Open Access

Prognostic roles of MAGE family members in breast cancer based on KM‑Plotter Data

  • Authors:
    • Binghan Jia
    • Xiaoling Zhao
    • Yao Wang
    • Jinlong Wang
    • Yingying Wang
    • Yuemei Yang
  • View Affiliations

  • Published online on: August 6, 2019     https://doi.org/10.3892/ol.2019.10722
  • Pages: 3501-3516
  • Copyright: © Jia et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 4.0].

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Abstract

Breast cancer is the second leading cause of cancer‑associated mortality among women worldwide, and the prevalence and mortality rates associated with this disease are high in Western countries. The melanoma‑associated antigen (MAGE) family proteins are well‑known tumor‑specific antigens; this family includes >60 proteins that serve an important part in cell cycle withdrawal, neuronal differentiation and apoptosis. The aim of the present study was to identify a biomarker within the MAGE family that is specific for breast cancer. In the present study, the prognostic role of MAGE mRNA expression was investigated in patients with breast cancer using the Kaplan‑Meier plotter database. The prognostic value of MAGE members in the different intrinsic subtypes of breast cancer was further investigated, as well as the clinicopathological features of the disease. The results of the present study indicated that patients with breast cancer that had high mRNA expression levels of MAGEA5, MAGEA8, MAGEB4 and MAGEB6 had an improved relapse‑free survival, whereas those with high mRNA expression levels of MAGEB18 and MAGED4 did not. These results suggested that MAGEA5, MAGEA8, MAGEB4 and MAGEB6 may have roles as tumor suppressors in the occurrence and development of breast cancer, whereas MAGEB18 and MAGED4 may possess carcinogenic potential. MAGED2, MAGED3 and MAGEF1 had different effects depending on the type of breast cancer. In particular, high MAGEC3 mRNA expression was associated with worse RFS in lymph node‑positive breast cancer, but with improved RFS in lymph node‑negative breast cancer. In patients with wild‑type TP53 and patients with different pathological grades of breast cancer, MAGEE2, MAGEH1 and MAGEL2 were more worthy of attention as potential prognostic factors. The results of the present study may help to elucidate the role of MAGE family members in the development of breast cancer, and may promote further research that identifies MAGE‑targeting reagents for the treatment of breast cancer.

Introduction

Breast cancer is the second leading cause of cancer-associated mortality among women worldwide (1). According to one published report, there were >240,000 new cases of breast cancer reported in the United States in 2017, of which >40,000 were expected to succumb to the disease (2). Distant metastasis and chemoresistance are leading causes of patient mortality and treatment failure (3). Despite advances in the screening, diagnosis and treatment options for breast cancer, the incidence and mortality of the disease are still increasing (4). Tumor recurrence and metastatic relapse remain the major contributing factors to the high mortality rates (5). Therefore, there is still an urgent need to investigate novel targets and/or biomarkers that can be used to predict or treat patients with breast cancer.

Melanoma-associated antigen (MAGE) family members are cancer/testis antigens that are expressed in germline cells, trophoblasts and various types of human cancer, including melanoma, lung cancer, breast cancer, oral squamous cell carcinoma, esophageal carcinoma, urothelial malignancies and hematopoietic malignancies (611). At present, >60 proteins in this family have been identified and subdivided into two categories on the basis of the location and expression patterns of the protein. The type I MAGE genes are restricted to clusters on the X-chromosome, and include MAGE-A, -B and -C. Their aberrant expression levels occur in numerous types of cancer and they serve as tumor-specific antigens (11,12). Unlike the type I genes, type II MAGE genes are not limited to chromosome clustering and include MAGE-D, -E, -F, -G, -H, -I, -J, -K, -L and necdin subfamilies (11,12). They serve an important role in cell cycle withdrawal, neuronal differentiation and apoptosis (13).

It has been reported that MAGEA1 can inhibit the proliferation and migration of MCF-7 and MDA-MB-231 breast cancer cell lines (14). In addition, MAGEA1-A3 and A12 have been investigated in the early detection of breast cancer (15). Ayyoub et al (16) reported that MAGEA3 and MAGEA6 expression in primary breast cancer is associated with hormone receptor-negative status, high histological grade and poor survival. Cabezón et al (17) indicated that MAGEA3 and MAGEA4 may be associated with risk and the clinicopathological parameters of breast cancer (17,18). In breast cancer, MAGEA9-A11 have been identified as being associated with poor prognosis (1923). Sypniewska et al (24,25) demonstrated that MAGEB1-B3 DNA vaccines are useful for breast cancer therapy in a mouse breast tumor model. Hou et al (26) reported that MAGEC1 and MAGEC2 may be potential targets for tumor immunotherapy, and demonstrated that MAGEC1 and MAGEC2 expression is associated with advanced stages of breast cancer and poor patient outcome. Du et al (27) demonstrated that MAGED1 inhibits the proliferation, migration and invasion of human breast cancer cells. However, the prognostic roles of each individual MAGE, particularly at the mRNA level in breast cancer, remain unknown.

The Kaplan-Meier plotter (KM-Plotter) database (http://kmplot.com/analysis/) is generated gene expression data and survival information of 1,809 patients downloading from Gene Expression Omnibus (GEO) (28). This database has been widely used to analyze the clinical impact of individual genes on relapse-free survival (RFS), distant metastasis-free survival (DMFS), overall survival (OS) and post-progression survival (PPS) for different types of cancer. In the present study, the prognostic role of the mRNA expression of each individual member of the MAGE family in breast cancer was assessed using the Kaplan-Meier plotter database.

Materials and methods

Data collection

The KM-Plotter database contains data regarding the survival of 3,955 patients with breast cancer (RFS data) (28). The association between the mRNA expression levels of individual MAGE family member genes and RFS was analyzed using an online KM-Plotter database using the gene expression data and the survival information of patients with breast cancer downloaded from the GEO (https://www.ncbi.nlm.nih.gov/pubmed/20020197) (28). Cohorts of patients were split by median expression values through auto select best cut-off. A collection of clinical data, including estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2) status, lymph node status, tumor pathological grade (29), intrinsic subtype and TP53 status were collected.

Different subtypes of breast cancer analysis by KM-Plotter

Briefly, 29 individual members of the MAGE family were entered into the database (kmplot.com/analysis/index.php?p=service&start=1) to obtain Kaplan-Meier survival plots. Of the 29 individual members of the MAGE family, 14 were selected to focus on: MAGEA5, -A8, -B4, -B6, -B18, -C3, -D2, -D3, -D4, -E1, -E2, -F1, -H1 and -L2, which, to the best of our knowledge, have not been reported in the literature by searching PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), Elsevier ScienceDirect (http://www.sciencedirect.com/) and Google Scholar (https://scholar.google.com/). Subsequently, they were used to analyze the different subtypes of breast cancer by KM-Plotter.

