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Lopez DS, Wulaningsih W, Tsilidis KK, Baillargeon J, Williams SB, Urban R, Rohrmann S. Environment-wide association study to comprehensively test and validate associations between nutrition and lifestyle factors and testosterone deficiency: NHANES 1988-1994 and 1999-2004. Hormones (Athens) 2020; 19:205-214. [PMID: 32077039 PMCID: PMC7323003 DOI: 10.1007/s42000-020-00179-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Testosterone (T) plays an important role in men's health and its deficiency is linked with poorer health. However, the role of nutritional and lifestyle factors in T regulation and production remains unclear. The objectives are to comprehensively test the cross-sectional associations of nutritional and lifestyle factors with T deficiency and to validate the associations in the NHANES survey. METHODS We performed weighted multivariable logistic regression analysis to examine the association of 173 nutritional and lifestyle factors with T deficiency (total testosterone ≤ 3.5 ng/mL) in NHANES III as the discovery set (mean age 41). We controlled for multiple comparisons with a false discovery rate (FDR) < 5% and replicated in NHANES 1999-2004 (mean age 44). RESULTS We identified seven nutritional factors as being inversely associated with T deficiency in NHANES 1999-2004, namely dietary intake of vitamin A, protein, saturated fatty acids, monounsaturated fatty acids, total fats, saturated fatty acid 16:0, and phosphorus. In a multivariable model, only vitamin A intake remained significantly associated with T deficiency (OR 0.97, 95% CI 0.94-0.99). Principal component analysis suggested that the two principal components, (1) dietary fats, protein, and phosphorous and (2) total vitamin A, may be associated with T deficiency. CONCLUSION Our systematic evaluation provided new insight into the modifiable factors that could play a role in the regulation of T production. This study has the potential to contribute to the current body of literature which seeks to formulate a clinical definition of T deficiency after taking into account nutritional and lifestyle factors.
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Affiliation(s)
- D S Lopez
- Deparment of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, USA.
| | - W Wulaningsih
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - K K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - J Baillargeon
- Deparment of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, USA
| | - S B Williams
- Deparment of Surgery, Division of Urology, University of Texas Medical Branch, Galveston, TX, USA
| | - R Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - S Rohrmann
- Division of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Preventive Institute (EBPI), University of Zurich, Zurich, Switzerland
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Knight WRC, Yip C, Wulaningsih W, Jacques A, Griffin N, Zylstra J, Van Hemelrijck M, Maisey N, Gaya A, Baker CR, Kelly M, Gossage JA, Lagergren J, Landau D, Goh V, Davies AR, Ngan S, Qureshi A, Deere H, Green M, Chang F, Mahadeva U, Gill‐Barman B, George S, Dunn J, Zeki S, Meenan J, Hynes O, Tham G, Iezzi C. Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus. BJS Open 2019; 3:767-776. [PMID: 31832583 PMCID: PMC6887675 DOI: 10.1002/bjs5.50211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
Background A positive circumferential resection margin (CRM) has been associated with higher rates of locoregional recurrence and worse survival in oesophageal cancer. The aim of this study was to establish if clinicopathological and radiological variables might predict CRM positivity in patients who received neoadjuvant chemotherapy before surgery for oesophageal adenocarcinoma. Methods Multivariable analysis of clinicopathological and CT imaging characteristics considered potentially predictive of CRM was performed at initial staging and following neoadjuvant chemotherapy. Prediction models were constructed. The area under the curve (AUC) with 95% confidence intervals (c.i.) from 1000 bootstrapping was assessed. Results A total of 223 patients were included in the study. Poor differentiation (odds ratio (OR) 2·84, 95 per cent c.i. 1·39 to 6·01) and advanced clinical tumour status (T3-4) (OR 2·93, 1·03 to 9·48) were independently associated with an increased CRM risk at diagnosis. CT-assessed lack of response (stable or progressive disease) following chemotherapy independently corresponded with an increased risk of CRM positivity (OR 3·38, 1·43 to 8·50). Additional CT evidence of local invasion and higher CT tumour volume (14 cm3) improved the performance of a prediction model, including all the above parameters, with an AUC (c-index) of 0·76 (0·67 to 0·83). Variables associated with significantly higher rates of locoregional recurrence were pN status (P = 0·020), lymphovascular invasion (P = 0·007) and poor response to chemotherapy (Mandard score 4-5) (P = 0·006). CRM positivity was associated with a higher locoregional recurrence rate, but this was not statistically significant (P = 0·092). Conclusion The presence of advanced cT status, poor tumour differentiation, and CT-assessed lack of response to chemotherapy, higher tumour volume and local invasion can be used to identify patients at risk of a positive CRM following neoadjuvant chemotherapy.
