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Parker JS, Mullins M, Cheang MCU, Leung S, Voduc D, Vickery T, Davies S, Fauron C, He X, Hu Z, Quackenbush JF, Stijleman IJ, Palazzo J, Marron JS, Nobel AB, Mardis E, Nielsen TO, Ellis MJ, Perou CM, Bernard PS. Supervised Risk Predictor of Breast Cancer Based on Intrinsic Subtypes. J Clin Oncol 2023; 41:4192-4199. [PMID: 37672882 DOI: 10.1200/jco.22.02511] [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: 09/08/2023] Open
Abstract
PURPOSE To improve on current standards for breast cancer prognosis and prediction of chemotherapy benefit by developing a risk model that incorporates the gene expression-based "intrinsic" subtypes luminal A, luminal B, HER2-enriched, and basal-like. METHODS A 50-gene subtype predictor was developed using microarray and quantitative reverse transcriptase polymerase chain reaction data from 189 prototype samples. Test sets from 761 patients (no systemic therapy) were evaluated for prognosis, and 133 patients were evaluated for prediction of pathologic complete response (pCR) to a taxane and anthracycline regimen. RESULTS The intrinsic subtypes as discrete entities showed prognostic significance (P = 2.26E-12) and remained significant in multivariable analyses that incorporated standard parameters (estrogen receptor status, histologic grade, tumor size, and node status). A prognostic model for node-negative breast cancer was built using intrinsic subtype and clinical information. The C-index estimate for the combined model (subtype and tumor size) was a significant improvement on either the clinicopathologic model or subtype model alone. The intrinsic subtype model predicted neoadjuvant chemotherapy efficacy with a negative predictive value for pCR of 97%. CONCLUSION Diagnosis by intrinsic subtype adds significant prognostic and predictive information to standard parameters for patients with breast cancer. The prognostic properties of the continuous risk score will be of value for the management of node-negative breast cancers. The subtypes and risk score can also be used to assess the likelihood of efficacy from neoadjuvant chemotherapy.
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Affiliation(s)
- Joel S Parker
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Michael Mullins
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Maggie C U Cheang
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Samuel Leung
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - David Voduc
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Tammi Vickery
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Sherri Davies
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Christiane Fauron
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Xiaping He
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Zhiyuan Hu
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - John F Quackenbush
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Inge J Stijleman
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Juan Palazzo
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - J S Marron
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Andrew B Nobel
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Elaine Mardis
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Torsten O Nielsen
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Matthew J Ellis
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Charles M Perou
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Philip S Bernard
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
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Wallden B, Storhoff J, Nielsen T, Dowidar N, Schaper C, Ferree S, Liu S, Leung S, Geiss G, Snider J, Vickery T, Davies SR, Mardis ER, Gnant M, Sestak I, Ellis MJ, Perou CM, Bernard PS, Parker JS. Development and verification of the PAM50-based Prosigna breast cancer gene signature assay. BMC Med Genomics 2015; 8:54. [PMID: 26297356 PMCID: PMC4546262 DOI: 10.1186/s12920-015-0129-6] [Citation(s) in RCA: 299] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/17/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The four intrinsic subtypes of breast cancer, defined by differential expression of 50 genes (PAM50), have been shown to be predictive of risk of recurrence and benefit of hormonal therapy and chemotherapy. Here we describe the development of Prosigna™, a PAM50-based subtype classifier and risk model on the NanoString nCounter Dx Analysis System intended for decentralized testing in clinical laboratories. METHODS 514 formalin-fixed, paraffin-embedded (FFPE) breast cancer patient samples were used to train prototypical centroids for each of the intrinsic subtypes of breast cancer on the NanoString platform. Hierarchical cluster analysis of gene expression data was used to identify the prototypical centroids defined in previous PAM50 algorithm training exercises. 304 FFPE patient samples from a well annotated clinical cohort in the absence of adjuvant systemic therapy were then used to train a subtype-based risk model (i.e. Prosigna ROR score). 232 samples from a tamoxifen-treated patient cohort were used to verify the prognostic accuracy of the algorithm prior to initiating clinical validation studies. RESULTS The gene expression profiles of each of the four Prosigna subtype centroids were consistent with those previously published using the PCR-based PAM50 method. Similar to previously published classifiers, tumor samples classified as Luminal A by Prosigna had the best prognosis compared to samples classified as one of the three higher-risk tumor subtypes. The Prosigna Risk of Recurrence (ROR) score model was verified to be significantly associated with prognosis as a continuous variable and to add significant information over both commonly available IHC markers and Adjuvant! Online. CONCLUSIONS The results from the training and verification data sets show that the FDA-cleared and CE marked Prosigna test provides an accurate estimate of the risk of distant recurrence in hormone receptor positive breast cancer and is also capable of identifying a tumor's intrinsic subtype that is consistent with the previously published PCR-based PAM50 assay. Subsequent analytical and clinical validation studies confirm the clinical accuracy and technical precision of the Prosigna PAM50 assay in a decentralized setting.
