Beyene Desta, Naab Tammey, Apprey Victor, Ricks-Santi Luisel, Esnakula Ashwini, Qasim Mustafa, George Mathew, Minoza Karen G, Copeland Robert L, Broome Carolyn, Kanaan Yasmine
Howard University Cancer Center, Washington, DC 20060, U.S.A.
Pathology Department, Howard University Hospital, Washington, DC 20060, U.S.A.
J Cancer Biol. 2023;4(1):3-16. doi: 10.46439/cancerbiology.4.048.
BACKGROUND: Diagnosed invasive breast carcinomas in African American patients are more aggressive compared with those in Caucasian patients and diagnosed at later stages of the disease with higher grade tumors. Despite advances in breast cancer systemic treatment, new prognostic and predictive biomarkers are still needed. Therefore, potential biomarkers were chosen to correlate with different subtypes, recurrence, and survival of invasive breast cancer in a cohort of African American women. METHODS: Eight protein biomarkers (ER, PR, HER2, Cyclin A2, Cytokeratin 5, Vimentin, Bcl2, and Ki-67) were evaluated using tissue microarrays (TMAs) and immunohistochemistry (IHC). The IHC results from TMAs were analyzed by both supervised and unsupervised clustering methods. The predictive clusters for the supervised and unsupervised methods were compared for agreement with the empirical classification. Kappa values were used to determine the overall percent correct clusters and agreement between specific clusters. Chi-square statistics was used to examine the association between hierarchical and multinomial logistic clustering methods. RESULTS: Five subtypes of breast tumors with distinct protein expression patterns were identified among the studied 166 breast tumors. Luminal B tumors have been distinguished from luminal A tumors by staining for cell cycle proteins Cyclin A2 and Ki-67, which promote cell proliferation. Forty-nine percent were stained positive for Cyclin A2, 39.2% positive for Ki-67, and 37% positive for both Cyclin A2 and Ki-67. The age of patients did not show any significant effect whether five (p-value= 0.576) or eight (p-value= 0.605) biomarkers were used, which indicating that age did not have any influence on the classification of the subtypes. Ninety percent of the thirty triple negative tumors were positive for Cyclin A2 or Ki-67 or both. Six-year overall survival was better for luminal A tumors (76%) than luminal B tumors (71%). Likewise, six-year relapse-free survival was better for luminal A tumors (76%) than luminal B tumors (29%). CONCLUSION: Discovery of molecular markers such as Cyclin A2 and Ki-67, and subtypes that are most prevalent in African Americans could lead to a better understanding of the factors contributing to higher morbidity and mortality in this group and to aid in decision-making to offer earlier treatment.
背景:与白人患者相比,非裔美国患者诊断出的浸润性乳腺癌更具侵袭性,且在疾病晚期诊断出的肿瘤分级更高。尽管乳腺癌全身治疗取得了进展,但仍需要新的预后和预测生物标志物。因此,在一组非裔美国女性中选择了潜在的生物标志物,以关联浸润性乳腺癌的不同亚型、复发和生存情况。 方法:使用组织微阵列(TMA)和免疫组织化学(IHC)评估八种蛋白质生物标志物(雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER2)、细胞周期蛋白A2、细胞角蛋白5、波形蛋白、Bcl2和Ki-67)。通过监督和非监督聚类方法分析TMA的IHC结果。比较监督和非监督方法的预测聚类与经验分类的一致性。使用kappa值确定总体正确聚类百分比和特定聚类之间的一致性。使用卡方统计检验层次聚类和多项逻辑聚类方法之间的关联。 结果:在研究的166例乳腺肿瘤中,鉴定出五种具有不同蛋白质表达模式的乳腺肿瘤亚型。通过对促进细胞增殖的细胞周期蛋白Cyclin A2和Ki-67进行染色,将管腔B型肿瘤与管腔A型肿瘤区分开来。49%的肿瘤Cyclin A2染色呈阳性,39.2%的肿瘤Ki-67染色呈阳性,37%的肿瘤Cyclin A2和Ki-67染色均呈阳性。无论使用五种(p值 = 0.576)还是八种(p值 = 0.605)生物标志物,患者年龄均未显示出任何显著影响,这表明年龄对亚型分类没有任何影响。30例三阴性肿瘤中有90%的肿瘤Cyclin A2或Ki-67或两者均呈阳性。管腔A型肿瘤的六年总生存率(76%)高于管腔B型肿瘤(71%)。同样,管腔A型肿瘤的六年无复发生存率(76%)高于管腔B型肿瘤(29%)。 结论:发现诸如Cyclin A2和Ki-67等分子标志物以及在非裔美国人中最普遍的亚型,可能有助于更好地理解导致该群体较高发病率和死亡率的因素,并有助于做出提供早期治疗的决策。
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