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Affiliation(s)
- W. R. C. Knight
- Department of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College London
- School of Cancer and Pharmaceutical Sciences, King's College London
| | - C. Yip
- School of Biomedical Engineering and Imaging Sciences, King's College London
| | - W. Wulaningsih
- Cancer Epidemiology and Population Health Associated Research Group, King's College London
| | - A. Jacques
- Department of Radiology, Guy's and St Thomas' Hospital, London, UK
| | - N. Griffin
- Department of Radiology, Guy's and St Thomas' Hospital, London, UK
| | - J. Zylstra
- Department of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College London
| | - M. Van Hemelrijck
- Cancer Epidemiology and Population Health Associated Research Group, King's College London
| | - N. Maisey
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | - A. Gaya
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | - C. R. Baker
- Department of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College London
| | - M. Kelly
- Department of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College London
| | - J. A. Gossage
- Department of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College London
- School of Cancer and Pharmaceutical Sciences, King's College London
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J. Lagergren
- Department of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College London
- School of Cancer and Pharmaceutical Sciences, King's College London
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - D. Landau
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | - V. Goh
- School of Biomedical Engineering and Imaging Sciences, King's College London
- Cancer Epidemiology and Population Health Associated Research Group, King's College London
| | - A. R. Davies
- Department of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College London
- School of Cancer and Pharmaceutical Sciences, King's College London
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Davies AR, Myoteri D, Zylstra J, Baker CR, Wulaningsih W, Van Hemelrijck M, Maisey N, Allum WH, Smyth E, Gossage JA, Lagergren J, Cunningham D, Green M. Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma. Br J Surg 2018; 105:1639-1649. [PMID: 30047556 DOI: 10.1002/bjs.10900] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 02/06/2018] [Revised: 04/12/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim was to define the pathological response in lymph nodes following neoadjuvant chemotherapy for oesophageal adenocarcinoma and to quantify any associated survival benefit. METHODS Lymph nodes retrieved at oesophagectomy were examined retrospectively by two pathologists for evidence of a response to chemotherapy. Patients were classified as lymph node-negative (either negative nodes with no evidence of previous tumour involvement or negative with evidence of complete regression) or positive (allocated a lymph node regression score based on the proportion of fibrosis to residual tumour). Lymph node responders (score 1, complete response; 2, less than 10 per cent remaining tumour; 3, 10-50 per cent remaining tumour) and non-responders (score 4, more than 50 per cent viable tumour; 5, no response) were compared in survival analyses using Kaplan-Meier and Cox regression analysis. RESULTS Among 377 patients, 256 had neoadjuvant chemotherapy. Overall, 68 of 256 patients (26·6 per cent) had a lymph node response and 115 (44·9 per cent) did not. The remaining 73 patients (28·5 per cent) had negative lymph nodes with no evidence of regression. Some patients had a lymph node response in the absence of a response in the primary tumour (27 of 99, 27 per cent). Lymph node responders had a significant survival benefit (P < 0·001), even when stratified by patients with or without a response in the primary tumour. On multivariable analysis, lymph node responders had decreased overall (hazard ratio 0·53, 95 per cent c.i. 0·36 to 0·78) and disease-specific (HR 0·42, 0·27 to 0·66) mortality, and experienced reduced local and systemic recurrence. CONCLUSION Lymph node regression is a strong prognostic factor and may be more important than response in the primary tumour.
