Obesity is associated with a poorer prognosis in women with hormone receptor positive breast cancer

Objective

Whether moderate to severe obesity (body mass index (BMI) ≥ 30 to <40 kg/m²) contributes to breast cancer recurrence and mortality remains uncertain.

Subjects and methods

1199 women, recruited within 12 months of their diagnosis of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−) invasive breast cancer completed an enrolment questionnaire and an annual follow-up questionnaire every 12 months for another 5 years. The impact of obesity on time to either local or distant recurrence or new breast cancer, or death due to breast cancer was determined by Cox regression. Women in the most extreme categories of BMI (<18.5 and ≥40) were excluded from the analysis.

Results

Of the 1155 included women, mean age, 58.4 ± 11.6 years, 53.8% had Stage 1 disease and 88.9% received oral adjuvant endocrine therapy (OAET) within 2 years of diagnosis. The likelihood of an event was significantly associated with moderate to severe obesity (HR = 1.71, 95%CI, 1.12–2.62, p = 0.014), disease beyond Stage 1 (HR = 2.87, 95% CI 1.73–4.75, p < 0.001), OAET (HR = 0.26, 95%CI 0.14–0.46, p < 0.001), mastectomy (HR = 3.28, 95%CI 1.98–5.44, p < 0.001) and radiotherapy (HR = 2.12, 95%CI 1.24–3.63, p = 0.006). For Stage 1 disease, only moderate to severe obesity (HR 3.23, 95%CI 1.48–7.03, p = 0.003) and OAET use (HR 0.41, 95%CI 0.17–0.98, p = 0.046) were significantly associated with an event.

Conclusion

Moderate to severe obesity is associated with a poorer invasive breast cancer prognosis; this is also true for women with Stage 1 disease, and is independent of age and treatment.     

瘦素受体在乳腺癌中的表达及其与乳腺癌相关基因的相关性分析

Objective To study the expression levels of leptin receptor（LEPR） in breast cancer cell lines, normal breast samples and malignant breast cancer samples, and to analyze the expression correlation between LEPR and estrogen receptor（ER）, E-cadherin（E-Cad）, c-Myc and cyclin D1 in order to provide mechanism clues for obesiety associated breast cancer. Methods Using RT-PCR and Western blotting, we examined the expression of LEPR in different breast cancer cell lines. The expression level of LEPR was analyzed by RT-PCR in 5 paired breast samples. In the meanwhile, The expression of LEPR, ER, E-Cad, c-Myc and cyclin D1 was analyzed using realtime PCR in 45 breast cancer samples and 15 normal breast samples. The correlation was analyzed between the expression of LEPR and the expression of ER, E-Cad, c-Myc and cyclin D1 using SPSS statistic software. Results LEPR mRNA and protein were expressed in all breast cancer cell lines tested in this study. The expression of LEPR in the breast cancer samples was higher than in the paired adjacent normal breast tissues. With the statistic analysis, the expression of LEPR was correlated with expression of ER in both normal and malignant breast samples. LEPR expression was also close correlated with E-Cad and c-Myc expression in the breast cancer samples, but not with cyclin D1 expression. Conclusion LEPR expresses in breast cancer cell lines. Compared to the normal breast tissues, the expression of LEPR in breast c     

Zinc finger of the cerebellum 5 promotes colorectal cancer cell proliferation and cell cycle progression through enhanced CDK1/CDC25c signaling

IntroductionColorectal cancer (CRC), mostly caused by external or environmental factors, is the third most common and lethal cancer worldwide. Although a large number of investigations have been carried out to reveal the evolution of CRC, the underlying mechanisms of CRC remain unclear.Material and methodsExpression of zinc finger of the cerebellum 5 (ZIC5) in CRC tissues and cell models was measured by qRT-PCR and IHC. Cell transfection was carried out for ZIC5 overexpression or knockdown. The MTT assay was applied to examine the capacity of glioma cell proliferation. Wound healing assay and tumor invasion assay were used to test the capacity of glioma cell migration and invasion respectively. Cell cycle analysis and western blot were used to verify the apoptosis rates of CRC cells upon ZIC5 overexpression or downregulation. A further tumor Xenograft study was used to examine the effects of ZIC5 on tumor malignancy in vivo.ResultsCell models using HCT116 and SW620 cells were established to study the ZIC5 function upon ZIC5 overexpression of knockdown. Consistently, we discovered that ZIC5 also significantly increased in Chinese CRC patients. In addition, ZIC5 promoted CRC cell proliferation through increasing the proportion of cells maintained in the S phase. ZIC5 overexpression facilitated the capacity of CRC cell migration and invasion. Inhibition of ZIC5 mitigated such malignant effects.ConclusionsCollectively, investigations of the ZIC5 in CRC provided a new insight into CRC diagnosis, treatment, prognosis and next-step translational therapeutic developments from bench to clinic.     

