Background Serum tumor markers such as carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and prostate-specific antigen (PSA) are crucial to clinical decision-making based on defined medical thresholds. However, significant inter-method variability and lack of harmonization limit result comparability and hinder consistent application of international guidelines. Objective This letter proposes an expanded role for External Quality Assessment (EQA) programs as active drivers of assay harmonization beyond conventional proficiency testing. Methods This proposal draws on recent studies evaluating the commutability of frozen human serum pools (FSPs) from the Korean Association of External Quality Assessment Service (KEQAS) and findings from EQA-based harmonization simulations. It demonstrated that harmonization of tumor markers such as CA 15-3 and CEA, is achievable. Results KEQAS FSPs demonstrated commutability for AFP, CEA, and total PSA across major diagnostic platforms. Simulation results indicated that “in silico” recalibration substantially reduced inter-method variability; for example, the bias range for CA 15-3 was reduced from [−29.28%, 9.86%] to [−0.09%, 0.12%], and recalibrating outlier methods for CEA improved the alignment also. Conclusions EQA programs can serve as practical harmonization hubs by leveraging commutable materials and implementing EQA-driven recalibration. Such approaches can help that medical decision points, retain consistent clinical significance across diverse analytical systems.
BackgroundTriple-negative breast cancer (TNBC) remains clinically challenging due to its aggressive nature, high recurrence rate, and lack of targeted therapies. To address these limitations, combination chemotherapies that synergistically enhance antitumor efficacy while permitting dose reduction and supporting dose-sparing strategies are urgently needed. Cisplatin has a broad spectrum of anticancer activity. However, its resistance and dose-limiting toxicities constrain clinical benefit. Digitoxin is a cardiac glycoside that has anticancer activity.ObjectiveWe aimed to assess the nature of interaction between digitoxin and cisplatin in TNBC cells, define the most synergistic area (MSA), and estimate dose-sparing potential.MethodsWe profiled digitoxin-cisplatin effects in MDA-MB-231 TNBC cell line by checkerboard and fixed-ratio designs, quantifying interaction with Chou-Talalay combination index/dose-reduction index by CompuSyn, and multiple matrix models by SynergyFinder.ResultsThe CI analysis demonstrated synergy across all tested ratios, with the strongest synergistic interaction at a digitoxin/cisplatin ratio of 1:200 (CI = 0.30 at ED97). Dose-reduction analysis showed up to 27-fold cisplatin sparing (ratio 1:25, ED97). Matrix-based models confirmed synergy (Bliss 6.9, Loewe 18.6, ZIP 7.1, and HSA 14), converging on MSA at 31.25 nM digitoxin and 6.25 µM cisplatin.ConclusionOur results highlight a robust synergistic interaction between digitoxin and cisplatin in MDA-MB-231 cells with a dosing window that maximizes cytotoxic effect while potentially reducing cisplatin exposure.
Background Tumour biomarkers have become increasingly important in oncology, shaping cancer diagnostics, classification, and patient management. Despite their potential, the use of cancer biomarkers in clinical settings remains limited. Objective This paper aims to outline biomarker development, from classical, serum protein markers to emerging tumour biomarkers, including meta-biomarkers, to show their diversity and point out the challenges in their development, reporting, and implementation in clinical practice as well as their relevance in evidence-based pathology and cancer classification. Methods A literature-based analysis, incorporating insights from our ongoing research, is presented. Results Although numerous potential biomarkers, biomarker signatures, and meta-biomarkers, are being discovered, existing innovations are often not supported by sufficiently rigorous research methodologies and standardised reporting practices to enable their translation into clinical practice. Conclusions To ensure that biomarker discoveries are both scientifically sound and clinically useful, improved research and validation methods, along with adherence to established reporting standards, are essential. We propose the use of the Hierarchy of Evidence for Tumour Pathology as a framework to evaluate and map existing evidence and identify knowledge gaps and research priorities.
BackgroundIn recent years, the significance of sirtuins in cancer biology has become increasingly evident, but their molecular mechanisms and prognostic impacts remain elusive.ObjectiveThe present study aimed to investigate the differential expression of the sirtuin gene family across cancers and to evaluate their prognostic value.MethodsWe used various bioinformatics databases and methodologies, including Oncomine, GEPIA, OncoDB, cBioPortal, R2 Kaplan-Meier Scanner, STRING, etc., to determine the expression pattern of the sirtuin family genes, along with their mutations and prognostic values in human cancers.ResultsIn the current study, SIRT1, SIRT2, SIRT4, and SIRT5 were downregulated in lymphoma, whereas SIRT6 and SIRT7 were overexpressed. In breast cancer, SIRT3, SIRT5, and SIRT7 were overexpressed, and in terms of kidney cancer, higher expression of SIRT2, SIRT3, and SIRT5 was observed. In contrast, for leukemia, bladder, and brain cancers, most sirtuin family members showed reduced expression. We found that most mutations occurred in uterine cancer, chRCC (chromophobe renal cell carcinoma), DLBCL (diffuse large B-cell lymphoma), melanoma, pRCC (papillary renal cell carcinoma), and esophageal cancer. Moreover, we identified the relevant functional proteins through protein-protein interaction analysis to evaluate copy number alterations (CNAs) in sirtuins. The most frequent alterations were amplifications and deep deletions. Survival analysis demonstrated that SIRT1 and SIRT2 overexpression correlated with improved overall survival in low-grade glioma but predicted poorer outcomes in ovarian cancer. Downregulation of SIRT1, SIRT3, and SIRT5 was associated with better prognosis in DLBCL, while SIRT3 and SIRT4 upregulation predicted favorable survival in testicular germ cell tumors. SIRT6 overexpression was linked to favorable prognosis in esophageal carcinoma and sarcoma, while unfavorable outcomes were observed in hepatocellular carcinoma and cholangiocarcinoma. SIRT7 upregulation was significantly associated with reduced survival in esophageal, liver, and uterine cancers, but surprisingly correlated with improved outcomes in urothelial carcinoma and cervical squamous cell carcinoma.ConclusionsTogether, this multi-omics analysis reveals the correlation and prognostic values of sirtuins across multiple types of human cancers and suggests that sirtuins may serve as promising biomarkers for different cancers.
Background Osteopontin is a glycophosphoprotein aberrantly expressed in several tumor types, which exhibits several isoforms generated by post-translational and post-transcriptional mechanisms, including alternative splicing. Among total osteopontin (tOPN), the osteopontin-c (OPN-c) splice variant has been the most explored with an oncogenic role described for a range of tumor types. Especially in ovarian cancer (OC) cells, OPN-c is found overexpressed, presenting both diagnostic and prognostic implications. Objective In this review article, we aim to outline OPN-c roles in cancer, particularly in OC, in which it has been reported as a diagnostic biomarker. Methods We used PubMed search, and experimental procedures were summarized at the Figure legends. Results We identified cytoplasmic, perinuclear, and nuclear OPN-c in OC cells that overexpress this OPN splice variant. Moreover, we report that OPN-c splicing isoform is found highly expressed in endometrioid OC patients’ samples, compared to non-neoplastic ovarian tissues. Also, OPN-c expression levels have been associated with worse overall survival and worse progression-free survival in patients with both endometrioid and serous OC. Furthermore, OPN-c may be involved in a wide range of tumor features evoked by signaling pathways, such as AKT, ERK, and FAK. Conclusions Therefore, a better comprehension of OPN-c roles in OC can further contribute to its application as a biomarker as well as a target for putative treatment strategies, especially those aiming to sensitize tumor cells to chemotherapeutic agents currently used in the OC treatment.