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Affiliation(s)
- A R Davies
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - D Myoteri
- Department of Cellular Pathology, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - J Zylstra
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - C R Baker
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
| | - W Wulaningsih
- Translational Oncology and Urology Research, School of Cancer Sciences, King's College London, London, UK
| | - M Van Hemelrijck
- Translational Oncology and Urology Research, School of Cancer Sciences, King's College London, London, UK
| | - N Maisey
- Department of Oncology, Guy's Cancer Centre, Guy's Hospital, London, UK
| | - W H Allum
- Department of Oncology, Royal Marsden Hospital, London, UK
| | - E Smyth
- Department of Oncology, Royal Marsden Hospital, London, UK
| | - J A Gossage
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Lagergren
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - D Cunningham
- Department of Oncology, Royal Marsden Hospital, London, UK
- Institute of Cancer Research, London, UK
| | - M Green
- Department of Cellular Pathology, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
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Wulaningsih W, Garmo H, Ahlgren J, Holmberg L, Folkvaljon Y, Wigertz A, Van Hemelrijck M, Lambe M. Determinants of non-adherence to adjuvant endocrine treatment in women with breast cancer: the role of comorbidity. Breast Cancer Res Treat 2018; 172:167-177. [PMID: 30030708 PMCID: PMC6208918 DOI: 10.1007/s10549-018-4890-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine factors associated with non-adherence during 5 years of endocrine treatment, including the possible influence of comorbidity burden and specific medical conditions. METHODS From all women diagnosed with stage I-III, ER-positive breast cancer in Stockholm-Gotland, Uppsala-Örebro and Northern Sweden between 2006 and 2009, we included 4645 women who had at least one dispensation of tamoxifen or aromatase inhibitors (AIs) and 5 years of follow-up without distant recurrence. A medical possession ratio of < 80% was used to define non-adherence. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of non-adherence. RESULTS During follow-up, 977 (21%) women became non-adherents. Non-adherence was associated with greater comorbidity burden assessed by Charlson comorbidity index (CCI) during follow-up (OR 1.43; 95% CI 1.08-1.88 for ≥ 2 additional scores compared to 0), pre-diagnostic HRT use (OR 1.99; 1.58-2.49), not married (OR 1.42; 1.23-1.64), high educational level (OR 1.25; 1.02-1.53 compared to lowest level), and use of symptom-relieving drugs. HER-2 positivity (OR 0.61; 0.45-0.81) and adjuvant chemotherapy (OR 0.42; 0.35-0.52) were associated with lower odds of non-adherence. Similar patterns were observed for the presence of lymph node metastasis, higher tumour grade, and use of AIs compared to tamoxifen. Myocardial infarction and chronic pulmonary disease was suggested as leading conditions associated with non-adherence in women with increasing CCI. CONCLUSION We identified subgroups of women with breast cancer at increased risk of non-adherence. Our findings related to comorbidity suggest the importance of focusing on the presence of specific co-existing conditions when monitoring adherence.
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Affiliation(s)
- W Wulaningsih
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.
- MRC Unit for Lifelong Health and Ageing at University College London, London, UK.
