Abstract
Background
There is limited knowledge about DCIS cellular composition and relationship with breast cancer events (BCE).
Methods
Immunofluorescence multiplexing (MxIF) was used to image and quantify 32 cellular biomarkers in FFPE DCIS tissue microarrays. Over 75,000 DCIS cells from 51 patients (median 9 years follow-up for non-BCE cases) were analysed for profiles predictive of BCE. K-means clustering was used to evaluate cellular co-expression of epithelial markers with ER and HER2.
Results
Only ER, PR and HER2 significantly correlated with BCE. Cluster analysis identified 6 distinct cell groups with different levels of ER, Her2, cMET and SLC7A5. Clusters 1 and 3 were not significant. Clusters 2 and 4 (high ER/low HER2 and SLC7A5/mixed cMET) significantly correlated with low BCE risk (P = 0.001 and P = 0.034), while cluster 6 (high HER2/low ER, cMET and SLC7A5) correlated with increased risk (P = 0.018). Cluster 5 (similar to cluster 6, except high SLC7A5) trended towards significance (P = 0.072). A continuous expression score (Escore) based on these 4 clusters predicted likelihood of BCE (AUC = 0.79, log-rank test P = 5E–05; LOOCV AUC = 0.74, log-rank test P = 0.006).
Conclusion
Multiplexed spatial analysis of limited tissue is a novel method for biomarker analysis and predicting BCEs. Further validation of Escore is needed in a larger cohort.
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References
- 1.
Ebctcg, McGale, P., Taylor, C., Correa, C., Cutter, D., Duane, F. et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383, 2127–2135 (2014).
- 2.
Cuzick, J., Sestak, I., Pinder, S. E., Ellis, I. O., Forsyth, S., Bundred, N. J. et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 12, 21–29 (2011).
- 3.
Wapnir, I. L., Dignam, J. J., Fisher, B., Mamounas, E. P., Anderson, S. J., Julian, T. B. et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J. Natl. Cancer Inst. 103, 478–488 (2011).
- 4.
Sanders, M. E., Schuyler, P. A., Dupont, W. D. & Page, D. L. The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer 103, 2481–2484 (2005).
- 5.
Jones, J. L. Overdiagnosis and overtreatment of breast cancer: progression of ductal carcinoma in situ: the pathological perspective. Breast Cancer Res. 8, 204 (2006).
- 6.
Collins, L. C., Tamimi, R. M., Baer, H. J., Connolly, J. L., Colditz, G. A. & Schnitt, S. J. Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses’ Health Study. Cancer 103, 1778–1784 (2005).
- 7.
Elshof, L. E., Tryfonidis, K., Slaets, L., van Leeuwen-Stok, A. E., Skinner, V. P., Dif, N. et al. Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ—The LORD study. Eur. J. Cancer 51, 1497–1510 (2015).
- 8.
Fallowfield, L., Francis, A., Catt, S., Mackenzie, M. & Jenkins, V. Time for a low-risk DCIS trial: harnessing public and patient involvement. Lancet Oncol. 13, 1183–1185 (2012).
- 9.
Groen, E. J., Elshof, L. E., Visser, L. L., Rutgers, E. J. T., Winter-Warnars, H. A. O., Lips, E. H. et al. Finding the balance between over- and under-treatment of ductal carcinoma in situ (DCIS). Breast 31, 274–283 (2017).
- 10.
Grimm, L. J., Ryser, M. D., Partridge, A. H., Thompson, A. M., Thomas, J. S., Wesseling, J. et al. Surgical Upstaging rates for vacuum assisted biopsy proven DCIS: implications for active surveillance trials. Ann. Surg. Oncol. 24, 3534–3540 (2017).
- 11.
Badve, S., A’Hern, R. P., Ward, A. M., Millis, R. R., Pinder, S. E., Ellis, I. O. et al. Prediction of local recurrence of ductal carcinoma in situ of the breast using five histological classifications: a comparative study with long follow-up. Hum. Pathol. 29, 915–923 (1998).
- 12.
Badve, S. & Gokmen-Polar, Y. Tumor heterogeneity in breast cancer. Adv. Anat. Pathol. 22, 294–302 (2015).
- 13.
Gerdes, M. J., Gokmen-Polar, Y., Sui, Y., Pang, A. S., LaPlante, N., Harris, A. L. et al. Single-cell heterogeneity in ductal carcinoma in situ of breast. Mod. Pathol. 31, 406–417 (2018).