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Affiliation(s)
- Brett Wallden
- NanoString Technologies, Inc, 530 Fairview Avenue North, Suite 2000, Seattle, WA, 98109, USA.
| | - James Storhoff
- NanoString Technologies, Inc, 530 Fairview Avenue North, Suite 2000, Seattle, WA, 98109, USA.
| | - Torsten Nielsen
- Genetic Pathology Evaluation Centre, Vancouver Coastal Health Research Institute and British Columbia Cancer Agency, 2655 Oak St, Vancouver, BC, V5Z 1M9, Canada.
| | - Naeem Dowidar
- NanoString Technologies, Inc, 530 Fairview Avenue North, Suite 2000, Seattle, WA, 98109, USA.
| | | | - Sean Ferree
- NanoString Technologies, Inc, 530 Fairview Avenue North, Suite 2000, Seattle, WA, 98109, USA.
| | - Shuzhen Liu
- Genetic Pathology Evaluation Centre, Vancouver Coastal Health Research Institute and British Columbia Cancer Agency, 2655 Oak St, Vancouver, BC, V5Z 1M9, Canada.
| | - Samuel Leung
- Genetic Pathology Evaluation Centre, Vancouver Coastal Health Research Institute and British Columbia Cancer Agency, 2655 Oak St, Vancouver, BC, V5Z 1M9, Canada.
| | - Gary Geiss
- NanoString Technologies, Inc, 530 Fairview Avenue North, Suite 2000, Seattle, WA, 98109, USA.
| | - Jacqueline Snider
- Washington University School of Medicine, 660 S Euclid, St. Louis, MO, 63110, USA.
| | - Tammi Vickery
- Washington University School of Medicine, 660 S Euclid, St. Louis, MO, 63110, USA.
| | - Sherri R Davies
- Washington University School of Medicine, 660 S Euclid, St. Louis, MO, 63110, USA.
| | - Elaine R Mardis
- Washington University School of Medicine, 660 S Euclid, St. Louis, MO, 63110, USA.
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Sq, London, EC1M 6BQ, UK.
| | - Matthew J Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, MS 600, Houston, TX, 77030, USA.
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, Department of Genetics, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
| | - Philip S Bernard
- Huntsman Comprehensive Cancer Center, Department of Pathology, 2000 Circle of Hope, Salt Lake City, UT, 84103, USA.
