Prognostic value of breast cancer subtypes on breast cancer specific survival, distant metastases and local relapse rates in conservatively managed early stage breast cancer: A retrospective clinical study
Introduction
Over the past few years, with the advent of modern diagnostic molecular technologies, breast cancer has not been considered a single disease, but a “wide range” of diseases.1 Gene profiling has determined a new classification of breast cancers2, 3 which correlates with breast cancer behaviors and different clinical outcomes.4, 5 Gene profiling, however, does not seem to be used in all facilities. An alternative way could be to evaluate known biomarkers and to combine them to obtain an approximate sub-classification of breast cancers,6, 7 useful to clinicians for treatment decisions. The aim of this retrospective study is to determine if the classification of breast cancer as subtypes correlates with clinical outcomes as breast cancer specific survival (BCSS) rates, distant metastases (DM) rates and local relapse (LR) rates. This is based on known biological markers as estrogen and progesterone receptors (ER and PR respectively) and HER2 status.
Section snippets
Patients and methods
All medical records of women treated between January 2000 and December 2008 were reviewed and 774 out of 1034 patients (74.8%) with early breast (pT1-2 N0-2) cancer resulted eligible for this study. Information was collected about age, tumor histology, tumor size, surgical margins, axillary node status, tumor grade, adjuvant therapy, estrogen and progesterone receptor status and HER2 status. Patients submitted to mastectomy, lost to follow up or with incomplete data were excluded (260 pts,
BCSS, DM and LR rates based on patient characteristics
Median age was 55.0 years old (range 27–80) and median follow up time of 59.0 months (range 13.6–109.7). Association between biological subtypes and other patient characteristics varied with age (P = 0.005), with tumor grade (P < 0.0001) and with adjuvant therapy (P < 0.0001). During follow up we registered 125 distant metastases, 93 deaths and 26 breast relapses. Taking into account all patients, mean 5-year BCSS, DM and LR rates were 82.9%, 18.7% and 4.4% respectively. 5-year BCSS rates, stratified
ER and PR status and BCSS and DM rates
Our results show that breast cancer subtypes distribution varies significantly with age (P = 0.005), with tumor grade (P < 0.0001) and with adjuvant therapy (P < 0.0001), but not in terms of axillary node status (P = 0.54), which has also been described by other authors,8 maybe due to an equally pattern of dissemination to lymphatics of the four subtypes.9 There was no difference in the distribution of subtypes in terms of tumor size, as reported by some authors.9 This study seems to evidence a
Conclusions
In this retrospective study, we demonstrated a variability in BCSS and DM rates among the four subtypes. New technologies allow, nowadays, gene profiling of breast cancer: nevertheless, clinicians, in their daily practice, have to make decisions on how to treat patients based on classic prognostic factors. An important question is whether a “surrogate” classification, instead of gene profiling, is corrected to classify breast tumors: the answer should come out from randomized trials that could
Conflict of interest statement
All authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) this work.
Funding source
All authors participated in the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript; and in the decision to submit the manuscript for publication. Any study sponsors had involvement in this manuscript.
Acknowledgments
The authors thank Dr. Michela Fabrocini and Dr. Loreta Sanpaolo for reviewing the whole manuscript and Reviewers for their helpful comments.
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