title: Associations between pathologic tumor features and preadjuvant therapy cognitive performance in women diagnosed with breast cancer.
abstract: Intertumor heterogeneity has been proposed as a potential mechanism to account for variability in cognitive performance in women diagnosed with breast cancer. The purpose of this study was to explore associations between variation in pathologic tumor features (PTFs) and variability in preadjuvant therapy cognitive performance in postmenopausal women newly diagnosed with early-stage breast cancer. Participants (N = 329) completed a comprehensive battery of neuropsychological tests to evaluate cognitive performance after primary surgery but prior to initiation of adjuvant anastrozole±chemotherapy. PTF data were abstracted from medical records. Robust multiple linear regression models were fit to estimate associations between individual PTFs and the cognitive function composite domain scores. All models controlled for age, estimated intelligence, and levels of depressive symptoms, anxiety, fatigue, and pain. Diagnosis of a HER2-positive tumor contributed to poorer verbal (b = -0.287, P = 0.018), visual (b = -0.270, P = 0.001), and visual working (b = -0.490, P < 0.001) memory performance compared to diagnosis of a HER2-negative tumor. Similarly, as HER2 immunohistochemistry classification score increased, verbal (b = -0.072, P = 0.093), visual (b = -0.081, P = 0.003), and visual working (b = -0.170, P < 0.001) memory performance score decreased. Associations with performance were also noted between location, focality/centricity, hormone receptor expression, cellular proliferation (i.e., Ki67), and Oncotype DX®Breast Cancer Assay Recurrence Score®.) Our results suggest that certain PTFs related to more aggressive tumor phenotypes or inferior breast cancer prognosis may be implicated in poorer preadjuvant therapy cognitive performance. Follow-up studies that include a cognitive assessment before primary surgery should be conducted to further delineate the role of intertumor heterogeneity on cognitive performance.
authors.affiliation: University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.|Columbia University School of Nursing, New York, New York.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Koleck
authors.affiliation: University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Bender
authors.affiliation: University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.|Departments of Biostatistics and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sereika
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, California.|Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Ryan
authors.affiliation: University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
authors.forename: Puja
authors.initials: P
authors.lastname: Ghotkar
authors.affiliation: Division of Hematology/Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania.|University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.|University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brufsky
authors.affiliation: University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.|University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Magee-Womens Hospital of UPMC, CancerCenter, Pittsburgh, Pennsylvania.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Jankowitz
authors.affiliation: University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.|University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Division of Breast Surgical Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania.
authors.forename: Priscilla F
authors.initials: PF
authors.lastname: McAuliffe
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Division of Gynecologic Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania.
authors.forename: Beth Z
authors.initials: BZ
authors.lastname: Clark
authors.affiliation: University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.|Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Yvette P
authors.initials: YP
authors.lastname: Conley
mesh_terms: D000368:Aged; D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000523:psychology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D009570:Nitriles / Q000008:administration & dosage / Q000627:therapeutic use; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000077384:Anastrozole; D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D018719:Erb-b2 Receptor Tyrosine Kinases; D014230:Triazoles; C508053:ERBB2 protein, human
keywords: Breast neoplasms; biomarkers; cognition; pathology; receptor ErbB-2