- 14.
Harrison, B. T., Hwang, S., Partridge, A., Thompson, A. & Schnitt, S. J. Variability in diagnostic threshold for comedo necrosis among pathologists: implications for patient eligibility for active surveillance trials of DCIS. Mod. Pathol. 31, 70 (2018).
- 15.
Solin, L. J., Gray, R., Hughes, L. L., Wood, W. C., Lowen, M. A., Badve, S. S. et al. Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study. J. Clin. Oncol. 33, 3938–3944 (2015).
- 16.
Sagara, Y., Mallory, M. A., Wong, S., Aydogan, F., DeSantis, S., Barry, W. T. et al. Survival benefit of breast surgery for low-grade ductal carcinoma in situ: a population-based cohort study. JAMA Surg. 150, 739–745 (2015).
- 17.
Kerlikowske, K., Molinaro, A. M., Gauthier, M. L., Berman, H. K., Waldman, F., Bennington, J. et al. Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. J. Natl. Cancer Inst. 102, 627–637 (2010).
- 18.
Bremer, T., Whitworth, P. W., Patel, R., Savala, J., Barry, T., Lyle, S. et al. A biological signature for breast ductal carcinoma in situ to predict radiotherapy benefit and assess recurrence risk. Clin. Cancer Res. 24, 5895–5901 (2018).
- 19.
Solin, L. J., Gray, R., Baehner, F. L., Butler, S. M., Hughes, L. L., Yoshizawa, C. et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J. Natl. Cancer Inst. 105, 701–710 (2013).
- 20.
Rakovitch, E., Nofech-Mozes, S., Hanna, W., Sutradhar, R., Baehner, F. L., Miller, D. P. et al. Multigene expression assay and benefit of radiotherapy after breast conservation in ductal carcinoma in situ. J Natl Cancer Inst. 109, djw256 (2017).
- 21.
Gokmen-Polar, Y., Nakshatri, H. & Badve, S. Biomarkers for breast cancer stem cells: the challenges ahead. Biomark. Med. 5, 661–671 (2011).
- 22.
Wright, H. J., Hou, J., Xu, B., Cortez, M., Potma, E. O., Tromberg, B. J. et al. CDCP1 drives triple-negative breast cancer metastasis through reduction of lipid-droplet abundance and stimulation of fatty acid oxidation. Proc. Natl. Acad. Sci. USA 114, E6556–E6565 (2017).
- 23.
Yang, C., He, P., Liu, Y., He, Y., Yang, C., Du, Y. et al. Down-regulation of CEACAM1 in breast cancer. Acta Biochim. Biophys. Sin. (Shanghai). 47, 788–794 (2015).
- 24.
Wakasugi, E., Kobayashi, T., Tamaki, Y., Ito, Y., Miyashiro, I., Komoike, Y. et al. p21(Waf1/Cip1) and p53 protein expression in breast cancer. Am. J. Clin. Pathol. 107, 684–691 (1997).
- 25.
Nasir, A., Holzer, T. R., Chen, M., Man, M. Z. & Schade, A. E. Differential expression of VEGFR2 protein in HER2 positive primary human breast cancer: potential relevance to anti-angiogenic therapies. Cancer Cell Int. 17, 56 (2017).
- 26.
Hicks, D. G., Janarthanan, B. R., Vardarajan, R., Kulkarni, S. A., Khoury, T., Dim, D. et al. The expression of TRMT2A, a novel cell cycle regulated protein, identifies a subset of breast cancer patients with HER2 over-expression that are at an increased risk of recurrence. BMC Cancer 10, 108 (2010).
- 27.
Bartlett, J. M., Thomas, J., Ross, D. T., Seitz, R. S., Ring, B. Z., Beck, R. A. et al. Mammostrat as a tool to stratify breast cancer patients at risk of recurrence during endocrine therapy. Breast Cancer Res. 12, R47 (2010).
- 28.
Kochel, T. J., Reader, J. C., Ma, X., Kundu, N. & Fulton, A. M. Multiple drug resistance-associated protein (MRP4) exports prostaglandin E2 (PGE2) and contributes to metastasis in basal/triple negative breast cancer. Oncotarget 8, 6540–6554 (2017).
- 29.
