labs on some cases, however, including in the range of clinically relevant cutoffs.
Conclusions: Previous evidence showed that absolute values and cutoffs for Ki67 cannot be transferred between labs without careful standardization of scoring methodology. Use of a common scoring method after training with a web-based calibration tool achieves high inter-laboratory reproducibility in Ki67 scoring on centrally-stained glass TMA slides. Future research should extend this approach to unstained biopsies and whole sections, and link to outcomes, particularly for cases around cutoffs.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S2-07.
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Affiliation(s)
- TO Nielsen
- University of British Columbia, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD; BIG-NABCG Collaboration http://www.breastinternationalgroup.org/what-we-do/big-nabcg
| | - M-YC Polley
- University of British Columbia, Vancouver, BC, Canada; National Cancer Institute, Bethesda, MD; BIG-NABCG Collaboration http://www.breastinternationalgroup.org/what-we-do/big-nabcg
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