Expression of the PIP/GCDFP-15 gene and survival in breast cancer

Expression of the PIP/GCDFP-15 gene was determined by measuring PIP/GCDFP-15-mRNA in breast carcinomas of 91 patients. The patients were followed-up for an average of 47 months after initial diagnosis and treatment of the disease. There were no deaths in the group of 14 patients with tumours of high PIP/GCDFP-15-mRNA levels, while 16 of 77 patients of the group with low PIP/GCDFP-15-mRNA tumour levels died. A similar advantage for high PIP/GCDFP-mRNA expression was observed with regard to disease free survival.     

Expression of E-cadherin (E-CD) as related to other prognostic factors and survival in breast cancer

A series of 208 breast cancer biopsies were analysed immunohistochemically for expression of E-cadherin (E-CD). Altogether, 72 per cent of the tumours showed E-CD positivity in over 50 per cent of cells, the staining being heterogeneous in nearly all tumours. In only 16 per cent of ductal carcinomas was positive staining seen in less than 1 per cent of cells. Expression of E-CD was not related to tumour diameter, nodal status, metastasis at diagnosis, histological grade, DNA ploidy, S-phase fraction, nuclear area, mitotic frequency, or PR content. There was a significant relationship between expression of E-CD, histological type (P=0.01), the proportion of intraductal growth (P=0.008), the density of tumour-infiltrating lymphocytes (P=0.0007), ER content (P=0.012), and morphometric nuclear factors (P=0.02). Expression of E-CD showed a weak association with a high survival probability (P=0.02), while the relation to recurrence-free survival was not significant (P=0.11). In axillary lymph node-negative tumours, E-CD expression was not related significantly to survival (P=0.11) or to recurrence-free survival (P=0.06). In multivariate analysis, E-CD expression had no independent prognostic value, while the axillary lymph node status, tumour diameter, patient age, and mitotic frequency were independent prognostic factors. The results indicate that E-CD expression is related to several histological features in breast cancer, but has no independent prognostic value over standard prognostic factors.     

EphA2在乳腺癌中的表达及其与上皮间质转化的关系

目的　研究EphA2、上皮间质转化（EMT）在乳腺癌中的表达情况及意义,探讨EphA2与EMT在乳腺癌的侵袭与转移过程中的关系。 方法　采用免疫组织化学方法检测30例乳腺纤维瘤组织和110例乳腺癌中EphA2、E-钙黏蛋白（E-cadherin）、β-连环蛋白（β-catenin）、波形蛋白（vimentin）的表达情况,分析其与乳腺癌临床病理因素的关系及EphA2、E-cadherin蛋白、β-catenin蛋白、vimentin蛋白表达的相关性。 结果　在30例乳腺纤维瘤组织中EphA2、E-cadherin蛋白、β-catenin蛋白、vimentin蛋白阳性率分别为20%、90%、26.67%、13.33%,在110例乳腺癌中的阳性率分别为61.82%、34.54%、64.54% 、68.18%。EphA2的高表达、E-cadherin蛋白的低表达、β-catenin蛋白和vimentin蛋白的高表达与临床分期、淋巴结转移、组织学分级显著相关（P<0.05）,EphA2的高表达与E-cadherin蛋白的低表达呈负相关（P<0.05）,与β-catenin蛋白、vimentin蛋白的高表达呈正相关（P<0.05）。 结论　EphA2、E-cadherin蛋白、β-catenin蛋白、vimentin蛋白与乳腺癌的侵袭与转移有相关性;EphA2可能通过调控E-cadherin蛋白、β-catenin蛋白、vimentin蛋白的表达来促进EMT,进而在乳腺癌的侵袭和转移过程发挥重要作用。     

Inhibition of RANKL blocks skeletal tumor progression and improves survival in a mouse model of breast cancer bone metastasis