Mao, Q. & Unadkat, J. D. Role of the breast cancer resistance protein (BCRP/ABCG2) in drug transport–an update. AAPS J. 17, 65–82 (2015).
- 30.
Delou, J. M. A., Vignal, G. M., Indio-do-Brasil, V., Accioly, M. T. S., da Silva, T. S. L., Piranda, D. N. et al. Loss of constitutive ABCB1 expression in breast cancer associated with worse prognosis. Breast Cancer (Dove Med Press). 9, 415–428 (2017).
- 31.
Gerdes, M. J., Sevinsky, C. J., Sood, A., Adak, S., Bello, M. O., Bordwell, A. et al. Highly multiplexed single-cell analysis of formalin-fixed, paraffin-embedded cancer tissue. Proc. Natl Acad. Sci. USA. 110, 11982–11987 (2013).
- 32.
Wilkerson, M. D. & Hayes, D. N. ConsensusClusterPlus: a class discovery tool with confidence assessments and item tracking. Bioinformatics 26, 1572–1573 (2010).
- 33.
Șenbabaoğlu, Y., Michailidis, G. & Li, J. Z. Critical limitations of consensus clustering in class discovery. Sci. Rep. 4, 6207 (2014).
- 34.
Cardoso, F., van’t Veer, L. J., Bogaerts, J., Slaets, L., Viale, G., Delaloge, S. et al. 70-Gene signature as an aid to treatment decisions in early-stage breast cancer. N. Engl. J. Med. 375, 717–729 (2016).
- 35.
Sparano, J. A., Gray, R. J., Makower, D. F., Pritchard, K. I., Albain, K. S., Hayes, D. F. et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N. Engl. J. Med. 379, 111–121 (2018).
- 36.
Narod, S. A., Iqbal, J., Giannakeas, V., Sopik, V. & Sun, P. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. 1, 888–896 (2015).
- 37.
Esserman, L. J., Thompson, I. M., Reid, B., Nelson, P., Ransohoff, D. F., Welch, H. G. et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol. 15, e234–e242 (2014).
- 38.
Leung, S. C. Y., Nielsen, T. O., Zabaglo, L., Arun, I., Badve, S. S., Bane, A. L. et al. Analytical validation of a standardized scoring protocol for Ki67: phase 3 of an international multicenter collaboration. NPJ Breast Cancer 2, 16014 (2016).
- 39.
Leung, S. C. Y., Nielsen, T. O., Zabaglo, L. A., Arun, I., Badve, S. S., Bane, A. L. et al. Analytical validation of a standardised scoring protocol for Ki67 immunohistochemistry on breast cancer excision whole sections: an international multicentre collaboration. Histopathology 75, 225–235 (2019).
- 40.
El Ansari, R., Craze, M. L., Miligy, I., Diez-Rodriguez, M., Nolan, C. C., Ellis, I. O. et al. The amino acid transporter SLC7A5 confers a poor prognosis in the highly proliferative breast cancer subtypes and is a key therapeutic target in luminal B tumours. Breast Cancer Res. 20, 21 (2018).
Acknowledgements
The authors gratefully acknowledge the contributions of Alex Corwin for Cell DIVE imaging workflows and quality control and Sean Dinn and Eric Williams for antibody conjugations.
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Concept, design, interpretation and execution of the entire project: S.S.B., Y.G.-P., M.G., P.H.T., A.H. and F.G. Statistical and bioinformatics analyses and interpretation: S.C., M.T., M.Z. and Y.S. Manuscript writing: S.S.B., S.C., Y.G.-P., P.H.T., M.G., A.H. and F.G. All authors approved the manuscript.
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The study was performed in accordance with the Declaration of Helsinki. Waiver of IRB was obtained from Indiana, and Oxford Universities.
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Additional information can be found in Supplemental data section. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
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A patent disclosure has been filed at IU for the EScore. The authors (S.S.B., Y.G.P., F.G., S.C. and A.L.H.) have been listed as inventors. S.C., Y.S., C.C., E.M., A.S., M.Z., M.G. and F.G. are employees of GE. The remaining authors do not have any competing interests..
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This study is supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA194600 to S. Badve, M. Gerdes and F. Ginty. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Badve, S.S., Cho, S., Gökmen-Polar, Y. et al. Multi-protein spatial signatures in ductal carcinoma in situ (DCIS) of breast. Br J Cancer (2021). https://doi.org/10.1038/s41416-020-01216-6
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