title: Association of RB/p16-pathway perturbations with DCIS recurrence: dependence on tumor versus tissue microenvironment.
abstract: The prevalence of ductal carcinoma in situ (DCIS) diagnoses has significantly increased as a result of active radiographic screening. Surgical resection and hormone and radiation therapies are effective treatments, but not all DCIS will progress to invasive breast cancer. Therefore, markers are needed to define tumors at low risk of recurrence and progression that can be treated by surgery alone rather than by adjuvant therapies. Initial analyses indicate that retinoblastoma (RB)-pathway perturbations occur at high frequency in DCIS and mirror the molecular alterations observed in invasive breast cancer. Particularly, the elevated expression of p16ink4a in DCIS was associated with loss of RB function and estrogen receptor-negative biology. Furthermore, high expression of p16ink4a in conjunction with Ki-67 was associated with increased risk of DCIS recurrence and progression to invasive disease in multivariate analyses. These data are consistent with a functional role for RB in modulating the invasive behavior of mammary epithelial cells. The tissue microenvironment is particularly relevant to the behavior of DCIS, and, surprisingly, elevated expression of p16ink4a in nonproliferative stroma was observed in a substantial fraction of cases. In this tissue compartment, p16ink4a expression was strongly associated with disease recurrence, independent of standard histopathologic features. Together, the data herein describe dual aspects of RB-pathway biology that are associated with disease recurrence through the epithelial or stromal compartment of DCIS.
authors.affiliation: Department of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Agnieszka K
authors.initials: AK
authors.lastname: Witkiewicz
authors.forename: Dayana B
authors.initials: DB
authors.lastname: Rivadeneira
authors.forename: Adam
authors.initials: A
authors.lastname: Ertel
authors.forename: Jessica
authors.initials: J
authors.lastname: Kline
authors.forename: Terry
authors.initials: T
authors.lastname: Hyslop
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Schwartz
authors.forename: Paolo
authors.initials: P
authors.lastname: Fortina
authors.forename: Erik S
authors.initials: ES
authors.lastname: Knudsen
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000401:mortality / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000235:genetics* / Q000401:mortality / Q000601:surgery; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000378:metabolism; D005260:Female; D016161:Genes, Retinoblastoma / Q000235:genetics*; D006801:Humans; D053208:Kaplan-Meier Estimate; D019394:Ki-67 Antigen / Q000378:metabolism; D046228:Microarray Analysis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics*; D014407:Tumor Cells, Cultured; D059016:Tumor Microenvironment / Q000502:physiology
chemical_list: D019941:Cyclin-Dependent Kinase Inhibitor p16; D019394:Ki-67 Antigen