Clinicopathological features of breast cancer by KM-Plotter

In addition, in order to further examine the clinicopathological survival condition 14 genes were studied. The clinicopathological features of breast cancer through the KM-Plotter, including the lymph node status, tumor grade, TP53 status and Pietenpol subtype (30) were examined.

Statistical analysis

The Kaplan-Meier survival plots with number at risk, hazard ratio (HR), 95% confidence intervals (CI) and log-rank P-values were obtained using the Kaplan-Meier plotter website. According to American Psychological Association (APA) formatting for P-values, P<0.05 was used indicate a statistically significant difference.

Results

Prognostic values of MAGE members in all patients with breast cancer

The prognostic values of the mRNA expression levels of 29 MAGE family members in patients with breast cancer were obtained from the Kaplan-Meier plotter website. Among these 29 MAGE members, 28 were significantly associated with the prognosis of all types of breast cancer (Fig. 1A). High mRNA expression levels of MAGEA1 (HR, 0.81; 95% CI, 0.71–0.91; P=0.0005), MAGEA4 (HR, 0.84; 95% CI, 0.75–0.93; P=0.0012), MAGEA5 (HR, 0.79; 95% CI, 0.71–0.88; P=2.5×10−5), MAGEA6 (HR, 0.87; 95% CI, 0.77–0.98; P=0.0200), MAGEA8 (HR, 0.71; 95% CI, 0.63–0.79; P=4.0×10−10), MAGEA9 (HR, 0.82; 95% CI, 0.72–0.93; P=0.0016), MAGEA10 (HR, 0.63; 95% CI, 0.56–0.71; P=3.7×10−15), MAGEA11 (HR, 0.80; 95% CI, 0.71–0.90; P=0.0003), MAGEA12 (HR, 0.79; 95% CI, 0.70–0.89; P=8.7×10−5) (Fig. 1B-1/4/5/6/8/9/10/11); MAGEB1 (HR, 0.82; 95% CI, 0.74–0.92; P=0.0005), MAGEB2 (HR, 0.68; 95% CI, 0.61–0.76; P=6.8×10−12), MAGEB3 (HR, 0.83; 95% CI, 0.74–0.93; P=0.0017), MAGEB4 (HR, 0.84; 95% CI, 0.73–0.95; P=0.0058), MAGEB6 (HR, 0.78; 95% CI, 0.65–0.92; P=0.0031), MAGEC1 (HR, 0.72; 95% CI, 0.64–0.82; P=2.2×10−7), MAGEC2 (HR, 0.67; 95% CI, 0.60–0.75; P=6.7×10−13), MAGEC3 (HR, 0.76; 95% CI, 0.68–0.86; P=7.5×10−6), MAGED2 (HR, 0.78; 95% CI, 0.69–0.87; P=3.1×10−5), MAGED3 (HR, 0.82; 95% CI, 0.74–0.92; P=0.0009), MAGEE1 (HR, 0.73; 95% CI, 0.62–0.86; P=8.7×10−5), MAGEF1 (HR, 0.76; 95% CI, 0.67–0.85; P=4.2×10−6) and MAGEL2 (HR, 0.77; 95% CI, 0.68–0.87; P=4.3×10−5) (Fig. 1C-1/2/3/4/5/7/8/9/11/12/14/16/18) were observed to be significantly associated with better prognosis. High mRNA expression levels of MAGED1 (HR, 1.49; 95% CI, 1.33–1.68; P=8.1×10−12), MAGED4 (HR, 1.26; 95% CI, 1.13–1.42; P=6.6×10−5) and MAGEH1 (HR, 1.29; 95% CI, 1.15–1.45; P=1.7×10−5) (Fig. 1C-10/13/17) were significantly associated with worse RFS, whereas the expression levels of MAGEA2 (HR, 1.11; 95% CI, 0.99–1.23; P=0.0700) (Fig. 1B-2) were not associated with RFS. High mRNA expression levels of MAGEA3 (HR, 0.87; 95% CI, 0.77–0.98; P=0.0270; Fig. 1B-3) and MAGEE2 (HR, 0.81; 95% CI, 0.67–0.98; P=0.0290; Fig. 1C-15) were significantly associated with improved prognosis, and low mRNA expression of MAGEB18 (HR, 1.17; 95% CI, 1.00–1.36; P=0.0490; Fig. 1C-6) was significantly associated with better prognosis.

Prognostic value of 14 MAGE members in different subtypes of breast cancer

The prognostic values of 14 MAGE members within the different intrinsic subtypes of breast cancer were determined, including all basal-like, luminal A, luminal B and HER2+. As presented in Fig. 2, high mRNA expression levels of MAGEA8 (HR, 0.59; 95% CI, 0.45–0.77; P=7.9×10−5; Fig. 2B), MAGEB4 (HR, 0.61; 95% CI, 0.46–0.82; P=0.0009; Fig. 2C) and MAGEB6 (HR, 0.61; 95% CI, 0.43–0.85; P=0.0035; Fig. 2D) were significantly associated with improved RFS in patients with the basal-like breast cancer subtype. High mRNA expression levels of MAGEA5 (HR, 0.75; 95% CI, 0.58–0.98; P=0.0320; Fig. 2A), MAGEC3 (HR, 0.70; 95% CI, 0.52–0.94; P=0.0180; Fig. 2E) MAGEE2 (HR, 0.64; 95% CI, 0.43–0.94; P=0.0230; Fig. 2G) and MAGEF1 (HR, 0.73; 95% CI, 0.56–0.95; P=0.0170; Fig. 2H) were significantly associated with improved RFS in patients with basal-like breast cancer subtype. However, high mRNA expression levels of MAGEH1 (HR, 1.51; 95% CI, 1.17–1.96; P=0.0016; Fig. 2I) were significantly associated with worse RFS in patients with the basal-like breast cancer subtype and high mRNA expression levels of MAGED2 (HR, 1.34; 95% CI, 1.02–1.74; P=0.0330; Fig. 2F) was significantly associated with improved RFS in patients with basal-like breast cancer subtype. The survival curves for the remaining members of the MAGE family in patients with basal-like breast cancer subtype were investigated, but they were not significantly associated with prognosis (Fig. S1).