Bone metastases cause severe skeletal morbidity including fractures and hypercalcemia. Tumor cells in bone induce activation of osteoclasts, which mediate bone resorption and release of growth factors from bone matrix, resulting in a “vicious cycle” of bone breakdown and tumor proliferation. Receptor activator of NF-κB ligand (RANKL) is an essential mediator of osteoclast formation, function, and survival, and is blocked by a soluble decoy receptor, osteoprotegerin (OPG). In human malignancies that metastasize to bone, dysregulation of the RANK/RANKL/OPG pathway can increase the RANKL:OPG ratio, a condition which favors excessive osteolysis. In a mouse model of bone metastasis, RANKL protein levels in MDA-MB-231 (MDA-231) tumor-bearing bones were significantly higher than tumor-free bones. The resulting tumor-induced osteoclastogenesis and osteolysis was dose-dependently inhibited by recombinant OPG-Fc treatment, supporting the essential role for RANKL in this process. Using bioluminescence imaging in a mouse model of metastasis, we monitored the anti-tumor efficacy of RANKL inhibition on MDA-231 human breast cancer cells in a temporal manner. Treatment with OPG-Fc in vivo inhibited growth of MDA-231 tumor cells in bony sites when given both as a preventative (dosed day 0) and as a therapeutic agent for established bone metastases (dosed day 7). One mechanism by which RANKL inhibition reduced tumor burden appears to be indirect through inhibition of the “vicious cycle” and involved an increase in tumor cell apoptosis, as measured by active caspase-3. Here, we demonstrate for the first time that OPG-Fc treatment of mice with established bone metastases resulted in an overall improvement in survival.     

Long-term survival in breast cancer related to overexpression of the c-erbB-2 oncoprotein: an immunohistochemical study using monoclonal antibody NCL-CB11.

In a previous series we have shown poor short-term (3-5 years) survival for patients with tumours overexpressing the c-erbB-2 oncoprotein. In this study we employed archival paraffin-embedded tissue from patients who underwent mastectomy 10-12 years prior to assessment (n = 187). Immunohistochemical staining was carried out by an indirect immunoperoxidase technique using the novel monoclonal antibody NCL-CB11. Tumours were scored according to intensity of membrane staining. Patient and tumour information was obtained by scrutiny of clinical records. Survival analysis was carried out for both time to relapse and time to death, using the log rank test. Patients with tumours demonstrating intense membrane staining had a poor prognosis compared with the rest, with a steeply sloped survival curve over the first 4 years; the survival difference was still evident at 12 years follow-up (P less than 0.001). The survival advantage for c-erbB-2 negative patients was maintained in lymph node negative patients (P less than 0.001). However, c-erbB-2 status did not influence survival in the node positive group, where all patients had a uniformly poor outlook. These results applied to both time to relapse and time to death. In conclusion, c-erbB-2 status, determined using NCL-CB11, is a powerful prognostic indicator, defining in particular node negative patients with a particularly poor prognosis, and for whom alternative therapeutic strategies may be appropriate.     

Expression of G protein-coupled receptor kinase 4 is associated with breast cancer tumourigenesis

G-protein-coupled receptor kinases (GRKs) comprise a family of seven mammalian serine/threonine protein kinases that phosphorylate and regulate agonist-bound, activated, G-protein-coupled receptors (GPCRs). GRKs and beta-arrestins are key participants in the canonical pathways leading to phosphorylation-dependent GPCR desensitization, endocytosis, intracellular trafficking and resensitization. Here we show that GRK4 isoforms are expressed in human breast cancer but not in normal epithelia. In addition, GRK4-over-expressing cells activated the mitogen-activated protein kinase (MAPK) mediated by ERK 1/2 and JNK phosphorylation in breast cancer-derived cell lines. Furthermore, suppression of beta-arrestins decreased GRK4-stimulated ERK 1/2 or JNK phosphorylations. These data indicate that high-level expression of GRK4 may activate MAPK signalling pathways mediated by beta-arrestins in breast cancer cells, suggesting that GRK4 may be implicated in breast cancer carcinogenesis.     

Expression of cyclin kinase subunit 2 in human breast cancer and its prognostic significance

Cyclin kinase subunit 2 (CKS2) protein is a small cyclin-dependent kinase-interacting protein, which is essential for the first metaphase/anaphase transition of mammalian meiosis. CKS2 is up-regulated in various malignancies, suggesting that CKS2 maybe an oncogene. However, data on its expression pattern and clinical relevance in breast cancer are unknown. The aim of this study is to investigate CKS2 expression and its prognostic significance in breast cancer. The CKS2 expression was examined at mRNA and protein levels by real-time quantitative polymerase chain reaction (RT-PCR) and Western blotting analysis in paired breast cancer tissues and the adjacent normal tissues. The expression of CKS2 protein in 126 specimens of breast cancer was determined by immunohistochemistry assay. The relations between CKS2 expression and clinicopathological features were analyzed. The result show the expression of CKS2 mRNA and protein was higher in breast cancer than the adjacent normal tissues. Compared with adjacent normal breast tissues, Overexpression of CKS2 was detected in 56.3% (71/126) patients. Overexpression of CKS2 was significantly associated with large tumor size (P = 0.035), poor cellular differentiation (P = 0.016), lack expression of progesterone receptor (P = 0.006), and decreased overall survival (P = 0.001). In multivariate analysis, CKS2 expression was an independent prognostic factor for overall survival (Hazard ratio [HR] = 3.404, 95% confidence interval [CI] 1.482-7.818; P = 0.004). CKS2 is up-regulated in breast cancer and associated with large tumor size, lack expression of progesterone receptor, poor tumor differentiation and survival. CKS2 may serve as a good prognostic indicator for patients with breast cancer.     

