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Objective: To determine the overall survival of metastatic breast cancer in the Pakistani patients and compare it with published information. Method: The design was a retrospective analysis of metastatic breast cancer patients from breast cancer database. Metastatic breast cancer (MBC) or Stage IV breast cancer is a major medical problem, which is not curable with the currently available therapies1. Clinicians practicing in South Asia feel that the outcome of breast cancer as a whole is poor in their part of the world. The records of all patients diagnosed to hance MBC between 1987 to 1999, were retrieved from the database of the Section of Oncology at the Aga Khan University Hospital in Karachi. A total of 137 evaluable cases with histopathologically proven metastatic breast cancer of all subtypes were identified. Metastatic cancer of the breast is currently an incurable disease with a reported median survival of approximately two to three years. 4.Ahmed R ,Shaikh H Hassan SH 1s carcinoma breast a different disease in Pakistani Population J, Pak. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. ABCD sponsors treatment for those in need regardless of gender, race or creed, helping them to reach their full potential, to live life with dignity and to take their rightful place in their community. ABCD works through local Palestinian partners, the Bethlehem Arab Society for Rehabilitation (BASR) based in Beit Jala, The Sheepfold in Beit Sahour and two UNWRA Refugee Camps in Jalazone and Nour Shams.
Funding is constantly needed for new projects and to update and refurbish existing facilities. Schematic model of TRIM37-directed transcriptional repression and Kaplan-Meier analysis comparing survival of breast cancer patients with high or low TRIM37 expression.
The ChIP-chip data have been deposited in the Gene Expression Omnibus under accession number GSE48196. Extended Data Figure 4: Additional experiments showing interaction between TRIM37 and PRC2 subunits. When you are told you have cancer and begin looking for treatment options, you may be concerned about life expectancy and quality of life. The chart below shows the cancer survival rates of 232 metastatic breast cancer patients who were diagnosed between 2000 and 2009. Of the CTCA metastatic breast cancer patients shown in the above chart, the estimated survival rate at six months was 95%. SEER is the only authoritative source of population-based information about cancer incidence and survival in the United States that includes the stage of cancer at the time of diagnosis and patient survival data.
The objective of this analysis was to see how long each group of patients survived after their diagnosis. The independent biostatistician computed the survival outcomes of metastatic breast cancer patients from the CTCA database and metastatic breast cancer patients from the SEER database who were diagnosed between 2000 and 2009. The chart below shows the cancer survival rates for a group of 323 metastatic breast cancer patients who were diagnosed between 2000 and 2011.
At Cancer Treatment Centers of America, we understand that you may also wish to see the survival rates of the group of metastatic breast cancer patients reported in the Surveillance, Epidemiology and End Results (SEER) database of the National Cancer Institute.
Therefore, we asked an independent biostatistician to analyze both the survival rates of the group of CTCA patients and the group of patients included in the SEER database. We also want to be sure you understand that cancer is a complex disease and each person's medical condition is different; therefore, CTCA makes no claims about the efficacy of specific treatments, the delivery of care, nor the meaning of the CTCA and SEER analyses.
This analysis included breast cancer patients from CTCA who were diagnosed from 2000 to 2011 (including 2000 and 2011) with primary tumor sites (as coded by ICD-O-2 (1973+)) from C500 to C509, and were considered analytic cases by the CTCA. Primary tumor sites (as coded by ICD-O-2 (1973+)), date of initial diagnosis, date of last contact, year of initial diagnosis, age of initial diagnosis, vital status, and cancer histologic type as coded by the ICD-O-3.
The database from the CTCA cohort was prepared by the CTCA cancer registrars from the following four hospitals: Southwestern Regional Medical Center hospital, Midwestern Regional Medical Center hospital, Eastern Regional Medical Center hospital, and Western Regional Medical Center hospital. The SEER program of the National Cancer Institute is an authoritative source of information on cancer incidence and survival in the United States. This analysis included breast cancer patients from the latest SEER Limited-Use Database (as of 2014) who were diagnosed from 2000 to 2011 (including 2000 and 2011) with primary tumor sites (as coded by ICD-O-2 (1973+)) from C500 to C509. Primary tumor sites (as coded by ICD-O-2 (1973+)), survival time recode as calculated by the date of initial diagnosis and the date of death or the follow-up cutoff date, year of initial diagnosis, age of initial diagnosis, vital status, and cancer histologic type as coded by the ICD-O-3. In order to make a meaningful survival analysis, basic cancer and patient characteristics such as age at initial diagnosis, year of initial diagnosis, cancer stages, and cancer primary sites were first analyzed for both the CTCA and SEER samples. For example, if a specific primary tumor site had patients in only one database, none of those patients were used in the analysis. The survival outcome from the CTCA database was defined as the time from the initial diagnosis to death and computed in number of years as the difference between the date of death and the date of initial diagnosis divided by 365.25. For each survival outcome from each database, the survival curve, defined as the probability of cancer patient survival as a function of time after the initial diagnosis, was estimated by the nonparametric product-limit method[1].