In patients with luminal A breast cancer, high mRNA expression levels of MAGEA5 (HR, 0.71; 95% CI, 0.60–0.84; P=8.9×10−5; Fig. 3A), MAGEA8 (HR, 0.69; 95% CI, 0.58–0.83; P=6.6×10−5; Fig. 3B), MAGEC3 (HR, 0.71; 95% CI, 0.59–0.85, P=0.0003; Fig. 3D); MAGED3 (HR, 0.71; 95% CI, 0.58–0.88; P=0.0016; Fig. 3E), MAGEF1 (HR, 0.74; 95% CI, 0.61–0.88; P=0.0009; Fig. 3G) and MAGEL2 (HR, 0.73; 95% CI, 0.60–0.88; P=0.0013; Fig. 3I) were significantly associated with improved RFS. In contrast, high mRNA expression levels of MAGEH1 (HR, 1.20; 95% CI, 1.01–1.43; P=0.0350; Fig. 3H) were significantly associated with worse RFS. High expression levels of MAGEB4 (HR, 0.84; 95% CI, 0.70–1.00; P=0.0470; Fig. 3C) and MAGEE1 (HR, 0.74; 95% CI, 0.57–0.96; P=0.0250; Fig. 3F) were significantly associated with improved RFS. The remaining MAGE family members were not significantly associated with the prognosis of luminal A breast cancer (Fig. S2).

In luminal B breast cancer, high mRNA expression levels of MAGEA5 (HR, 0.70; 95% CI, 0.58–0.85; P=0.0002; Fig. 4A), MAGEA8 (HR, 0.68; 95% CI, 0.56–0.83; P=9.6×10−5; Fig. 4B), MAGEB4 (HR, 0.72; 95% CI, 0.59–0.89; P=0.0020; Fig. 4C), MAGEC3 (HR, 0.73; 95% CI, 0.60–0.88; P=0.0011; Fig. 4E), MAGED3 (HR, 0.78; 95% CI, 0.64–0.94; P=0.0110; Fig. 4F), MAGEE1 (HR, 0.68; 95% CI, 0.49–0.93; P=0.0016; Fig. 4G) was significantly associated with improved RFS. High mRNA expression levels of MAGEL2 (HR, 0.80; 95% CI, 0.66–0.97; P=0.0210; Fig. 4I) was significantly associated with improved RFS. However, high mRNA expression levels of MAGEH1 (HR, 1.55; 95% CI, 1.26–1.90; P=2.4×10−5; Fig. 4H) was significantly associated with worse RFS and high mRNA expression levels of MAGEB18 (HR, 1.44; 95% CI, 1.06–1.97; P=0.0200; Fig. 4D) was significantly associated with worse RFS. The remaining MAGE members were not significantly associated with the prognosis of luminal B breast cancer (Fig. S3).

In HER2+ breast cancer, high mRNA expression levels of MAGEA8 (HR, 0.67; 95% CI, 0.46–0.99; P=0.0410; Fig. 5A) and MAGEC3 (HR, 0.62; 95% CI, 0.42–0.90; P=0.0120; Fig. 5B) were significantly associated with improved RFS. However, high mRNA expression levels of MAGED2 (HR, 1.82; 95% CI, 1.24–2.68; P=0.0020; Fig. 5C) and MAGEH1 (HR, 1.79; 95% CI, 1.21–2.64; P=0.0032; Fig. 5D) were significantly associated with worse RFS. The remaining MAGE family members were not significantly associated with the RFS of HER2+ breast cancer (Fig. S4).

Prognostic values of 14 MAGE members in breast cancer according to clinicopathological features

The present study also investigated the association between the MAGE family members and patients' clinicopathological features. As presented in Table I, high mRNA expression levels of MAGEF1 (HR, 0.75; 95% CI, 0.61–0.93; P=0.0094) were significantly associated with improved RFS in lymph node-positive breast cancer. In contrast, high mRNA expression levels of MAGEF1 (HR, 1.26; 95% CI, 1.07–1.50; P=0.0063) were significantly associated with worse RFS in lymph node-negative breast cancer. High mRNA expression levels of MAGED2 were significantly associated with improved RFS in lymph node-positive breast cancer (HR, 0.79; 95% CI, 0.65–0.96; P=0.0200) and lymph node-negative breast cancer (HR, 0.82; 95% CI, 0.68–0.99; P=0.0400) breast cancer. MAGED4 expression levels were significantly associated with worse prognosis in lymph node-positive breast cancer (HR, 1.24; 95% CI, 1.02–1.51; P=0.0290) and significantly associated with worse prognosis in lymph node-negative breast cancer (HR, 1.27; 95% CI, 1.07–1.51; P=0.0062). High mRNA expression levels of MAGED3 (HR, 0.81; 95% CI, 0.67–0.99; P=0.0390) were significantly associated with improved RFS in lymph node-positive breast cancer. High mRNA expression levels of MAGEA5 (HR, 1.24; 95% CI, 1.00–1.53; P=0.0447), MAGED4 (HR, 1.24; 95% CI, 1.02–1.51; P=0.0290) and MAGEH1 (HR, 1.30; 95% CI, 1.04–1.62; P=0.0185) were significantly associated with worse RFS in lymph node-positive breast cancer. However, high mRNA expression levels of MAGEB6 (HR, 0.55; 95% CI, 0.33–0.91; P=0.0188), MAGEE2 (HR, 0.57; 95% CI, 0.33–0.98; P=0.0376) and MAGEL2 (HR, 0.83; 95% CI, 0.69–1.00; P=0.0464) were significantly associated with improved RFS in lymph node-negative breast cancer. The remaining MAGE family members were not significantly associated with the RFS of lymph node positive and negative breast cancer.

Table I.

Associations between the different MAGE family members and positive or negative lymph node status of patients with breast cancer.

Table I.

Associations between the different MAGE family members and positive or negative lymph node status of patients with breast cancer.