| | - H Garmo
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - J Ahlgren
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
- Faculty of Medicine, University of Örebro, Örebro, Sweden
| | - L Holmberg
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - Y Folkvaljon
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - A Wigertz
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
| | - M Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
| | - M Lambe
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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5
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Knight WRC, Zylstra J, Wulaningsih W, Van Hemelrijck M, Landau D, Maisey N, Gaya A, Baker CR, Gossage JA, Largergren J, Davies AR. Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma. BJS Open 2018; 2:229-237. [PMID: 30079392 PMCID: PMC6069345 DOI: 10.1002/bjs5.65] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/02/2018] [Indexed: 01/04/2023] Open
Abstract
Background Previous analyses of the oesophageal circumferential resection margin (CRM) have focused on the prognostic validity of two different definitions of a positive CRM, that of the College of American Pathologists (tumour at margin) and that of the Royal College of Pathologists (tumour within 1 mm). This study aimed to analyse the validity of these definitions and explore the risk of recurrence and survival with incremental tumour distances from the CRM. Methods This cohort study included patients who underwent resection for adenocarcinoma of the oesophagus between 2000 and 2014. Kaplan-Meier and Cox regression analyses were performed to determine the hazard ratio (HR) with 95 per cent confidence intervals for recurrence and mortality in CRM increments: tumour at the cut margin, extending to within 0·1-0·9, 1·0-1·9, 2·0-4·9 mm, and 5·0 mm or more from the margin. Results A total of 444 patients were included in the study. Kaplan-Meier and unadjusted analyses showed a significant incremental improvement in overall survival (P < 0·001) and recurrence (P for trend < 0·001) rates with increasing distance from the CRM. Tumour distance of 2·0 mm or more remained a significant predictor of survival on multivariable analysis (HR for risk of death 0·66, 95 per cent c.i. 0·44 to 1·00). Multivariable analysis of overall survival demonstrated a significant difference between a positive and negative CRM with the Royal College of Pathologists' definition (HR 1·37, 1·01 to 1·85), but not with the College of American Pathologists' definition (HR 1·22, 0·90 to 1·65). Conclusion This study demonstrated an incremental improvement in survival and recurrence rates with increasing tumour distance from the CRM.
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Affiliation(s)
- W R C Knight
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK.,Division of Cancer Studies, King's College London, London, UK
| | - J Zylstra
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - W Wulaningsih
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - M Van Hemelrijck
- Cancer Epidemiology and Population Health Associated Research Group, King's College London, London, UK
| | - D Landau
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | - N Maisey
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | - A Gaya
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | - C R Baker
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK
| | - J A Gossage
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK.,Division of Cancer Studies, King's College London, London, UK.,Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Largergren
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK.,Division of Cancer Studies, King's College London, London, UK.,Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A R Davies
- Department of Surgery, Guy's and St Thomas' Oesophago-Gastric Centre, London, UK.,Division of Cancer Studies, King's College London, London, UK.,Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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6
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Anwar S, Tampubolon G, Hutajulu S, Watkins J, Wulaningsih W. Determinants of cancer screening awareness and participation among Indonesian women: A nationwide study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx729.005] [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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7
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Weitsman G, Mitchell NJ, Evans R, Cheung A, Kalber TL, Bofinger R, Fruhwirth GO, Keppler M, Wright ZVF, Barber PR, Gordon P, de Koning T, Wulaningsih W, Sander K, Vojnovic B, Ameer-Beg S, Lythgoe M, Arnold JN, Årstad E, Festy F, Hailes HC, Tabor AB, Ng T. Detecting intratumoral heterogeneity of EGFR activity by liposome-based in vivo transfection of a fluorescent biosensor. Oncogene 2017; 36:3618-3628. [PMID: 28166195 PMCID: PMC5421598 DOI: 10.1038/onc.2016.522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/12/2016] [Accepted: 12/21/2016] [Indexed: 12/20/2022]
Abstract
Despite decades of research in the epidermal growth factor receptor (EGFR) signalling field, and many targeted anti-cancer drugs that have been tested clinically, the success rate for these agents in the clinic is low, particularly in terms of the improvement of overall survival. Intratumoral heterogeneity is proposed as a major mechanism underlying treatment failure of these molecule-targeted agents. Here we highlight the application of fluorescence lifetime microscopy (FLIM)-based biosensing to demonstrate intratumoral heterogeneity of EGFR activity. For sensing EGFR activity in cells, we used a genetically encoded CrkII-based biosensor which undergoes conformational changes upon tyrosine-221 phosphorylation by EGFR. We transfected this biosensor into EGFR-positive tumour cells using targeted lipopolyplexes bearing EGFR-binding peptides at their surfaces. In a murine model of basal-like breast cancer, we demonstrated a significant degree of intratumoral heterogeneity in EGFR activity, as well as the pharmacodynamic effect of a radionuclide-labeled EGFR inhibitor in situ. Furthermore, a significant correlation between high EGFR activity in tumour cells and macrophage-tumour cell proximity was found to in part account for the intratumoral heterogeneity in EGFR activity observed. The same effect of macrophage infiltrate on EGFR activation was also seen in a colorectal cancer xenograft. In contrast, a non-small cell lung cancer xenograft expressing a constitutively active EGFR conformational mutant exhibited macrophage proximity-independent EGFR activity. Our study validates the use of this methodology to monitor therapeutic response in terms of EGFR activity. In addition, we found iNOS gene induction in macrophages that are cultured in tumour cell-conditioned media as well as an iNOS activity-dependent increase in EGFR activity in tumour cells. These findings point towards an immune microenvironment-mediated regulation that gives rise to the observed intratumoral heterogeneity of EGFR signalling activity in tumour cells in vivo.