| | - Joel S Parker
- Lineberger Comprehensive Cancer Center, Department of Genetics, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
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Prat A, Lluch A, Albanell J, Barry WT, Fan C, Chacón JI, Parker JS, Calvo L, Plazaola A, Arcusa A, Seguí-Palmer MA, Burgues O, Ribelles N, Rodriguez-Lescure A, Guerrero A, Ruiz-Borrego M, Munarriz B, López JA, Adamo B, Cheang MCU, Li Y, Hu Z, Gulley ML, Vidal MJ, Pitcher BN, Liu MC, Citron ML, Ellis MJ, Mardis E, Vickery T, Hudis CA, Winer EP, Carey LA, Caballero R, Carrasco E, Martín M, Perou CM, Alba E. Predicting response and survival in chemotherapy-treated triple-negative breast cancer. Br J Cancer 2014; 111:1532-41. [PMID: 25101563 PMCID: PMC4200088 DOI: 10.1038/bjc.2014.444] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 06/26/2014] [Accepted: 07/13/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In this study, we evaluated the ability of gene expression profiles to predict chemotherapy response and survival in triple-negative breast cancer (TNBC). METHODS Gene expression and clinical-pathological data were evaluated in five independent cohorts, including three randomised clinical trials for a total of 1055 patients with TNBC, basal-like disease (BLBC) or both. Previously defined intrinsic molecular subtype and a proliferation signature were determined and tested. Each signature was tested using multivariable logistic regression models (for pCR (pathological complete response)) and Cox models (for survival). Within TNBC, interactions between each signature and the basal-like subtype (vs other subtypes) for predicting either pCR or survival were investigated. RESULTS Within TNBC, all intrinsic subtypes were identified but BLBC predominated (55-81%). Significant associations between genomic signatures and response and survival after chemotherapy were only identified within BLBC and not within TNBC as a whole. In particular, high expression of a previously identified proliferation signature, or low expression of the luminal A signature, was found independently associated with pCR and improved survival following chemotherapy across different cohorts. Significant interaction tests were only obtained between each signature and the BLBC subtype for prediction of chemotherapy response or survival. CONCLUSIONS The proliferation signature predicts response and improved survival after chemotherapy, but only within BLBC. This highlights the clinical implications of TNBC heterogeneity, and suggests that future clinical trials focused on this phenotypic subtype should consider stratifying patients as having BLBC or not.
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Affiliation(s)
- A Prat
- Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Pg Vall d'Hebron, 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - A Lluch
- Department of Medical Oncology and Department of Pathology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - J Albanell
- Department of Medical Oncology, Hospital del Mar, IMIM, 08003 Barcelona, Spain
- Department of Medical Oncology, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
| | - W T Barry
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - C Fan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - J I Chacón
- Department of Medical Oncology, Hospital Virgen de la Salud, 45004 Toledo, Spain
| | - J S Parker
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27519, USA
| | - L Calvo
- Department of Medical Oncology, Complexo Hospitalario Universitario de A Coruña, 15002 A Coruña, Spain
| | - A Plazaola
- Department of Medical Oncology, Onkologikoa, 20014 San Sebastián, Spain
| | - A Arcusa
- Department of Medical Oncology, Consorci Sanitari de Terrassa, 08225 Barcelona, Spain
| | - M A Seguí-Palmer
- Department of Medical Oncology, Corporació Sanitària Parc Taulí, 08208 Sabadell, Spain
| | - O Burgues
- Department of Medical Oncology and Department of Pathology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - N Ribelles
- Department of Medical Oncology and Department of Pathology, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
| | - A Rodriguez-Lescure
- Department of Medical Oncology, Hospital General de Elche, 03203 Alicante, Spain
| | - A Guerrero
- Department of Medical Oncology, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain
| | - M Ruiz-Borrego
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - B Munarriz
- Department of Medical Oncology, Hospital Universitario La Fe, 46026 Valencia, Spain
| | - J A López
- Department of Medical Oncology, Hospital San Camilo, 28006 Madrid, Spain
| | - B Adamo
- Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Pg Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - M C U Cheang
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - Y Li
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - Z Hu
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - M L Gulley
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - M J Vidal
- Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Pg Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - B N Pitcher