MAGE family memberAffymetrix IDLymph node statusHR95% CIP-value
MAGEA5214642_x_atPositive1.24b 1.00–1.53b0.0447b
Negative0.900.76–1.060.2129
MAGEA8210274_atPositive1.220.99–1.520.0646
Negative0.850.71–1.030.0946
MAGEB4207580_atPositive1.180.95–1.480.1385
Negative0.870.72–1.060.1809
MAGEB61552858_atPositive0.780.60–1.000.0515
Negative0.55a 0.33–0.91a0.0188a
MAGEB181552913_atPositive0.840.65–1.090.1869
Negative1.470.98–2.210.0601
MAGEC3216592_atPositive1.200.98–1.480.0810
Negative0.850.71–1.010.0640
MAGED2213627_atPositive0.79a 0.65–0.96a0.0200a
Negative0.82a 0.68–0.99a0.0400a
MAGED3205028_atPositive0.81a 0.67–0.99a0.0390a
Negative1.100.93–1.300.2800
MAGED4221261_x_atPositive1.24b 1.02–1.51b0.0290b
Negative1.27b 1.07–1.51b0.0062b
MAGEE11556047_s_atPositive0.810.62–1.040.1013
Negative0.790.54–1.170.2400
MAGEE21553254_atPositive1.230.95–1.580.1096
Negative0.57a 0.33–0.98a0.0376a
MAGEF1218176_atPositive0.75a 0.61–0.93a0.0094a
Negative1.26b 1.07–1.50b0.0063b
MAGEH1218573_atPositive1.30b 1.04–1.62b0.0185b
Negative0.910.75–1.110.3438
MAGEL2219894_atPositive1.080.88–1.310.4600
Negative0.83a 0.69–1.00a0.0464a

{ label (or @symbol) needed for fn[@id='tfn1-ol-0-0-10722'] } P<0.05 was considered to indicate a statistically significant difference.

a High mRNA expression levels associated with improved RFS

b high mRNA expression levels associated with worse RFS. Total patients assigned a lymph node status, n=3,718; lymph node-positive patients, n=1,459; lymph node-negative patients, n=2,259, analyzed by ANOVA. CI, confidence interval; HR, hazard ratio; MAGE, melanoma-associated antigen; RFS, relapse-free survival.

As presented in Table II, high mRNA expression levels of MAGEB6 (HR, 0.29; 95% CI, 0.10–0.83; P=0.0136), MAGEE1 (HR, 0.35; 95% CI, 0.12–1.02; P=0.0435) and MAGEH1 (HR, 0.52; 95% CI, 0.30–0.88; P=0.0140) in grade I breast cancer; MAGEA8 (HR, 0.74; 95% CI, 0.57–0.96; P=0.0248) and MAGEC3 (HR, 0.74; 95% CI, 0.57–0.96; P=0.0210) in grade II breast cancer; and MAGEA8 (HR, 0.78; 95% CI, 0.61–0.99; P=0.0373) in grade III breast cancer were significantly associated with improved RFS. High expression levels of MAGEF1 (HR, 0.70; 95% CI, 0.54–0.90; P=0.0057) and MAGEH1 (HR, 0.63; 95% CI, 0.47–0.85, P=0.0020) in grade II breast cancer; and MAGEB4 (HR, 0.72; 95% CI, 0.58–0.90; P=0.0041) and MAGEB6 (HR, 0.62; 95% CI, 0.46–0.85; P=0.0029) in grade III breast cancer were significantly associated with improved RFS.

Table II.

Association between the MAGE family members and pathological tumor grade of patients with breast cancer.

Table II.

Association between the MAGE family members and pathological tumor grade of patients with breast cancer.

MAGE family memberAffymetrix IDTumor gradeHR95% CIP-value
MAGEA5214642_atI0.720.43–1.220.2269
II1.270.95–1.680.1038
III1.120.88–1.430.3578
MAGEA8210274_atI0.630.33–1.220.1702
II0.74a 0.57–0.96a0.0248a
III0.78a 0.61–0.99a0.0373a
MAGEB4207580_atI1.91b 1.06–3.43b0.0288b
II0.790.60–1.020.0732
III0.72a 0.58–0.90a0.0041a
MAGEB61552858_atI0.29a 0.10–0.83a0.0136a
II1.190.72–1.990.4982
III0.62a 0.46–0.85a0.0029a
MAGEB181552913_atI3.46b 1.20–9.98b0.0142b
II1.650.93–2.930.0840
III1.270.90–1.780.1706
MAGEC3216592_atI1.510.80–2.850.2000
II0.74a 0.57–0.96a0.0210a
III0.890.71–1.110.2900
MAGED2213627_atI1.470.87–2.480.1500
II0.860.67–1.100.2200
III1.39b 1.11–1.73b0.0042b
MAGED3205028_atI1.640.95–2.830.0720
II0.790.62–1.010.0620
III1.35b 1.07–1.69b0.0101b
MAGED4221261_x_atI0.540.26–1.100.0827
II1.52b 1.18–1.95b0.0009b
III1.200.97–1.500.0946
MAGEE11556047_s_atI0.35a 0.12–1.02a0.0435a
II0.610.35–1.050.0730
III1.53b 1.12–2.08b0.0075b
MAGEE21553254_atI0.560.19–1.670.2903
II1.220.73–2.040.4500
III1.180.87–1.610.2900
MAGEF1218176_atI0.670.36–1.240.1993
II0.70a 0.54–0.90a0.0057a
III0.850.67–1.080.1788
MAGEH1218573_atI0.52a 0.30–0.88a0.0140a
II0.63a 0.47–0.85a0.0020a
III1.180.94–1.490.1600
MAGEL2219894_atI0.710.42–1.190.1907
II0.790.62–1.000.0513
III1.25b 1.01–1.56b0.0420b

{ label (or @symbol) needed for fn[@id='tfn4-ol-0-0-10722'] } P<0.05 was considered to indicate a statistically significant difference.

a High mRNA expression levels associated with improved RFS

b high mRNA expression levels associated with worse RFS. Total patients with a pathological tumor grade, n=2,545; patients with tumor grade I, n=378; patients with tumor grade II, n=1,077; patients with tumor grade III, n=1,090 patients. CI, confidence interval; HR, hazard ratio; MAGE, melanoma-associated antigen; RFS, relapse-free survival.

High mRNA expression levels of MAGEB4 (HR, 1.91; 95% CI, 1.06–3.43; P=0.0288) and MAGEB18 (HR, 3.46; 95% CI, 1.20–9.98; P=0.0142) in grade I breast cancer were significantly associated with worse RFS; high mRNA expression levels of MAGED4 (HR, 1.52; 95% CI, 1.18–1.95; P=0.0009) in grade II breast cancer; and MAGED2 (HR, 1.39; 95% CI, 1.11–1.73; P=0.0042), MAGED3 (HR, 1.35; 95% CI, 1.07–1.69; P=0.0101), MAGEE1 (HR, 1.53; 95% CI, 1.12–2.08; P=0.0075) in grade III breast cancer were significantly associated with worse RFS; high mRNA expression levels of MAGEL2 (HR, 1.25; 95% CI, 1.01–1.56; P=0.0420) in grade III were significantly associated with worse RFS. The remaining MAGE family members were not associated with the RFS of different grade breast cancer.

