ASO Author Reflections: Transitioning From Morphology to Transcriptomics in Capturing Tumor Biology
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Transitioning From Morphology to Transcriptomics in Capturing Tumor Biology Hideo Takahashi, MD1, Masanori Oshi, MD1,2, Mariko Asaoka, MD1,3, Takashi Ishikawa, MD, PhD3, Itaru Endo, MD, PhD2, and Kazuaki Takabe, MD, PhD, FACS1,2,3,4,5 1
Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY; 2Department of Surgery, Yokohama City University, Yokohama, Japan; 3Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan; 4Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 5Department of Surgery, University at Buffalo Jacobs, The State University of New York, School of Medicine and Biomedical Sciences, Buffalo, NY
PAST In the world of surgical oncology, it is said that biology is King and selection of cases is Queen.1 Capturing tumor biology has been challenging because it is difficult to define accurately. Historically, tumor biology has been defined anatomically as clinical stage based on tumor size, lymph node metastases, and distant metastasis. With a deeper understanding of tumor morphology, pathologic findings such as lymphovascular invasion (LVI), perineural invasion (PNI), and grade have been considered surrogate markers of aggressive tumor biology. However, pathologic analyses are limited by subjective morphologic evaluation. In breast cancers, better understanding of hormonal receptors (HRs) as well as human epidermal growth factor receptor 2 (HER2), immunohistochemistry (IHC), and fluorescence in situ hybridization (FISH) assessments have added another method for capturing tumor biology. Compared with other cancer types, histologic grade in breast cancer has demonstrated compelling evidence for predicting tumor biology. Especially, the Nottingham grading system, composed of three pathologic findings (tubular formation, nuclear pleomorphism, and mitotic counts), is the most validated system and has demonstrated the least interobserver variability among various grading systems.
Society of Surgical Oncology 2020 First Received: 11 May 2020; Published Online: 29 May 2020 K. Takabe, MD, PhD, FACS e-mail: [email protected]
Thus, Nottingham histologic grade is incorporated into a significant component of the tumor stated in the latest eighth edition of the American Joint Commission on Cancer (AJCC) Breast Cancer Staging system.2 However, subjectivity of morphologic assessment remains. PRESENT In recent years, innovation in genomic sequencing technology and computational bioinformatics analysis has enabled researchers to dissect the tumor immune microenvironment (TIME) at the genomic level, promoting further understanding of immunogenomics.3 For example, the authors’ group found that anti-cancer immunity counterbalances aggressive tumor biology in breast cancer with a high mutation rate.4 It is now possible to assess tumor biology and underlying immunogenicity in a more objective way using transcriptomic data from the tumor samples combined with
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