- Alliance Statistical and Data Center, Duke University, Durham, NC 27708, USA
| | - M C Liu
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - M L Citron
- ProHEALTH Care Associates, LLP, Lake Success, NY 11803, USA
| | - M J Ellis
- Department of Oncology, Washington University, St. Louis, MO 63130, USA
| | - E Mardis
- Department of Oncology, Washington University, St. Louis, MO 63130, USA
| | - T Vickery
- Department of Oncology, Washington University, St. Louis, MO 63130, USA
| | - C A Hudis
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - E P Winer
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - L A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - R Caballero
- GEICAM (Spanish Breast Cancer Research Group), 28700 Madrid, Spain
| | - E Carrasco
- GEICAM (Spanish Breast Cancer Research Group), 28700 Madrid, Spain
| | - M Martín
- GEICAM (Spanish Breast Cancer Research Group), 28700 Madrid, Spain
- Department of Medical Oncology, Instituto de Investigación Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, 28007 Madrid, Spain
| | - C M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27519, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27519, USA
| | - E Alba
- Department of Medical Oncology and Department of Pathology, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
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Moyer J, Vickery T. Interference from an integral feature in visual statistical summary representations. J Vis 2014. [DOI: 10.1167/14.10.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vickery T, Friedman K, Bristol R. Unreliable associations between visual features and values interfere with reward-based decision-making. J Vis 2014. [DOI: 10.1167/14.10.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cheang MCU, Parker J, DeSchryver K, Snider J, Walsh T, Davies S, Prat A, Vickery T, Reed J, Zehnbauer B, Leung S, Voduc D, Nielsen T, Mardis E, Bernard P, Perou C, Ellis M. Abstract P6-07-10: Luminal A vs. Basal-like Breast Cancer: time dependent changes in the risk of relapse in the absence of treatment. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-07-10] [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: Numerous retrospective analyses of prospective randomized clinical trials of patients treated with adjuvant tamoxifen and chemotherapy have demonstrated that the breast cancer intrinsic subtype Luminal A tumors generally have favorable early initial outcomes, while basal-like tumors are associated with a marked risk of early relapse. To determine the extended natural history of the intrinsic subtypes across two decades of follow up the PAM50 “non-commercial open source bioinformatics” qPCR assay was conducted on node negative tumors accrued through the Cooperative Breast Cancer Tissue Registry (CBCTR) from patients who did not receive systemic therapy.
Methods: Intrinsic subtype calls were obtained from 331 CBCTR cases treated with local interventions only. Tumors were classified into Luminal A (LumA), Luminal B (LumB), HER2-enriched (HER2-E) and Basal-like (BLBC), and correlated relapse-free (RFS). Patient survival and hazard rate were estimated using Kaplan-Meier plots and log-rank test. Multivariable Cox regression analyses were used to determine the significance of the intrinsic subtypes, adjusted with standard clinicopathological variables including tumor size, age at diagnosis, grade, radiation therapy treatment, centralized reviewed estrogen receptor, progesterone receptor and human epidermal growth factor 2 status measured by immunohistochemistry. Patients were diagnosed from 1978 to 1992, with a mean follow-up time of 13 years (range 0.5–31).
Results: Of the 331 tumors tested, 51% of cases were classified as LumA, 18% as LumB, 11% as HER2-E and 20% as BLBC. Although LumA was associated with the best outcome for the first 10-year of follow-up, the final number of RFS events were eventually comparable with those observed for BLBC with prolonged follow up (Table 1). In the multivariable Cox model, only BLBC tumors were associated with worse prognosis than LumA with borderline significance (Hazard ratio: 2.0 (95% CI 0.9–5), p = 0.07). BLBC had the highest hazard rates for the first 5 years (7% at first year to 5% at 5 yr), consistent with previous observations. Interestingly, in the absence of treatment, the slow growing LumA subtype had a gradual increase of hazard for an RFS event from 3% at 5 yrs to 4% at 10 yrs to 7% at 20 yrs. The hazard rates of LumA cross with those of BLBC at 10 years.
Conclusions: Basal-like breast cancers are associated with an early risk of relapse that decreases over time. In contrast, Luminal A breast cancer has a low risk of relapse at the outset but the risk of relapse increases over time and is responsible of the majority of the RFS events after 20 years of follow up. Luminal A breast cancers are therefore not truly low risk, particularly if they do not receive endocrine therapy; and may experience the consequences of inadequate treatment decades after diagnosis.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-10.