As shown in Table III, high mRNA expression levels of MAGEB4 (HR, 0.53; 95% CI, 0.31–0.88; P=0.0136) and MAGED3 (HR, 0.59; 95% CI, 0.37–0.95; P=0.0280) were significantly associated with improved RFS in patients with TP53-mutated breast cancer, whereas high mRNA expression levels of MAGEL2 (HR, 0.58; 95% CI, 0.34–0.99; P=0.0430) were significantly associated with improved RFS in TP53 wild-type breast cancer. In contrast, high mRNA expression levels of MAGED2 (HR, 2.10; 95% CI, 1.28–3.46; P=0.0028) were significantly associated with worse RFS in TP53-mutated breast cancer. High mRNA expression levels of MAGEB18 (HR, 3.51; 95% CI, 1.50–8.22; P=0.0021) and MAGED4 (HR, 1.82; 95% CI, 1.18–2.83; P=0.0065) were significantly associated with worse RFS in TP53 wild-type breast cancer; and high mRNA expression levels of MAGEE2 (HR, 2.35; 95% CI, 1.01–5.48; P=0.0414), MAGEB6 (HR, 5.08; 95% CI, 1.18–21.89; P=0.0157) were significantly associated with worse RFS in TP53 wild-type breast cancer. Notably, high mRNA expression levels of MAGEF1 were significantly associated with worse RFS in TP53-mutated (HR, 1.68; 95% CI, 1.04–2.71; P=0.0318) and TP53 wild-type (HR, 1.65; 95% CI, 1.06–2.55; P=0.0240) breast cancer. The remaining MAGE family members were not significantly associated with RFS of TP53 mutated and wild-type breast cancer.

Table III.

Association between MAGE family members and the TP53 status of patients with breast cancer.

Table III.

Association between MAGE family members and the TP53 status of patients with breast cancer.

MAGE family memberAffymetrix IDTP53 statusHR95% CIP-value
MAGEA5214642_atMutated1.380.81–2.370.2357
Wild-type1.390.88–2.170.1236
MAGEA8210274_atMutated0.690.43–1.120.1317
Wild-type0.800.50–1.270.3462
MAGEB4207580_atMutated0.53a 0.31–0.88a0.0136a
Wild-type0.780.51–1.200.2634
MAGEB61552858_atMutated0.640.34–1.180.1506
Wild-type5.08b 1.18–21.89b0.0157
MAGEB181552913_atMutated0.660.35–1.240.1931
Wild-type3.51b 1.50–8.22b0.0021b
MAGEC3216592_atMutated0.750.46–1.230.2500
Wild-type0.850.56–1.310.4700
MAGED2213627_atMutated2.10b 1.28–3.46b0.0028b
Wild-type0.800.53–1.230.3100
MAGED3205028_atMutated0.59a 0.37–0.95a0.0280a
Wild-type0.740.45–1.210.2286
MAGED4221261_x_atMutated0.710.44–1.140.1513
Wild-type1.82b 1.18–2.83b0.0065b
MAGEE11556047_s_atMutated1.760.96–3.250.0660
Wild-type0.480.19–1.230.1200
MAGEE21553254_atMutated0.540.25–1.170.1138
Wild-type2.35b 1.01–5.48b0.0414b
MAGEF1218176_atMutated1.68b 1.04–2.71b0.0318b
Wild-type1.65b 1.06–2.55b0.0240b
MAGEH1218573_atMutated1.600.98–2.640.0600
Wild-type0.670.44–1.040.0710
MAGEL2219894_atMutated1.580.95–2.640.0777
Wild-type0.58a 0.34–0.99a0.0430a

{ label (or @symbol) needed for fn[@id='tfn7-ol-0-0-10722'] } P<0.05 was considered to indicate a statistically significant difference.

a High mRNA expression levels associated with improved RFS

b high mRNA expression levels associated with worse RFS. Total patients assigned a TP53 status, n=595; patients with TP53-mutated breast cancer, n=232; patients with wild-type TP53 breast cancer, n=363. CI, confidence interval; HR, hazard ratio; MAGE, melanoma-associated antigen; RFS, relapse-free survival.

As presented in Table IV, high mRNA expression levels of MAGEA8 in the basal-like 1 subtype (HR, 0.50; 95% CI, 0.31–0.83; P=0.0059) and luminal androgen receptor subtype (HR, 0.52; 95% CI, 0.31–0.85; P=0.0076); and MAGEB18 in mesenchymal stem-like breast cancer subtype (HR, 0.19; 95% CI, 0.05–0.66; P=0.0039) were significantly associated with improved RFS. High expression levels of MAGEA5 in the basal-like 1 subtype (HR, 0.60; 95% CI, 0.37–0.96; P=0.0327); MAGEB6 (HR, 0.43; 95% CI, 0.19–0.97; P=0.0356), MAGED2 (HR, 0.46; 95% CI, 0.23–0.95; P=0.0308), MAGEE1 (HR, 0.25; 95% CI, 0.07–0.85; P=0.0160), MAGEF1 (HR 0.33; 95% CI, 0.14–0.81; P=0.0110) in the basal-like 2 subtype; MAGEB6 (HR, 0.41; 95% CI, 0.17–0.96; P=0.0333) in the immunomodulatory subtype; MAGEA8 (HR, 0.60; 95% CI, 0.38–0.95; P=0.0268), MAGEB6 (HR, 0.47; 95% CI, 0.24–0.89; P=0.0181), MAGEL2 (HR, 0.62; 95% CI, 0.39–0.99; P=0.0433) in the mesenchymal subtype; MAGEA8 (HR, 0.41; 95% CI, 0.18–0.93; P=0.0280), MAGEC3 (HR, 0.32; 95% CI, 0.12–0.85; P=0.0159), MAGEE2 (HR, 0.34; 95% CI, 0.12–0.97; P=0.0345), MAGEF1 (HR, 0.41; 95% CI, 0.18–0.94; P=0.0292) in the mesenchymal stem-like subtype; and MAGEA5 (HR, 0.62; 95% CI, 0.41–0.93; P=0.0195), MAGEB4 (HR, 0.64; 95% CI, 0.41–1.00; P=0.0471), MAGEF1 (HR, 0.61; 95% CI, 0.41–0.91; P=0.0158) and MAGEL2 (HR, 0.61; 95% CI, 0.41–0.93; P=0.0188) in the luminal androgen receptor breast cancer subtype were significantly associated with improved RFS. However, high mRNA expression levels of MAGEH1 (HR, 1.87; 95% CI, 1.16–3.02; P=0.0090) in the basal-like 1 subtype; MAGED3 (HR, 2.93; 95% CI, 1.34–6.39; P=0.0047) in the basal-like 2 subtype; MAGEA5 (HR, 1.81; 95% CI, 1.17–2.79; P=0.0066) in the mesenchymal subtype; and MAGEH1 (HR, 1.72; 95% CI, 1.15–2.59; P=0.0079) in the luminal androgen receptor breast cancer subtype were significantly associated with worse RFS. High mRNA expression levels of MAGED2 (HR, 1.68; 95% CI, 1.02–2.77; P=0.0386), MAGED4 (HR, 1.61; 95% CI, 1.00–2.59; P=0.0494) in the basal-like 1 subtype; MAGEB4 (HR, 2.74; 95% CI, 1.22–6.14; P=0.0106) and MAGEH1 (HR, 2.17; 95% CI, 1.06–4.40; P=0.0288) in the basal-like 2 subtype; MAGEB18 (HR, 2.39; 95% CI, 1.03–5.51; P=0.0353) and MAGEH1 (HR, 1.89; 95% CI, 1.05–3.42; P=0.0314) in the immunomodulatory subtype; MAGED3 (HR, 1.59; 95% CI, 1.04–2.43; P=0.0317), MAGEE1 (HR, 1.82; 95% CI, 1.06–3.15; P=0.0284) and MAGEH1 (HR, 1.56; 95% CI, 1.01–2.42; P=0.0421) in the mesenchymal subtype; MAGED4 (HR, 3.16; 95% CI, 0.94–10.56; P=0.0488) in the mesenchymal stem-like subtype; and MAGEB18 (HR, 2.04; 95% CI, 1.11–3.77; P=0.0211) and MAGED4 (HR, 1.59; 95% CI, 1.05–2.40; P=0.0267) in the luminal androgen receptor breast cancer subtype were significantly associated with worse RFS.