MiR-449a suppresses cell migration and invasion by targeting PLAGL2 in breast cancer

Background

Breast cancer is one of the most common malignancies worldwide. However, the detailed molecular mechanisms underlying breast cancer metastasis are still incompletely clear. MicroRNAs (miRNAs) play a crucial role in cancer metastasis. In this study, we aimed to analyze the expression and function of miR-449a in breast cancer.

肿瘤抑制基因ING4在乳腺癌中的表达及其临床意义

目的探讨乳腺癌组织及其正常乳腺组织中ING4基因表达及其意义。方法采用逆转录-聚合酶链反应（RT—PCR）检测25例伴淋巴结转移的乳腺癌、40例无淋巴结转移的乳腺癌及20例癌旁正常组织中ING4 mRNA表达。结果乳腺癌组织中ING4 mRNA表达水平显著低于癌旁正常组织（P〈0．001）。且随着淋巴结转移的出现,ING4 mRNA表达水平逐渐降低,各组间差异具有显著性意义（P〈0．01）。ING4 mRNA表达量随乳腺癌的临床分期增高而降低。结论ING4基因可作为乳腺癌的重要生物学指标,有助于对乳腺癌生物学行为的了解,从而指导临床治疗。     

A prospective study on women with a history of breast cancer and with or without estrogen replacement therapy

Objective: Because a categorical refusal of estrogen replacement therapy (ERT) from postmenopausal patients with a history of breast cancer is not based on any research evidence and may be more harmful than beneficial, we evaluated the safety and efficacy of ERT in these women. Methods: We recruited 131 patients who had been treated for breast cancer for a mean of 4.2 years (range 1 month to 20 years) before. Eighty-eight decided to use ERT, whereas 43 refused or had no need for ERT. At recruitment, the patients were carefully examined for breast and gynaecologic findings. Non-hysterectomized patients wishing to receive ERT (n=54) then started using estradiol as oral tablets (2 mg/day) (n=44) or as transdermal gel (1.5 mg/day) (n=10) in combination with 10-day courses of oral medroxyprogesterone acetate at 4-week intervals, whereas hysterectomized patients (n=34) used only estradiol, orally (2 mg/day) (n=31) or transdermally (1.5 mg/day) (n=3). The patients using ERT were carefully examined 6 and 12 months later, and then annually at a specific outpatient department, and the mean follow-up time is now 2.5 years (range from 1 month to 5.2 years, 216 woman-years). The 43 patients not wishing to receive ERT were followed annually at the oncologic department for a mean of 2.6 years (range from 1 month to 4.7 years), and served as a control group. Results: ERT significantly reduced climacteric symptoms, and the Kupperman score fell by 63%, from 26.9±8.6 to 9.9±6.7 (mean±SD). In non-hysterectomized women, medroxyprogesterone acetate triggered withdrawal bleeding in all except seven women. Seven patients (13%) experienced spotting during ERT. In 27 women, endometrial thickness exceeded 10 mm, and two of the total of 54 patients (3.7%) had simple hyperplasia. This vanished spontaneously in 3–6 months. Ten patients terminated the use of ERT within the first 12 to 39 months due to the lack of severe vasomotor symptoms (n=4) or due to the recurrence of breast cancer or to cancer of the contralateral breast (n=6). Eighty-one of the 88 patients (92%) using ERT showed no evidence of recurrence, whereas five patients (5.7%) had recurrence in 12–36 months and two patients (2.3%) developed a cancer of the contralateral breast in 14–24 months; another one of those wanted to continue with ERT. Thus the combined risk of recurrence or a new cancer of the contralateral breast in ERT users was 7/216 woman-years (3% per year). In the control group, 38 of 43 patients (88.4%) showed no evidence of recurrence or contralateral cancer, whereas four patients had recurrence and one developed a contralateral breast cancer (5/112 woman-years, 4% per year). Conclusions: Symptomatic climacteric patients with a history of breast cancer benefited from ERT without increasing their risk of recurrence, but the short follow-up and the small number of patients limit any definitive recommendations.