Covariates such as age at initial diagnosis and year of initial diagnosis could affect the survival of breast cancer patients. We understand you may be feeling overwhelmed with questions and concerns about your type of cancer and what it all means. Explore our cancer hospitals, which house the latest treatments, technologies and integrative oncology services under one roof. Discover our patient-centered approach, and how you get all your questions answered in a single visit by a dedicated team of cancer experts. 5-year overall and cancer-related survival rate according to colorectal cancer obstruction and non-obstruction.
LAC was independently associated with reduced risk of tumour relapse and increased cancer related survival rate. Besides medical issues a significant amount of time, emotional energy and financial resources are required for its management.
In order to understand the differences of biological behavior between different ethnic communities, a stage for stage comparison would be helpful between such groups. Hepatic involvement was documented mostly by an ultrasound examination of the abdomen or in a few cases by a CT examination.
It is a hetrogenous disease and the inter play of a number of factors results in variations of the outcome in an individual patient. Case LD et al: A comparison Of treatment outcomes for black patients and white patients with unetastatic breast cancer.
As a negative control, TRIM37 binding at three non-TRIM37 target genes, ACTB, EEF1A1 and GAPDH, is shown. MCF7 nuclear extracts were immunoprecipitated with a TRIM37, EZH2 or SUZ12 antibody, or an IgG control, and the immunoprecipitates were analysed for TRIM37, EZH2 or SUZ12 by immunoblotting.



At Cancer Treatment Centers of America® (CTCA), we believe you have the right to know our statistics for breast cancer treatment outcomes, so you can choose the best cancer care for you and your family. Therefore, we asked an independent biostatistician to analyze the survival results of CTCA® patients. This means that six months after their diagnosis, 95% of the patients in this group were still living. Therefore, we asked an independent biostatistician to analyze both the survival rates of CTCA patients and those of patients included in the SEER database. Therefore, SEER is currently the most comprehensive database for the analysis of CTCA results and national results.
Our fifth hospital, located near Atlanta, Georgia, was not included because it was not open to patients until August 2012. Across all the 11 cancer types whose survival results are presented on the CTCA website, 0.48% of the CTCA patients included in the analyses were only diagnosed by CTCA and received no initial course of treatment from CTCA. In both cases, the patients had been diagnosed with metastatic or distant cancer – cancer that had traveled from the primary site (breast) to one or more distant sites in the body where it continued to grow. These factors significantly reduced the size of the CTCA sample, which means that the estimates reflected in the survival chart may be subject to high variation and may not be replicated in the future when we have a larger CTCA sample for analysis. Not all cancer patients who are treated at a CTCA hospital may experience these same results. SEER is a source of population-based information about cancer incidence and survival in the United States that includes the stage of cancer at the time of diagnosis and patient survival data. The independent biostatistician computed the survival outcomes of metastatic breast cancer patients from the CTCA database and metastatic breast cancer patients from the SEER database who were diagnosed between 2000 and 2011. More specifically, the SEER Limited-Use Database contained a combination of three databases. The survival outcome from the SEER database was provided by the SEER Limited-Use Data File as the number of completed years and the number of completed months.
Similar estimates were also computed to estimate the difference of the survival rates at these time points between the two cohorts. Therefore, additional adjusted analyses were completed on the survival outcomes between the CTCA and SEER samples after adjusting for the effects of these covariates. First, although a large cancer sample was available from the SEER program across many geographic regions in the United States, both samples, including the sample from CTCA, are convenience samples. It may be particularly relevant to study MBC since current treatments do not prolong life substantially in this setting and the behavior of the disease itself may be a major factor which determines the ultimate outcome of survival1,6.
Some of these are the age of a patient, estrogen and progesterone receptor status and visceral involvement especially the liver. Prognosis among African-American women and white women with lymph node negative breast cancer. Clinical course of breast cancer patients with osseous metastasis treated with combination chemotherapy. Clinical characteristics of patients with metastatic breast cancer with complete remission following systemic treatment. The number of surviving patients at 0-, 5-, 10- and 15-year time points is indicated below the graph.