Table IV.

Association between the MAGE family members and different Pietenpol subtypes of patients with breast cancer.

Table IV.

Association between the MAGE family members and different Pietenpol subtypes of patients with breast cancer.

MAGE family memberAffymetrix IDPietenpol subtypeHR95% CIP-value
MAGEA5214642_atBasal-like 10.60a 0.37–0.96a0.0327a
Basal-like 21.710.84–3.460.1324
Immunomodulatory1.480.73–2.990.2723
Mesenchymal1.81b 1.17–2.79b0.0066b
Mesenchymal stem-like2.620.78–8.760.1041
Luminal androgen receptor0.62a 0.41–0.93a0.0195a
MAGEA8210274_atBasal-like 10.50a 0.31–0.83a0.0059a
Basal-like 21.510.75–3.060.2499
Immunomodulatory1.360.71–2.610.3555
Mesenchymal0.60a 0.38–0.95a0.0268a
Mesenchymal stem-like0.41a 0.18–0.93a0.0280a
Luminal androgen receptor0.52a 0.31–0.85a0.0076a
MAGEB4207580_atBasal-like 10.600.36–1.020.0550
Basal-like 22.74b 1.22–6.14b0.0106b
Immunomodulatory0.660.36–1.200.1708
Mesenchymal0.820.5–1.330.4204
Mesenchymal stem-like0.400.14–1.160.0794
Luminal androgen receptor0.64a 0.41–1.00a0.0471a
MAGEB61552858_atBasal-like 10.640.31–1.330.2293
Basal-like 20.43a 0.19–0.97a0.0356a
Immunomodulatory0.41a 0.17–0.96a0.0333a
Mesenchymal0.47a 0.24–0.89a0.0181a
Mesenchymal stem-like0.540.17–1.720.2907
Luminal androgen receptor0.580.33–1.020.0546
MAGEB181552913_atBasal-like 11.750.90–3.400.0922
Basal-like 20.510.22–1.180.1092
Immunomodulatory2.39b 1.03–5.51b0.0353b
Mesenchymal1.700.98–2.930.0543
Mesenchymal stem-like0.19a 0.05–0.66a0.0039a
Luminal androgen receptor2.04b 1.11–3.77b0.0211b
MAGEC3216592_atBasal-like 10.630.35–1.140.1255
Basal-like 20.550.27–1.120.0933
Immunomodulatory0.690.35–1.370.2890
Mesenchymal0.650.43–1.000.0505
Mesenchymal stem-like0.32a 0.12–0.85a0.0159a
Luminal androgen receptor0.730.47–1.120.1508
MAGED2213627_atBasal-like 11.68b 1.02–2.77b0.0386b
Basal-like 20.46a 0.23–0.95a0.0308a
Immunomodulatory1.340.72–2.490.3553
Mesenchymal1.430.83–2.460.1993
Mesenchymal stem-like0.600.27–1.320.2002
Luminal androgen receptor1.320.86–2.020.2000
MAGED3205028_atBasal-like 10.740.43–1.250.2584
Basal-like 22.93b 1.34–6.39b0.0047b
Immunomodulatory1.460.80–2.650.2138
Mesenchymal1.59b 1.04–2.43b0.0317b
Mesenchymal stem-like2.060.92–4.630.0729
Luminal androgen receptor0.700.47–1.050.0839
MAGED4221261_x_atBasal-like 11.61b 1.00–2.59b0.0494b
Basal-like 20.560.25–1.260.1558
Immunomodulatory0.640.34–1.180.1502
Mesenchymal0.800.51–1.260.3402
Mesenchymal stem-like3.16b 0.94–10.56b0.0488b
Luminal androgen receptor1.59b 1.05–2.40b0.0267b
MAGEE11556047_s_atBasal-like 11.740.90–3.370.0980
Basal-like 20.25a 0.07–0.85a0.0160a
Immunomodulatory0.410.12–1.370.1343
Mesenchymal1.82b 1.06–3.15b0.0284b
Mesenchymal stem-like0.410.15–1.130.0757
Luminal androgen receptor0.730.43–1.260.2576
MAGEE21553254_atBasal-like 10.580.27–1.260.1636
Basal-like 20.600.25–1.430.2440
Immunomodulatory1.910.82–4.410.1257
Mesenchymal0.720.39–1.300.2718
Mesenchymal stem-like0.34a 0.12–0.97a0.0345a
Luminal androgen receptor1.590.90–2.800.1067
MAGEF1218176_atBasal-like 10.750.46–1.230.2538
Basal-like 20.33a 0.14–0.81a0.0110a
Immunomodulatory0.570.32–1.040.0623
Mesenchymal1.670.98–2.840.0573
Mesenchymal stem-like0.41a 0.18–0.94a0.0292a
Luminal androgen receptor0.61a 0.41–0.91a0.0158a
MAGEH1218573_atBasal-like 11.87b 1.16–3.02b0.0090b
Basal-like 22.17b 1.06–4.40b0.0288b
Immunomodulatory1.89b 1.05–3.42b0.0314b
Mesenchymal1.56b 1.01–2.42b0.0421b
Mesenchymal stem-like0.560.23–1.360.1943
Luminal androgen receptor1.72b 1.15–2.59b0.0079b
MAGEL2219894_atBasal-like 11.550.96–2.490.0726
Basal-like 20.550.25–1.200.1258
Immunomodulatory1.630.82–3.250.1574
Mesenchymal0.62a 0.39–0.99a0.0433a
Mesenchymal stem-like1.500.67–3.330.3206
Luminal androgen receptor0.61a 0.41–0.93a0.0188a

