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Sajjadi E, Venetis K, Ivanova M, Noale M, Blundo C, Di Loreto E, Scarfone G, Ferrero S, Maggi S, Veronesi P, Galimberti VE, Viale G, Peccatori FA, Fusco N, Guerini-Rocco E. Immune microenvironment dynamics in breast cancer during pregnancy: impact of gestational age on tumor-infiltrating lymphocytes and prognosis. Front Oncol 2023; 13:1116569. [PMID: 37671051 PMCID: PMC10475935 DOI: 10.3389/fonc.2023.1116569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
Background Breast cancer during pregnancy (PrBC) is a rare condition known for its aggressive clinical behavior. The presence of tumor-infiltrating lymphocytes (TILs) has been shown to have a significant impact on the prognosis of these patients. Despite some biological characteristics of the tumor that may differ depending on the gestational age, little is known about the dynamics of the immune landscape within the tumor microenvironment (TME) in PrBC. Therefore, in this study, our objective was to gain comprehensive insights into the relationship between gestational age at breast cancer diagnosis and the composition of the TME. Methods n = 108 PrBC were selected from our institutional registry and categorized based on the gestational age by trimester. For all cases, TILs were profiled according to the International TILs Working Group recommendations, and subtyped by CD4, CD8, and forkhead box P3 (FOXP3) immunohistochemistry. PD-L1 was tested according to the combined positive score (CPS) using the IHC 22C3 pharmDx assay, with a cutoff value of ≥10 for positivity. The statistical approach encompassed Fisher's and Chi-squared tests, with appropriate adjustments for multiple comparisons, logistic regression models, and survival analyses based on the Kaplan-Meier method. Results The proportion of patients with poorly differentiated (G3) neoplasms increased as the gestational age advanced (first trimester, n = 25, 56.8%; second trimester, n = 27, 69.2%; third trimester, n = 21, 87.5%; p = 0.03). The histologic subtypes as well as the hormone receptor (HR) and HER2 status did not show significant changes across different pregnancy trimesters. In the HR+/HER2- subtype, there was a higher proportion of tumors with high/moderate TILs in the early phases of pregnancy, similar to FOXP3 expression (TILs: first trimester, n = 10, 35.7%; second trimester, n = 2, 10.5%; third trimester, n = 0; p = 0.02; FOXP3: first trimester, n = 10, 40%; second trimester, n = 3, 15.8%; third trimester, n = 0; p = 0.03). The median follow-up for our cohort was 81 months. Patients who relapsed after a breast cancer diagnosis during the first trimester were more frequently PD-L1-negative, unlike those with no disease recurrence (n = 9, 100% vs. n = 9, 56.3%; p = 0.03; hormone therapy and n = 9, 100% vs. n = 7, 53.9%; p = 0.02; chemotherapy). No statistically significant differences were seen among the three trimesters in terms of survival outcome. Conclusion The TME dynamics of HR+/HER2- PrBC vary based on gestational age, suggesting that immune tolerance expression during later gestational age could explain the increased aggressiveness of tumors diagnosed at that stage.
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Affiliation(s)
- Elham Sajjadi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Konstantinos Venetis
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mariia Ivanova
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marianna Noale
- Neuroscience Institute Aging Branch, National Research Council (CNR), Padua, Italy
| | - Concetta Blundo
- Breast Surgery Unit, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Scarfone
- Gynecology Unit, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Stefania Maggi
- Neuroscience Institute Aging Branch, National Research Council (CNR), Padua, Italy
| | - Paolo Veronesi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Giuseppe Viale
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fedro A. Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Guerini-Rocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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3
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Blundo C, Giroda M, Fusco N, Sajjadi E, Venetis K, Leonardi MC, Vicini E, Despini L, Rossi CF, Runza L, Sfondrini MS, Piciotti R, Di Loreto E, Scarfone G, Guerini-Rocco E, Viale G, Veronesi P, Buonomo B, Peccatori FA, Galimberti VE. Early Breast Cancers During Pregnancy Treated With Breast-Conserving Surgery in the First Trimester of Gestation: A Feasibility Study. Front Oncol 2021; 11:723693. [PMID: 34504801 PMCID: PMC8421851 DOI: 10.3389/fonc.2021.723693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/04/2021] [Indexed: 01/07/2023] Open
Abstract
Breast cancer is the most common malignancy occurring during gestation. In early-stage breast cancer during pregnancy (PrBC), breast-conserving surgery (BCS) with delayed RT is a rational alternative to mastectomy, for long considered the standard-of-care. Regrettably, no specific guidelines on the surgical management of these patients are available. In this study, we investigated the feasibility and safety of BCS during the first trimester of pregnancy in women with early-stage PrBC. All patients with a diagnosis of PrBC during the first trimester of pregnancy jointly managed in two PrBC-specialized Centers were included in this study. All patients underwent BCS followed by adjuvant radiotherapy to the ipsilateral breast after delivery. Histopathological features and biomarkers were first profiled on pre-surgical biopsies. The primary outcome was the isolated local recurrence (ILR). Among 168 PrBC patients, 67 (39.9%) were diagnosed during the first trimester of gestation. Of these, 30 patients (age range, 23-43 years; median=36 years; gestational age, 2-12 weeks; median=7 weeks; median follow-up time=6.5 years) met the inclusion criteria. The patients that were subjected to radical surgery (n=14) served as controls. None of the patients experienced perioperative surgical complications. No ILR were observed within three months (n=30), 1 year (n=27), and 5 years (n=18) after surgery. Among the study group, 4 (12.3%) patients experienced ILR or new carcinomas after 6-13 years, the same number (n=4) had metastatic dissemination after 3-7 years. These patients are still alive and disease-free after 14-17 years of follow-up. The rate of recurrences and metastasis in the controls were not significantly different. The findings provide evidence that BCS in the first trimester PrBC is feasible and reasonably safe for both the mother and the baby.