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Affiliation(s)
- MCU Cheang
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - J Parker
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - K DeSchryver
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - J Snider
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - T Walsh
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - S Davies
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - A Prat
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - T Vickery
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - J Reed
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - B Zehnbauer
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - S Leung
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - D Voduc
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - T Nielsen
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - E Mardis
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - P Bernard
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - C Perou
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
| | - M Ellis
- University of North Carolina at Chapel Hill, NC; University of British Columbia, Vancouver, BC, Canada; Washington University School of Medicine; University of Utah
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Vickery T, Kuhl B, Chun M. Temporally specific visual working memory representations revealed by multivoxel pattern analysis. J Vis 2012. [DOI: 10.1167/12.9.1272] [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: 11/24/2022] Open
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Chia SK, Bramwell VH, Tu D, Shepherd LE, Jiang S, Vickery T, Mardis E, Leung S, Ung K, Pritchard KI, Parker JS, Bernard PS, Perou CM, Ellis MJ, Nielsen TO. A 50-gene intrinsic subtype classifier for prognosis and prediction of benefit from adjuvant tamoxifen. Clin Cancer Res 2012; 18:4465-72. [PMID: 22711706 DOI: 10.1158/1078-0432.ccr-12-0286] [Citation(s) in RCA: 222] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Gene expression profiling classifies breast cancer into intrinsic subtypes based on the biology of the underlying disease pathways. We have used material from a prospective randomized trial of tamoxifen versus placebo in premenopausal women with primary breast cancer (NCIC CTG MA.12) to evaluate the prognostic and predictive significance of intrinsic subtypes identified by both the PAM50 gene set and by immunohistochemistry. EXPERIMENTAL DESIGN Total RNA from 398 of 672 (59%) patients was available for intrinsic subtyping with a quantitative reverse transcriptase PCR (qRT-PCR) 50-gene predictor (PAM50) for luminal A, luminal B, HER-2-enriched, and basal-like subtypes. A tissue microarray was also constructed from 492 of 672 (73%) of the study population to assess a panel of six immunohistochemical IHC antibodies to define the same intrinsic subtypes. RESULTS Classification into intrinsic subtypes by the PAM50 assay was prognostic for both disease-free survival (DFS; P = 0.0003) and overall survival (OS; P = 0.0002), whereas classification by the IHC panel was not. Luminal subtype by PAM50 was predictive of tamoxifen benefit [DFS: HR, 0.52; 95% confidence interval (CI), 0.32-0.86 vs. HR, 0.80; 95% CI, 0.50-1.29 for nonluminal subtypes], although the interaction test was not significant (P = 0.24), whereas neither subtyping by central immunohistochemistry nor by local estrogen receptor (ER) or progesterone receptor (PR) status were predictive. Risk of relapse (ROR) modeling with the PAM50 assay produced a continuous risk score in both node-negative and node-positive disease. CONCLUSIONS In the MA.12 study, intrinsic subtype classification by qRT-PCR with the PAM50 assay was superior to IHC profiling for both prognosis and prediction of benefit from adjuvant tamoxifen.
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Affiliation(s)
- Stephen K Chia
- Department of Medical Oncology, British Columbia Cancer Agency, British Columbia, Canada.