{ label (or @symbol) needed for fn[@id='tfn10-ol-0-0-10722'] } P<0.05 was considered to indicate a statistically significant difference.

a High mRNA expression levels associated with improved RFS

b high mRNA expression levels associated with worse RFS. Total patients assigned a Pietenpol subtype (31), n=1,246; patients with the basal-like 1 subtype, n=239; patients with the basal-like 2 subtype, n=97; patients with the immunomodulatory subtype, n=290; patients with the mesenchymal subtype, n=229; patients with the mesenchymal stem-like subtype, n=115; patients with the luminal androgen receptor subtype, n=276. CI, confidence interval; HR, hazard ratio; MAGE, melanoma-associated antigen.

Discussion

Breast cancer, which is one of the most common malignant tumors, was the second leading cause of cancer-associated mortality among women worldwide in the year 2017 (1,2). MAGE gene family members have been demonstrated to be expressed in male germ line and placental cells, as well as in a number of different tumor types, including melanoma, brain, lung, prostate and breast cancer (31,32). The aberrant expression levels of the MAGE family members have been demonstrated to be associated with progressive disease; however, the mechanisms underlying how individual MAGE family members contribute to disease occurrence are largely unknown (33). In addition, to the best of our knowledge, many of these genes have not been reported in breast cancer.

In the present study, high mRNA expression levels of MAGEA5 were significantly associated with improved prognosis in luminal and basal-like breast cancer subtypes, and significantly associated with worse RFS in lymph node-positive breast cancer. In addition, high mRNA expression levels of MAGEA8 were significantly associated with improved prognosis in luminal and basal-like breast cancer subtypes, as well as HER2+ breast cancer. Previously, there have been few reports regarding the genes MAGEA5 and MAGEA8 in breast cancer, despite other members of the MAGEA family being investigated in this disease. Raghavendra et al (34) revealed that MAGEA1 is frequently expressed in triple-negative breast cancer, and Park et al (35) demonstrated that MAGEA2 promotes the progression of breast cancer by regulating the Akt and Erk1/2 pathways. Taylor et al (36) suggested that a vaccine that targets MAGEA10 may be of potential use in ≤70% of breast cancers. Abd-Elsalam and Ismaeil (37) reported that measuring the expression levels of the gene MAGEA1-A6 and MAGEA12 at the same time may aid in monitoring the effectiveness of breast cancer therapy. Through a comprehensive analysis, MAGEA5 and MAGEA8 were predicted to serve a protective role in the occurrence and development of breast cancer in the present study.

The administration of a MAGEB vaccination to elderly mice (20 months) leads to the absence of CD8 T-cell responses and reduced protection against metastatic breast cancer (38). In the present study, high mRNA expression levels of MAGEB4 and MAGEB6 were significantly associated with improved RFS in all breast cancer subtypes; high MAGEB6 expression was significantly associated with improved RFS in lymph node-negative, tumor grades I and III, but was also associated with worse RFS in TP53 wild-type breast cancer. High mRNA expression levels of MAGEB4 were significantly associated with improved RFS in TP53-mutated breast cancer, but also with worse RFS in grade I breast cancer. MAGEB18 was moderately associated with worse RFS in all breast cancer, and in immunomodulatory and luminal androgen receptor breast cancer subtypes. Previous studies have demonstrated that MAGEB4 may be a potential biomarker in patients with transitional cell carcinoma (39), and that it is specifically expressed during germ cell differentiation (40). The mRNA-positivity expression of MAGEB6 is associated with a poor prognosis in patients with head and neck squamous cell carcinoma (41), and the mouse MAGEB18 gene encodes a ubiquitously expressed type I MAGE protein, and regulates cell proliferation and apoptosis in melanoma B16-F0 cells (42). Overall, to the best of our knowledge, there are currently no published studies that demonstrate the function of the MAGE family members in breast cancer, and only a small number of studies that indicate their association with other diseases. Following a detailed database analysis, MAGEB18 was predicted to have a damaging effect on the occurrence and development of breast cancer in the present study. Despite the contrasting prognostic effects of MAGEB4 and MAGEB6 in the different types of breast cancer, it could be suggested that these two molecules are more likely to serve roles as tumor suppressor genes, according to the results from the present study. Further investigation is required to verify this suggestion.

MAGEC was also analyzed in the present study. It was revealed that high mRNA expression levels of MAGEC3 were significantly associated with improved RFS in luminal, basal, HER2+, tumor grade II and mesenchymal stem-like breast cancer subtypes. Eng et al (43) indicated that MAGEC3 may be associated with earlier onset of ovarian cancer. Bao et al (44) used a single-cell sample of >100 pairs of primary breast cancer and corresponding metastatic lymph node samples to perform whole exome and deep-target sequencing analyses, and revealed that MAGEC3 is associated with lymph node metastasis in patients with breast cancer. In the present study it was demonstrated that high mRNA expression levels of MAGEC3 were associated with worse RFS in lymph node-status (positive) breast cancer, but were also associated with improved RFS in lymph node-status (negative)breast cancer; however, these results were not statistically significant. These results provided further support for the hypothesis that MAGEC3 may promote cell metastasis in breast cancer, particularly lymph node metastasis.