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Affiliation(s)
- G Weitsman
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
| | - N J Mitchell
- Department of Chemistry, University College London, London, UK
| | - R Evans
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
| | - A Cheung
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
- Breast Cancer Now Research Unit, King’s College London, London, UK
| | - T L Kalber
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - R Bofinger
- Department of Chemistry, University College London, London, UK
| | - G O Fruhwirth
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
| | - M Keppler
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
| | - Z V F Wright
- Department of Chemistry, University College London, London, UK
| | - P R Barber
- Gray Laboratories, Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Oxford, UK
| | - P Gordon
- Breast Cancer Now Research Unit, King’s College London, London, UK
| | - T de Koning
- Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
| | - W Wulaningsih
- Cancer Epidemiology Group, Division of Cancer Studies, King’s College London, London, UK
| | - K Sander
- Institute of Nuclear Medicine, University College London, London, UK
| | - B Vojnovic
- Gray Laboratories, Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Oxford, UK
| | - S Ameer-Beg
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
| | - M Lythgoe
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - J N Arnold
- Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
| | - E Årstad
- Institute of Nuclear Medicine, University College London, London, UK
| | - F Festy
- King’s College London Dental Institute, Tissue Engineering and Biophotonics, Guy’s Hospital Campus, London, UK
| | - H C Hailes
- Department of Chemistry, University College London, London, UK
| | - A B Tabor
- Department of Chemistry, University College London, London, UK
| | - T Ng
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London, UK
- Breast Cancer Now Research Unit, King’s College London, London, UK
- UCL Cancer Institute, Paul O’Gorman Building, University College London, London, UK
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8
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Rowley M, Garmo H, Van Hemelrijck M, Wulaningsih W, Grundmark B, Zethelius B, Hammar N, Walldius G, Inoue M, Holmberg L, Coolen ACC. A latent class model for competing risks. Stat Med 2017; 36:2100-2119. [PMID: 28233395 DOI: 10.1002/sim.7246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/18/2015] [Revised: 01/05/2017] [Accepted: 01/18/2017] [Indexed: 11/11/2022]
Abstract
Survival data analysis becomes complex when the proportional hazards assumption is violated at population level or when crude hazard rates are no longer estimators of marginal ones. We develop a Bayesian survival analysis method to deal with these situations, on the basis of assuming that the complexities are induced by latent cohort or disease heterogeneity that is not captured by covariates and that proportional hazards hold at the level of individuals. This leads to a description from which risk-specific marginal hazard rates and survival functions are fully accessible, 'decontaminated' of the effects of informative censoring, and which includes Cox, random effects and latent class models as special cases. Simulated data confirm that our approach can map a cohort's substructure and remove heterogeneity-induced informative censoring effects. Application to data from the Uppsala Longitudinal Study of Adult Men cohort leads to plausible alternative explanations for previous counter-intuitive inferences on prostate cancer. The importance of managing cardiovascular disease as a comorbidity in women diagnosed with breast cancer is suggested on application to data from the Swedish Apolipoprotein Mortality Risk Study. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- M Rowley
- Institute for Mathematical and Molecular Biomedicine, King's College London, London, U.K
- Saddle Point Science, London, U.K
| | - H Garmo
- Cancer Epidemiology Group, King's College London, Guy's Hospital, London, U.K
| | - M Van Hemelrijck
- Cancer Epidemiology Group, King's College London, Guy's Hospital, London, U.K
| | - W Wulaningsih
- Cancer Epidemiology Group, King's College London, Guy's Hospital, London, U.K
| | - B Grundmark
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Medical Products Agency, Uppsala, Sweden
| | - B Zethelius
- Medical Products Agency, Uppsala, Sweden
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - N Hammar
- Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- AstraZeneca Sverige, Södertalje, Sweden
| | - G Walldius
- Department of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Inoue
- Department of Electrical Engineering and Bioscience, Waseda University, Tokyo, Japan
| | - L Holmberg
- Cancer Epidemiology Group, King's College London, Guy's Hospital, London, U.K
| | - A C C Coolen
- Institute for Mathematical and Molecular Biomedicine, King's College London, London, U.K
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Wulaningsih W, Astuti Y, Matsuguchi T, Anggriyadanny P, Watkins J. 54P Circulating prostate-specific antigen and telomere length in a nationally representative sample of men without history of prostate cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw574.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Wulaningsih W, Garmo H, Ahlgren J, Holmberg L, van Hemelrijck M, Lambe M. 62O_PR Non-adherence to adjuvant endocrine treatment and its determinants among early stage breast cancer patients. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw575.001] [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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Wulaningsih W, Garmo H, Holmberg L, van Hemelrijck M, Lambe M. 62O_PR Non-adherence to adjuvant endocrine treatment and its determinants among early stage breast cancer patients. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00743-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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12
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Lee S, Liyanage S, Wulaningsih W, Wolfe K, Carr T, Younis C, Van Hemelrijck M, Popert R, Acher P. Towards a magnetic resonance imaging-based nomogram for the prediction of transperineal prostate biopsy outcome. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.063] [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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13
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Arulappu A, Battle M, Eisenblaetter M, McRobbie G, Khan I, Monypenny J, Weitsman G, Galazi M, Hoppmann S, Gazinska P, Wulaningsih W, Dalsgaard GT, Macholl S, Ng T. c-Met PET Imaging Detects Early-Stage Locoregional Recurrence of Basal-Like Breast Cancer. J Nucl Med 2016; 57:765-70. [PMID: 26635342 DOI: 10.2967/jnumed.115.164384] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/13/2015] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Locoregional recurrence of breast cancer poses significant clinical problems because of frequent inoperability once the chest wall is involved. Early detection of recurrence by molecular imaging agents against therapeutically targetable receptors, such as c-Met, would be of potential benefit. The aim of this study was to assess (18)F-AH113804, a peptide-based molecular imaging agent with high affinity for human c-Met, for the detection of early-stage locoregional recurrence in a human basal-like breast cancer model, HCC1954. METHODS HCC1954 tumor-bearing xenograft models were established, and (18)F-AH113804 was administered. Distribution of radioactivity was determined via PET at 60 min after radiotracer injection. PET and CT images were acquired 10 d after tumor inoculation, to establish baseline distribution and uptake, and then on selected days after surgical tumor resection. CT images and caliper were used to determine the tumor volume. Radiotracer uptake was assessed by (18)F-AH113804 PET imaging. c-Met expression was assessed by immunofluorescence imaging of tumor samples and correlated with (18)F-AH113804 PET imaging results. RESULTS Baseline uptake of (18)F-AH113804, determined in tumor-bearing animals after 10 d, was approximately 2-fold higher in the tumor than in muscle tissue or the contralateral mammary fat pad. The tumor growth rate, determined from CT images, was comparable between the animals with recurrent tumors, with detection of tumors of low volume (<10 mm(3)) only possible by day 20 after tumor resection. (18)F-AH113804 PET detected local tumor recurrence as early as 6 d after surgery in the recurrent tumor-bearing animals and exhibited significantly higher (18)F-AH113804 uptake (in comparison to mammary fatty tissue), with a target-to-background (muscle) ratio of approximately 3:1 (P < 0.01). The c-Met expression of individual resected tumor samples, determined by immunofluorescence, correlated with the respective (18)F-AH113804 imaging signals (r = 0.82, P < 0.05). CONCLUSION (18)F-AH113804 PET provides a new diagnostic tool for the detection of c-Met-expressing primary tumor and has potential utility for the detection of locoregional recurrence from an early stage.