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Vickery T, Chun M. Object-based warping: Distribution of distortions over an object's surface and independence of shape. J Vis 2011. [DOI: 10.1167/11.11.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cheang MCU, Voduc D, Tu D, Jiang S, Leung S, Chia SKL, Shepherd LE, Levine MN, Pritchard KI, Vickery T, Davies S, Stijleman IJ, Davis C, Parker JS, Ellis MJ, Bernard PS, Perou CM, Nielsen TO. The responsiveness of intrinsic subtypes to adjuvant anthracyclines versus nonanthracyclines in NCIC.CTG MA.5 randomized trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wartman LD, Larson DE, Xiang Z, Ding L, Chen K, Lin L, Cahan P, Klco JM, Welch JS, Li C, Payton JE, Uy GL, Varghese N, Ries RE, Hoock M, Koboldt DC, McLellan MD, Schmidt H, Fulton RS, Abbott RM, Cook L, McGrath SD, Fan X, Dukes AF, Vickery T, Kalicki J, Lamprecht TL, Graubert TA, Tomasson MH, Mardis ER, Wilson RK, Ley TJ. Sequencing a mouse acute promyelocytic leukemia genome reveals genetic events relevant for disease progression. J Clin Invest 2011; 121:1445-55. [PMID: 21436584 DOI: 10.1172/jci45284] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 01/19/2011] [Indexed: 01/12/2023] Open
Abstract
Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML). It is characterized by the t(15;17)(q22;q11.2) chromosomal translocation that creates the promyelocytic leukemia-retinoic acid receptor α (PML-RARA) fusion oncogene. Although this fusion oncogene is known to initiate APL in mice, other cooperating mutations, as yet ill defined, are important for disease pathogenesis. To identify these, we used a mouse model of APL, whereby PML-RARA expressed in myeloid cells leads to a myeloproliferative disease that ultimately evolves into APL. Sequencing of a mouse APL genome revealed 3 somatic, nonsynonymous mutations relevant to APL pathogenesis, of which 1 (Jak1 V657F) was found to be recurrent in other affected mice. This mutation was identical to the JAK1 V658F mutation previously found in human APL and acute lymphoblastic leukemia samples. Further analysis showed that JAK1 V658F cooperated in vivo with PML-RARA, causing a rapidly fatal leukemia in mice. We also discovered a somatic 150-kb deletion involving the lysine (K)-specific demethylase 6A (Kdm6a, also known as Utx) gene, in the mouse APL genome. Similar deletions were observed in 3 out of 14 additional mouse APL samples and 1 out of 150 human AML samples. In conclusion, whole genome sequencing of mouse cancer genomes can provide an unbiased and comprehensive approach for discovering functionally relevant mutations that are also present in human leukemias.
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Affiliation(s)
- Lukas D Wartman
- Department of Internal Medicine, Division of Oncology, Stem Cell Biology Section, Washington University School of Medicine, Siteman Cancer Center, St. Louis, Missouri, USA
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Nielsen TO, Parker JS, Leung S, Voduc D, Ebbert M, Vickery T, Davies SR, Snider J, Stijleman IJ, Reed J, Cheang MCU, Mardis ER, Perou CM, Bernard PS, Ellis MJ. A comparison of PAM50 intrinsic subtyping with immunohistochemistry and clinical prognostic factors in tamoxifen-treated estrogen receptor-positive breast cancer. Clin Cancer Res 2010; 16:5222-32. [PMID: 20837693 DOI: 10.1158/1078-0432.ccr-10-1282] [Citation(s) in RCA: 541] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To compare clinical, immunohistochemical (IHC), and gene expression models of prognosis applicable to formalin-fixed, paraffin-embedded blocks in a large series of estrogen receptor (ER)-positive breast cancers from patients uniformly treated with adjuvant tamoxifen. EXPERIMENTAL DESIGN Quantitative real-time reverse transcription-PCR (qRT-PCR) assays for 50 genes identifying intrinsic breast cancer subtypes were completed on 786 specimens linked to clinical (median follow-up, 11.7 years) and IHC [ER, progesterone receptor (PR), HER2, and Ki67] data. Performance of predefined intrinsic subtype and risk-of-relapse scores was assessed using multivariable Cox models and Kaplan-Meier analysis. Harrell's C-index was used to compare fixed models trained in independent data sets, including proliferation signatures. RESULTS Despite clinical ER positivity, 10% of cases were assigned to nonluminal subtypes. qRT-PCR signatures for proliferation genes gave more prognostic information than clinical assays for hormone receptors or Ki67. In Cox models incorporating standard prognostic variables, hazard ratios for breast cancer disease-specific survival over the first 5 years of follow-up, relative to the most common luminal A subtype, are 1.99 [95% confidence interval (CI), 1.09-3.64] for luminal B, 3.65 (95% CI, 1.64-8.16) for HER2-enriched subtype, and 17.71 (95% CI, 1.71-183.33) for the basal-like subtype. For node-negative disease, PAM50 qRT-PCR-based risk assignment weighted for tumor size and proliferation identifies a group with >95% 10-year survival without chemotherapy. In node-positive disease, PAM50-based prognostic models were also superior. CONCLUSION The PAM50 gene expression test for intrinsic biological subtype can be applied to large series of formalin-fixed, paraffin-embedded breast cancers, and gives more prognostic information than clinical factors and IHC using standard cut points.