High mRNA expression levels of MAGED2 and MAGED3 were significantly associated with improved RFS in all breast cancer. High mRNA expression levels of MAGED2 were significantly associated with improved RFS in lymph node-positive and -negative breast cancer, as well as in the basal-like 2 breast cancer subtype; in contrast, high mRNA expression levels of MAGED2 were associated with worse RFS in HER2+, all basal-like, TP53-mutated, tumor grade III and basal-like 1 breast cancer subtype; high mRNA expression levels of MAGED3 were significantly associated with improved RFS in luminal, lymph node-positive and TP53-mutated breast cancer, but also with worse RFS in basal-like 2 subtype, mesenchymal subtype and tumor grade III breast cancer. High mRNA expression levels of MAGED4 were significantly associated with worse RFS in lymph node-positive and -negative, TP53 wild-type, basal-like 1, mesenchymal stem-like, luminal androgen receptor breast cancer, and all breast cancer. A previous study revealed that MAGED2 is able to control cell cycle progression and modulate the DNA damage response (45), and that increased expression of MAGED2 is associated with nodal and hematogenous metastasis and is an independent prognostic factor for gastric cancer (26,46). Zhang et al (47) reported that MAGED4 is frequently and highly expressed in glioma, and is partly regulated by DNA methylation. Ma et al (48) reported that MAGED4 may be used as a specific antigen for non-small cell lung cancer to influence the improvement of diagnosis, prognosis and immunological therapy outcomes in patients with lung cancer. According to these data, it was predicted that MAGED4 may be a cancer-promoting gene in breast cancer; however, MAGED2 and MAGED3 may have different effects depending on the type of breast cancer.

High mRNA expression levels of MAGEE1 were significantly associated with improved RFS in grade I and basal-like 2 breast cancer, but also with worse RFS in grade III and mesenchymal breast cancer; high mRNA expression levels of MAGEE2 were significantly associated with improved RFS in basal, lymph node-negative and mesenchymal stem-like breast cancer, but also with worse RFS in TP53 wild-type breast cancer. MAGEE2 expression has been reported to be associated with poor OS in The Cancer Genome Atlas human breast cancer cohort (n=1,082) (49). In general, these findings indicated that MAGEE2 was closely associated with the occurrence and development of breast cancer, particularly in TP53 wild-type breast cancer. However, whether MAGEE2 can be used as a prognostic factor requires further investigation.

High mRNA expression levels of MAGEF1 were significantly associated with improved RFS in basal, lymph node-positive, grade II, basal-like 2, mesenchymal stem-like and luminal androgen receptor breast cancer, but also with worse RFS in lymph node-negative, TP53-mutated and TP53 wild-type breast cancer. Stone et al (50) demonstrated that MAGEF1 is ubiquitously expressed in normal tissues, as well as in melanoma, leukemia, ovarian and cervical tumor tissues and cell lines. It is possible, therefore, that the mechanism underlying MAGEF1 in these different types of breast cancer varies, but whether MAGEF1 can be used as a prognostic factor in TP53-mutated or wild-type patients requires further investigation.

Finally, high mRNA expression levels of MAGEH1 were significantly associated with worse RFS in luminal B, HER2+, basal, basal-like 1 and luminal androgen receptor breast cancer subtypes, but also with improved RFS in tumor grades I and II breast cancer. High mRNA expression levels of MAGEL2 were significantly associated with improved RFS in luminal A breast cancer subtypes, but also with worse RFS in tumor grade III breast cancer. Wang et al (51) demonstrated that MAGEH1 enhances hepatocellular carcinoma progression and serves as a biomarker for patient prognosis, whereas Ojima et al (52) revealed that negative expression (anti-MAGEH1) of the MAGEH1 protein serves as a potential predictive marker for the effectiveness of gemcitabine therapy in biliary tract carcinoma. These findings, while preliminary, suggested that MAGEH1 and MAGEL2 have effects in breast cancer patients with different pathological grades.

Despite obtaining a number of useful insights in the present study, there were some limitations. Firstly, the roles that the selected members of the MAGE family serve in breast cancer were demonstrated using bioinformatics analyses only. Secondly, the underlying molecular mechanisms were not identified. Thus, more in-depth investigations in vitro and in vivo are required in order to verify the conclusions drawn within the present study.

In summary, the prognostic value of the mRNA expression levels of 29 members of the MAGE family were analyzed in patients with breast cancer using the Kaplan-Meier plotter database. Through searching PubMed and other database, among these 29 members, 14 members were significantly associated with the prognosis of patients with breast cancer. Further investigation regarding the prognostic values of the MAGE family members in breast cancer with different clinical features suggested that MAGEA5, MAGEA8, MAGEB4 and MAGEB6 may have protective roles in the occurrence and development of breast cancer, whereas MAGEB18 and MAGED4 may possess carcinogenic effects. MAGED2, MAGED3 and MAGEF1 incur different effects depending on the type of breast cancer. It is worth noting that MAGEC3 may promote cell metastasis in breast cancer, particularly lymph node metastasis. Whether MAGEE2, MAGEH1 and MAGEL2 may be used as prognostic factors in TP53 wild-type breast cancer, as well as in the different pathological grades of breast cancer requires further study.

The present study provided novel insights regarding the contribution of the MAGE family members to breast cancer progression and may aid in the discovery of MAGE-target inhibitors for treating breast cancer.

Supplementary Material

Supporting Data

Acknowledgements

Not applicable.

Funding

The present study was funded by Beijing Dongcheng District Excellent Talents Training Project (grant no. 2014080536381G064).

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Authors' contributions

BJ and YW conceived and designed the study. JW and YYW managed and maintained research data for initial and future use, and applied statistical, mathematical, compu-tational, and other techniques to analyze or synthesize research data. BJ, XZ and YY prepared figures and tables, interpreted the data and wrote the manuscript. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Not applicable.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Glossary

Abbreviations

Abbreviations:

MAGE

melanoma-associated antigen

GEO

Gene Expression Omnibus

RFS

relapse-free survival

OS

overall survival

DMFS

distant metastasis-free survival

PPS

post-progression survival

HR

hazard ratio

CI

confidence interval

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October 2019
Volume 18 Issue 4

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Online ISSN:1792-1082

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APA
Jia, B., Zhao, X., Wang, Y., Wang, J., Wang, Y., & Yang, Y. (2019). Prognostic roles of MAGE family members in breast cancer based on KM‑Plotter Data. Oncology Letters, 18, 3501-3516. https://doi.org/10.3892/ol.2019.10722
MLA
Jia, B., Zhao, X., Wang, Y., Wang, J., Wang, Y., Yang, Y."Prognostic roles of MAGE family members in breast cancer based on KM‑Plotter Data". Oncology Letters 18.4 (2019): 3501-3516.
Chicago
Jia, B., Zhao, X., Wang, Y., Wang, J., Wang, Y., Yang, Y."Prognostic roles of MAGE family members in breast cancer based on KM‑Plotter Data". Oncology Letters 18, no. 4 (2019): 3501-3516. https://doi.org/10.3892/ol.2019.10722