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Affiliation(s)
- Appitha Arulappu
- Richard Dimbleby Department of Cancer Research, Kings College London, London, United Kingdom
| | - Mark Battle
- GE Healthcare, Life Sciences, Amersham, United Kingdom
| | - Michel Eisenblaetter
- Richard Dimbleby Department of Cancer Research, Kings College London, London, United Kingdom Division of Imaging Sciences & Biomedical Engineering, King's College London, London, United Kingdom Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | | | - Imtiaz Khan
- GE Healthcare, Life Sciences, Amersham, United Kingdom
| | - James Monypenny
- Richard Dimbleby Department of Cancer Research, Kings College London, London, United Kingdom
| | - Gregory Weitsman
- Richard Dimbleby Department of Cancer Research, Kings College London, London, United Kingdom
| | - Myria Galazi
- Richard Dimbleby Department of Cancer Research, Kings College London, London, United Kingdom
| | | | - Patrycja Gazinska
- Breast Cancer NOW Unit, King's College London School of Medicine, London, United Kingdom
| | - Wulan Wulaningsih
- Richard Dimbleby Department of Cancer Research, Kings College London, London, United Kingdom
| | | | - Sven Macholl
- GE Healthcare, Life Sciences, Amersham, United Kingdom Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; and
| | - Tony Ng
- Richard Dimbleby Department of Cancer Research, Kings College London, London, United Kingdom Breast Cancer NOW Unit, King's College London School of Medicine, London, United Kingdom UCL Cancer Institute, University College London, London, United Kingdom
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14
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Wulaningsih W, Vahdaninia M, Rowley M, Holmberg L, Garmo H, Malmstrom H, Lambe M, Hammar N, Walldius G, Jungner I, Coolen A, Van Hemelrijck M. Abstract P5-07-06: A competing risks analysis of the association between prediagnostic serum glucose and lipids and breast cancer survival. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-07-06] [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: Abnormal levels of glucose and lipids may be linked to survival after breast cancer (BC) diagnosis, but their association to other causes of mortality such as cardiovascular (CV) disease may result in a competing risk problem and invalidate conventional analyses.
Methods: We assessed serum glucose, triglycerides (TG) and total cholesterol (TC) measured prospectively three months to three years before diagnosis in 1,798 women with BC in the Swedish Apolipoprotein Mortality Risk Study (AMORIS). In addition to using multivariable Cox proportional hazards regression, we employed latent class proportional hazards models to capture any heterogeneity of associations between these markers and BC death. The latter method was extended to include the primary outcome (BC death) and competing outcomes (CV death and death from other causes), allowing latent class-specific hazard estimation for cause-specific deaths.
Results: No association between prediagnostic glucose, TG or TC with BC death was observed with Cox regression. With latent class proportional hazards model, two latent classes (Class I and II) were identified in the cohort. Class I, comprising the majority (81.5%) of BC patients, had an increased risk of BC death following higher TG levels (HR: 1.87, 95% CI: 1.01-3.45 for every log TG increase). Lower overall survival was observed in Class II, but no association for BC death was found. On the other hand, TC positively corresponded to CV death in Class II, and similarly, glucose to death from other causes.