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Affiliation(s)
- Torsten O Nielsen
- Genetic Pathology Evaluation Centre, Vancouver Coastal Health Research Institute, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
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Chia SK, Ung K, Bramwell VH, Tu D, Perou CM, Ellis MJ, Bernard PS, Vickery T, Shepherd LE, Nielsen TO. Prognostic and predictive impact of biologic classification by qRT-PCR with a 50-gene subtype predictor (PAM50) for adjuvant tamoxifen in premenopausal breast cancer: Results from the NCIC CTG MA.12 randomized trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vickery T, Shim WM, Jiang Y, Chakravarthi R, Luedeman R. Supercrowding: Weakly masking a target greatly enhances crowding. J Vis 2010. [DOI: 10.1167/8.6.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Matthews C, Eng H, Vickery T, Shim WM, Jiang Y. Learning of arbitrary visual associations by trial-and-error. J Vis 2010. [DOI: 10.1167/6.6.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Vickery T, Gauthier I. Keeping a straight face: configural processing and the aperture capture illusion. J Vis 2010. [DOI: 10.1167/3.9.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hartshorne J, Vickery T, Jiang Y. Knowledge about target category: A dissociation between categorization and search. J Vis 2010. [DOI: 10.1167/7.9.1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Parker JS, Mullins M, Cheang MC, Leung S, Voduc D, Vickery T, Davies S, Fauron C, He X, Hu Z, Quackenbush JF, Stijleman IJ, Palazzo J, Marron J, Nobel AB, Mardis E, Nielsen TO, Ellis MJ, Perou CM, Bernard PS. Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol 2009; 27:1160-7. [PMID: 19204204 PMCID: PMC2667820 DOI: 10.1200/jco.2008.18.1370] [Citation(s) in RCA: 3032] [Impact Index Per Article: 202.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 11/04/2008] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED PURPOSE To improve on current standards for breast cancer prognosis and prediction of chemotherapy benefit by developing a risk model that incorporates the gene expression-based "intrinsic" subtypes luminal A, luminal B, HER2-enriched, and basal-like. METHODS A 50-gene subtype predictor was developed using microarray and quantitative reverse transcriptase polymerase chain reaction data from 189 prototype samples. Test sets from 761 patients (no systemic therapy) were evaluated for prognosis, and 133 patients were evaluated for prediction of pathologic complete response (pCR) to a taxane and anthracycline regimen. RESULTS The intrinsic subtypes as discrete entities showed prognostic significance (P = 2.26E-12) and remained significant in multivariable analyses that incorporated standard parameters (estrogen receptor status, histologic grade, tumor size, and node status). A prognostic model for node-negative breast cancer was built using intrinsic subtype and clinical information. The C-index estimate for the combined model (subtype and tumor size) was a significant improvement on either the clinicopathologic model or subtype model alone. The intrinsic subtype model predicted neoadjuvant chemotherapy efficacy with a negative predictive value for pCR of 97%. CONCLUSION Diagnosis by intrinsic subtype adds significant prognostic and predictive information to standard parameters for patients with breast cancer. The prognostic properties of the continuous risk score will be of value for the management of node-negative breast cancers. The subtypes and risk score can also be used to assess the likelihood of efficacy from neoadjuvant chemotherapy.