Right, box plot of number of enriched regions per gene for H2Aub in parental MCF7 cells or after TRIM37 knockdown. The IgG control and BMI1 and EZH2 signal in cells expressing an NS shRNA are the same as those shown in Fig.
SEER collects information on cancer incidence, prevalence and survival from specific geographic areas that represent 28% of the population of the United States. In both cases, the patients had been diagnosed with distant (metastatic) cancer, as discussed above. The SEER Program is a comprehensive source of population-based information in the United States that includes stage of cancer at the time of diagnosis and patient survival data.
Patients whose age at initial diagnosis fell into the overlap of the two ranges from the CTCA and SEER samples were included in the survival analysis.
These were then converted to the number of years by dividing the number of total months by 12. Because the estimated survival curves might not estimate the survival probability at these specific time points, survival rates from the closest observed survival times were used. The nature of these convenience samples prevents a causal interpretation of the statistical inferences. The medical oncologist is helped in managing MBC by the knowledge of individual disease characteristics, which are known to be of prognostic significance in such a setting.
This study reports the survival of patients with MBC from a single tertiary care institution in Pakistan. An MRI or a CT scan of the head was done in 11 cases of which 7 cases (63.6%) showed cerebral metastasis. Patients with only bone metastasis do better than the other subtypes with a niedian survival of four years or more1,7.
MCF7 nuclear extracts were immunoprecipitated with a TRIM37 or EZH2 antibody, or an IgG control, in the presence of ethidium bromide, and the immunoprecipitates were analysed for TRIM37 or EZH2 by immunoblotting. Red indicates increased copy number and green indicates decreased copy number (see Methods). It is also possible that the SEER database may contain some of the CTCA cancer cases that were part of the analysis. This means that the cancer had traveled from the primary site (breast) to one or more distant sites in the body where it continued to grow. For these patients who were still alive or lost to follow-up at the time of entering the databases, their survival time was treated as statistically censored[1] at the difference between the date of last contact and the date of initial diagnosis.
Because five-year survival rates have been popularly used in many cancer survival reports, five-year survival curves were also obtained by treating those who survived more than five years after the initial diagnosis as statistically censored at five years. Second, although some types of matching, as described above, were implemented to select the appropriate SEER and CTCA comparison samples, the distributions of important covariates such as age at initial diagnosis, race and year of initial diagnosis were not exactly the same between the CTCA sample and SEER sample. Copyright (2003) National Academy of Sciences USA.PowerPoint slides for teachingDownloading may take up to 30 seconds. Race and ethnic origin are recognized as significant prognostic factors for the outcome of many diseases including breast cancer2.
In those instances where this information was not available from the records, patients or other family members were contacted at home either by telephone or a letter. In any given case however predictions of outcome are difficult and the treating physician relies very heavily on the published survival data in diverse situations to formulate a treatment plan. The analysis was performed using an online survival analysis tool to analyse the effect of gene expression on breast cancer prognosis using microarray data from 1,809 patients41.


The results confirm that TRIM37 occupancy is reduced upon TRIM37 knockdown, demonstrating the specificity of the TRIM37 antibody in ChIP experiments. The results show that interaction between TRIM37 and EZH2 occurs in the presence of ethidium bromide and is thus not mediated by DNA. Because patients surviving more than five years remained part of the risk sets in the estimation of survival rates at any time within five years of diagnosis, the truncated survival curves were identical to the first portion of the complete survival curves.
Hence, even with the adjusted analyses, the possible confounding of these factors to the analyses and results cannot be ruled out.
In the United States, black populations do worse stage for stage, than the white women with breast cancer3,4.
When confronted with such a case the physician has to be aware of some statistical figures in order to rationally discuss the treatment options with a patient and her family. Another Cox proportional hazards model was also used to simultaneously adjust for the effects of both covariates (age at diagnosis and year of initial diagnosis) in the survival analysis.
The general treatment of MBC consists of hormonal therapy and chemotherapy with supportive care keeping in view the quality of life issues. The results are given relative to expression after treatment with an NS shRNA, which was set to 1.
