title: Aldehyde dehydrogenase 1-positive cells in axillary lymph node metastases after chemotherapy as a prognostic factor in patients with lymph node-positive breast cancer.
abstract: BACKGROUND
  Aldehyde dehydrogenase 1 (ALDH1)-positive cells exhibit stem-like or progenitor ability and have been considered a clinically important diagnostic and therapeutic target in patients with breast cancer. In this study, the authors evaluated responsiveness to chemotherapy of ALDH1-positive cells in primary and metastatic lesions and its relation to prognosis for patients with lymph node-positive breast cancer.
  
  
  METHODS
  In total, 115 patients who had breast cancer with cytologically confirmed lymph node metastases and who underwent surgery after neoadjuvant chemotherapy (NAC) were evaluated. By using ALDH1 immunohistochemistry in core-needle biopsy specimens of the primary tumor, cytology samples of axillary lymph nodes before NAC, and pathologic samples of each after NAC, the clinical significance of ALDH1-positive cell status was evaluated in primary and metastatic lesions before and after NAC.
  
  
  RESULTS
  The presence of ALDH1-positive cancer cells, but not ALDH1-negative cancer cells, in primary and metastatic lesions after NAC was associated with a worse prognosis. In multivariate analysis, only ALDH1-positive cells in metastatic lesions after NAC correlated with overall survival. The responsiveness of ALDH1-positive cells to chemotherapy differed between primary and metastatic lesions, and the findings indicated that ALDH1-positive cells in metastatic lesions after NAC may clinically precede those in the primary lesion.
  
  
  CONCLUSIONS
  The responsiveness of ALDH1-positive cells to chemotherapy in primary and metastatic lesions and its prognostic significance were clarified in patients with breast cancer. The authors concluded that ALDH1-positive status may represent a surrogate marker as a new concept in patients with lymph node-positive breast cancer.
authors.affiliation: Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. sakaki@faculty.chiba-u.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sakakibara
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Fujimori
authors.forename: Tetsutaro
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagashima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujimoto
authors.forename: Hiroshi Tiberu
authors.initials: HT
authors.lastname: Suzuki
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Ohki
authors.forename: Koya
authors.initials: K
authors.lastname: Fushimi
authors.forename: Jissei
authors.initials: J
authors.lastname: Yokomizo
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nakatani
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000080924:Aldehyde Dehydrogenase 1 Family; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000378:metabolism*; D008198:Lymph Nodes / Q000201:enzymology; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D050697:Retinal Dehydrogenase / Q000378:metabolism*
chemical_list: D007527:Isoenzymes; D000080924:Aldehyde Dehydrogenase 1 Family; C510223:ALDH1A1 protein, human; D050697:Retinal Dehydrogenase