Conclusion: Higher TG was associated with an increased risk of BC death in the majority of BC patients. Our study also identified a subgroup of BC patients at higher risk of early death likely driven by other metabolic-related diseases, which adds to our understanding into BC survival in presence of competing outcomes.
Citation Format: Wulaningsih W, Vahdaninia M, Rowley M, Holmberg L, Garmo H, Malmstrom H, Lambe M, Hammar N, Walldius G, Jungner I, Coolen A, Van Hemelrijck M. A competing risks analysis of the association between prediagnostic serum glucose and lipids and breast cancer survival. [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 P5-07-06.
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Affiliation(s)
- W Wulaningsih
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - M Vahdaninia
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - M Rowley
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - L Holmberg
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - H Garmo
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - H Malmstrom
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - M Lambe
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - N Hammar
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - G Walldius
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - I Jungner
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - A Coolen
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
| | - M Van Hemelrijck
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group; King's College London, Institute for Mathematical and Molecular Biomedicine; Uppsala Universit; Regional Cancer Centre, Uppsala; Institute of Environmental Medicine, Karolinska Institutet; Karolinska Institutet; AstraZeneca R&D, Mlndal; Karolinska Institutet and CALAB Research
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Wulaningsih W, Garmo H, Holmberg L, Malmstrom H, Lambe M, Hammar N, Walldius G, Jungner I, van Hemelrijck M. 42P Atopy and cancer risk: Insights from a prospective study on serum specific and total immunoglobulin E. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv518.17] [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] Open
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16
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Wulaningsih W, Van Hemelrijck M, Michaelsson K, Kanarek N, Nelson WG, Ix JH, Platz EA, Rohrmann S. Association of serum inorganic phosphate with sex steroid hormones and vitamin D in a nationally representative sample of men. Andrology 2014; 2:967-76. [PMID: 25270590 PMCID: PMC4324600 DOI: 10.1111/andr.285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 12/14/2022]
Abstract
Defects in bone regulatory pathways have been linked to chronic diseases including cardiovascular disease and cancer. In men, a link between bone metabolism and gonadal hormones has been suggested. However, to date, there is lack of evidence on the association between serum inorganic phosphate (Pi) and sex steroid hormones. The objective of this study was to investigate the association between Pi, sex steroid hormones and a known Pi metabolic regulator, vitamin D, in men in the National Health and Nutrition Examination Survey III (NHANES III). From NHANES III, we selected 1412 men aged 20+ who participated in the morning session of Phase I (1988-1991) with serum measurements of Pi, sex hormones, and vitamin D. Multivariable linear regression was used to calculate crude and geometric mean Pi by total and estimated free testosterone and estradiol, sex hormone-binding globulin, androstanediol glucuronide (AAG), and vitamin D. Similar analyses were performed while stratifying by race/ethnicity and vitamin D levels. We found a lack of statistically significant difference in geometric means of Pi across quintiles of concentrations of sex hormones, indicating a tight regulation of Pi. However, Pi levels were inversely associated with calculated free testosterone in non-Hispanic black men, with geometric mean levels of Pi of 1.16 and 1.02 ng/mL for those in the lowest and highest quintiles of free testosterone, respectively (p-trend < 0.05). A similar but weaker pattern was seen between total testosterone and Pi. An inverse association was also seen between AAG and Pi in men with vitamin D concentration below the median (<24.2 ng/mL). No associations were observed among men with vitamin D levels at or above the median. Our findings suggest a weak link among sex hormones, vitamin D, and Pi in men. The observed effects of race/ethnicity and vitamin D indicate a complex association involving various regulators of Pi homeostasis.
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Affiliation(s)
- W Wulaningsih
- Cancer Epidemiology Unit, Division of Cancer Studies, King's College London, School of Medicine, London, UK
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Wulaningsih W, Holmberg L, Van Hemelrijck M. CRP and Granulocyte-to-Lymphocyte Ratio as Predictors of Breast Cancer Death in American Non-Institutionalized Women. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu066.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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