Nuclear extracts from MCF7 cells ectopically expressing Flag–TRIM37 were immunoprecipitated with anti-Flag magnetic beads, a EZH2 or SUZ12 antibody, or an IgG control, and the immunoprecipitates were analysed for TRIM37, EZH2 or SUZ12 by immunoblotting. Despite the vast number of agents available today to treat MBC there is very little clear cut evidence that different treatment modalities prolong life substantially1. Right, box plot of number of enriched regions per gene for H3K27me3 in parental MCF7 cells or after TRIM37 knockdown. The level of DNA methylation is shown ranging from low (green) to high (red); white indicates data were not available. Third, the survival analyses were based on the statistical comparisons of the rate of death from all possible causes, not solely the cancer-specific death. Selected results from the liquid chromatography tandem mass spectroscopy analysis listing TRIM37 or PRC2 subunits, and their total spectra score in samples immunoprecipitated using either IgG or a TRIM37 antibody. The results indicate that BMI1 and EZH2 levels are unaffected by TRIM37 knockdown in MCF7 cells. Data from CTCA are not available for a statistical comparison on cancer cause-specific death rates. The results indicate no significant correlation between TRIM37 expression and promoter methylation of TRIM37 target genes. Purified H2B was incubated with E1 (UBE1), E2 (UBCH5B), E3 (TRIM37 or BRCA1), ATP and HA-tagged ubiquitin. A two-sample test for equality of proportions with continuity correction showed that there was no statistically significant difference in CpG island content between the EZH2-bound and EZH2, TRIM37 co-bound promoters. The results indicate that knockdown of EZH2 but not TRIM37 de-represses ADAM7 and YES1 expression.
The general perception amongst physicians in Pakistan and Asia in general, except for the advanced Asian countries like Japan, is that women patients with MBC do poorly because of late presentation. Right, ChIP monitoring EZH2 enrichment at the promoters of ADAM7 and YES1 in MCF7 cells expressing an NS or TRIM37 shRNA. The US SEER data however indicates that Asian women as a whole may do better for outcomes than either white or black women9. Purified glutathione-S-transferase (GST)–TRIM37 was incubated with an in vitro translated biotinylated PRC2 subunit (indicated on left). The patients in this series had patterns of metastatic disease, which were comparable to the other published reports 8, Chemotherapy in MBC is used in many ways, yet appears to have little impact on survival as such.
BRCA1, which is known to ubiquitinate H2B at K120 (refs 39, 40) was used as a positive control. Expression of each gene was normalized to that obtained with an NS shRNA, which was set to 1. GST–TRIM37 was purified using GST-agarose beads, and the presence of the PRC2 subunit was analysed by immunoblotting with an anti-biotin antibody.
The results show that knockdown of TRIM37 has no effect on EZH2 binding at ADAM7 and YES1 promoters. In this study, treatments ranged from single agents to high dose chemotherapy with stem cell rescue. The results indicate that TRIM37 interacts strongly with EZH2 and weakly with RBBP4, and does not detectably interact with AEBP2, EED or SUZ12.
Thus, loss of EZH2 binding and de-repression after TRIM37 knockdown is not general to PRC2-bound genes but rather is selective for TRIM37 target genes. In this series a median survival of 2.8 years of the group as a whole is comparable to what is reported from the West.
Expression of TRIM37 and RNF2 was normalized to that obtained in HMECs, which was set to 1. Expression of each gene was normalized to that obtained with an NS shRNA, which was set to 1 (indicated by the dotted red line). Top, schematic diagram of TRIM37 showing the location of the RING, BBOX, coiled coil (CC), MATH and nuclear localization sequence (NLS) motifs. The results indicate that knockdown of EZH2 but not TRIM37 de-represses p14ARF expression in BT474 cells. The results indicate that the GAL4–TRIM37 fusion protein was able to recruit both EZH2 and SUZ212 to the GAL4-binding sites. Middle, right, ChIP monitoring binding of EZH2 and SUZ12 in the presence of GAL4–TRIM37 deletion mutants. The GAL4–TRIM37 wild-type (WT) samples are the same as those shown in the left panel. The results indicate that the ability of GAL4–TRIM37 to recruit EZH2 and SUZ212 requires the TRIM37 RING domain and NLS (presumably for nuclear entry), but not the BBCC or MATH domains. Bottom, immunoblot analysis monitoring expression of GAL4–TRIM37 fusion proteins using a GAL4 antibody. The results show that knockdown of TRIM37 has no effect on proliferation of breast cancer cell lines lacking 17q23 amplification. The results were normalized to TRIM37 expression in MCF10A cells expressing empty vector, which was set to 1.



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