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Affiliation(s)
- Concetta Blundo
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Giroda
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Elham Sajjadi
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M Cristina Leonardi
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa Vicini
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Despini
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia F Rossi
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Letterio Runza
- Division of Pathology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria S Sfondrini
- Breast Imaging Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Piciotti
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Scarfone
- Gynecology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Guerini-Rocco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Paolo Veronesi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Buonomo
- Fertility and Procreation Unit, Division of Gynecologic Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Viviana E Galimberti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
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5
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Azim HA, Brohée S, Peccatori FA, Desmedt C, Loi S, Lambrechts D, Dell'Orto P, Majjaj S, Jose V, Rotmensz N, Ignatiadis M, Pruneri G, Piccart M, Viale G, Sotiriou C. Biology of breast cancer during pregnancy using genomic profiling. Endocr Relat Cancer 2014; 21:545-54. [PMID: 24825746 DOI: 10.1530/erc-14-0111] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breast cancer during pregnancy is rare and is associated with relatively poor prognosis. No information is available on its biological features at the genomic level. Using a dataset of 54 pregnant and 113 non-pregnant breast cancer patients, we evaluated the pattern of hot spot somatic mutations and did transcriptomic profiling using Sequenom and Affymetrix respectively. We performed gene set enrichment analysis to evaluate the pathways associated with diagnosis during pregnancy. We also evaluated the expression of selected cancer-related genes in pregnant and non-pregnant patients and correlated the results with changes occurring in the normal breast using a pregnant murine model. We finally investigated aberrations associated with disease-free survival (DFS). No significant differences in mutations were observed. Of the total number of patients, 18.6% of pregnant and 23% of non-pregnant patients had a PIK3CA mutation. Around 30% of tumors were basal, with no differences in the distribution of breast cancer molecular subtypes between pregnant and non-pregnant patients. Two pathways were enriched in tumors diagnosed during pregnancy: the G protein-coupled receptor pathway and the serotonin receptor pathway (FDR <0.0001). Tumors diagnosed during pregnancy had higher expression of PD1 (PDCD1; P=0.015), PDL1 (CD274; P=0.014), and gene sets related to SRC (P=0.004), IGF1 (P=0.032), and β-catenin (P=0.019). Their expression increased almost linearly throughout gestation when evaluated on the normal breast using a pregnant mouse model underscoring the potential effect of the breast microenvironment on tumor phenotype. No genes were associated with DFS in a multivariate model, which could be due to low statistical power. Diagnosis during pregnancy impacts the breast cancer transcriptome including potential cancer targets.
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Affiliation(s)
- Hatem A Azim
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumDepartment of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxel
| | - Sylvain Brohée
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fedro A Peccatori
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christine Desmedt
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sherene Loi
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumDepartment of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxel
| | - Diether Lambrechts
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumDepartment of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxel
| | - Patrizia Dell'Orto
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Samira Majjaj
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Vinu Jose
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicole Rotmensz
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michail Ignatiadis
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumDepartment of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxel
| | - Giancarlo Pruneri
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Martine Piccart
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Giuseppe Viale
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christos Sotiriou
- Department of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumDepartment of MedicineInstitut Jules Bordet, BrEAST Data Centre, Université Libre de Bruxelles (ULB), Boulevard de Waterloo, 121, 1000 Brussels, BelgiumBreast Cancer Translational Research Laboratory (BCTL) J. C. HeusonInstitut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, BelgiumFertility and Procreation UnitDepartment of Gynecologic Oncology, European Institute of Oncology, Milan, ItalyTranslational Breast Cancer Genomic LabCancer Therapeutics Program, Peter MacCallum Cancer Centre, East Melbourne, Victoria, AustraliaSir Peter MacCallum Department of OncologyUniversity of Melbourne, Parkville, Victoria, AustraliaVesalius Research CentreVIB, Leuven, BelgiumLaboratory of Translational GeneticsDepartment of Oncology, University of Leuven, Leuven, BelgiumDepartment of PathologyDivision of Epidemiology and BiostatisticsEuropean Institute of Oncology, Milan, ItalyDepartment of MedicineMedical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxel
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