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Affiliation(s)
- Joel S. Parker
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Michael Mullins
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Maggie C.U. Cheang
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Samuel Leung
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - David Voduc
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Tammi Vickery
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Sherri Davies
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Christiane Fauron
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Xiaping He
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Zhiyuan Hu
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - John F. Quackenbush
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Inge J. Stijleman
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Juan Palazzo
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - J.S. Marron
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Andrew B. Nobel
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Elaine Mardis
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Torsten O. Nielsen
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Matthew J. Ellis
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Charles M. Perou
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Philip S. Bernard
- From the Lineberger Comprehensive Cancer Center and Departments of Genetics, Pathology and Laboratory Medicine, and Department of Statistics and Operations Research, Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, University of Utah Health Sciences Center; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Genetic Pathology Evaluation Centre, Department of Pathology, Vancouver Coastal Health Research Institute; Departments of Pathology and Radiation Oncology, British Columbia Cancer Agency; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Genome Sequencing Facility and Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO; and Department of Pathology, Thomas Jefferson University, Philadelphia, PA
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Ding L, Getz G, Wheeler DA, Mardis ER, McLellan MD, Cibulskis K, Sougnez C, Greulich H, Muzny DM, Morgan MB, Fulton L, Fulton RS, Zhang Q, Wendl MC, Lawrence MS, Larson DE, Chen K, Dooling DJ, Sabo A, Hawes AC, Shen H, Jhangiani SN, Lewis LR, Hall O, Zhu Y, Mathew T, Ren Y, Yao J, Scherer SE, Clerc K, Metcalf GA, Ng B, Milosavljevic A, Gonzalez-Garay ML, Osborne JR, Meyer R, Shi X, Tang Y, Koboldt DC, Lin L, Abbott R, Miner TL, Pohl C, Fewell G, Haipek C, Schmidt H, Dunford-Shore BH, Kraja A, Crosby SD, Sawyer CS, Vickery T, Sander S, Robinson J, Winckler W, Baldwin J, Chirieac LR, Dutt A, Fennell T, Hanna M, Johnson BE, Onofrio RC, Thomas RK, Tonon G, Weir BA, Zhao X, Ziaugra L, Zody MC, Giordano T, Orringer MB, Roth JA, Spitz MR, Wistuba II, Ozenberger B, Good PJ, Chang AC, Beer DG, Watson MA, Ladanyi M, Broderick S, Yoshizawa A, Travis WD, Pao W, Province MA, Weinstock GM, Varmus HE, Gabriel SB, Lander ES, Gibbs RA, Meyerson M, Wilson RK. Somatic mutations affect key pathways in lung adenocarcinoma. Nature 2008; 455:1069-75. [PMID: 18948947 PMCID: PMC2694412 DOI: 10.1038/nature07423] [Citation(s) in RCA: 2027] [Impact Index Per Article: 126.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/10/2008] [Indexed: 02/08/2023]
Abstract
Determining the genetic basis of cancer requires comprehensive analyses of large collections of histopathologically well-classified primary tumours. Here we report the results of a collaborative study to discover somatic mutations in 188 human lung adenocarcinomas. DNA sequencing of 623 genes with known or potential relationships to cancer revealed more than 1,000 somatic mutations across the samples. Our analysis identified 26 genes that are mutated at significantly high frequencies and thus are probably involved in carcinogenesis. The frequently mutated genes include tyrosine kinases, among them the EGFR homologue ERBB4; multiple ephrin receptor genes, notably EPHA3; vascular endothelial growth factor receptor KDR; and NTRK genes. These data provide evidence of somatic mutations in primary lung adenocarcinoma for several tumour suppressor genes involved in other cancers--including NF1, APC, RB1 and ATM--and for sequence changes in PTPRD as well as the frequently deleted gene LRP1B. The observed mutational profiles correlate with clinical features, smoking status and DNA repair defects. These results are reinforced by data integration including single nucleotide polymorphism array and gene expression array. Our findings shed further light on several important signalling pathways involved in lung adenocarcinoma, and suggest new molecular targets for treatment.
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Affiliation(s)
- Li Ding
- The Genome Center at Washington University, Department of Genetics, Washington University School of Medicine, St Louis, Missouri 63108, USA
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