Cited by 54Breast Cancer Treatment StudiesCancer, Hypoxia, and MetabolismBreast Lesions and Carcinomas

Breast cancer hypoxia in relation to prognosis and benefit from radiotherapy after breast-conserving surgery in a large, randomised trial with long-term follow-up

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Tutzauer, Julia, Sjöström, Martin, Holmberg, Erik, Karlsson, Per, Killander, Fredrika, Leeb-Lundberg, L. M. Fredrik, Malmström, Per, Niméus, Emma +2 more·2022·British Journal of Cancer

Abstract

Background: Breast-conserving surgery followed by radiotherapy is part of standard treatment for early-stage breast cancer. Hypoxia is common in cancer and may affect the benefit of radiotherapy. Cells adapt to hypoxic stress largely via the transcriptional activity of hypoxia-inducible factor (HIF)-1α. Here, we aim to determine whether tumour HIF-1α-positivity and hypoxic gene-expression signatures associated with the benefit of radiotherapy, and outcome. Methods: Tumour HIF-1α-status and expression of hypoxic gene signatures were retrospectively analysed in a clinical trial where 1178 women with primary T1-2N0M0 breast cancer were randomised to receive postoperative radiotherapy or not and followed 15 years for recurrence and 20 years for breast cancer death. Results: The benefit from radiotherapy was similar in patients with HIF-1α-positive and -negative primary tumours. Both ipsilateral and any breast cancer recurrence were more frequent in women with HIF-1α-positive primary tumours (hazard ratio, HR 0–5 yrs 1.9 [1.3–2.9], p = 0.003 and HR 0–5 yrs = 2.0 [1.5–2.8], p < 0.0001). Tumour HIF-1α-positivity is also associated with increased breast cancer death (HR 0–10 years 1.9 [1.2–2.9], p = 0.004). Ten of the 11 investigated hypoxic gene signatures correlated positively to HIF-1α-positivity, and 5 to increased rate/risk of recurrence. Conclusions: The benefit of postoperative radiotherapy persisted in patients with hypoxic primary tumours. Patients with hypoxic primary breast tumours had an increased risk of recurrence and breast cancer death.

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Authors
Tutzauer, J., Sjöström, M., Holmberg, E., Karlsson, P., Killander, F., Leeb-Lundberg, L. M. F., Malmström, P., Niméus, E., Fernö, M., & Jögi, A.
Affiliations
  • Lund University (SE)
  • University of Gothenburg (SE)
Corresponding author
Jögi, Annika
Venue
British Journal of Cancer
Published
2022-02-09
Volume
126
Issue
8
Pages
1145-1156
ISSN
  • 0007-0920 (ISSN-L)
  • 1532-1827
OpenAlex
W4210934033
Cited by
53
References
50
Citations by year
2026: 5 · 2025: 15 · 2024: 20 · 2023: 6 · 2022: 6 · 2013: 1
FWCI
5.05
Type
journal article
Language
en
Open access
Locations
  • British Journal of Cancer (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Funders
  • Falk Foundation
  • Swedish Cancer Foundation
  • Percy Falk Foundation
  • Cancerfonden
  • Allmänna Sjukhusets i Malmö Stiftelse för Bekämpande av Cancer
  • Marcus och Amalia Wallenbergs minnesfond
  • University of California, San Francisco
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Hypoxia, and Metabolism
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
Keywords
breast cancer, tumor hypoxia, hypoxia-inducible factor-1α, HIF-1α expression, breast-conserving surgery, postoperative radiotherapy, breast cancer recurrence, breast cancer mortality, early breast cancer, prognostic factors
MeSH terms
Hypoxia, Breast Neoplasms, Female, Follow-Up Studies, Humans, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Mastectomy, Segmental, Hypoxia-Inducible Factor 1, alpha Subunit

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