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

doi:10.1016/j.ejso.2011.07.001

European Journal of Surgical Oncology (EJSO)

Volume 37, Issue 10, October 2011, Pages 876-882

https://doi.org/10.1016/j.ejso.2011.07.001 Get rights and content

Abstract

Aim

To ascertain if breast cancer subtypes had prognostic effect on breast cancer specific survival, distant metastases and local relapse rates in women affected by early stage breast cancer.

Patients and methods

Data of 774 patients affected by early stage breast cancer and treated with breast-conserving therapy were reviewed. Patients were grouped, based on steroid receptor status and HER2 status as: Luminal A (ER+/PR+/HER2−), Luminal B (ER+/PR+/HER2+), Basal-like (ER−/PR−/HER2−) and HER2 (ER−/PR−/HER2+). Distribution of variables among subtypes was evaluated with Pearson’s test. Survival rates were calculated with life tables; Cox regression stepwise method was used to identify predictive variables of survival.

Results

Median age was 55.0 years old (range 27–80) and median follow up time of 59.0 months (range 13.6–109.7). Breast cancer specific survival and distant metastases rates were different among breast cancer subtypes (both outcomes P = 0.00001) but there was no difference regarding local relapse rates (P = 0.07). Axillary nodes status (P = 0.00001), adjuvant therapy (P = 0.03) and breast cancer subtypes (P = 0.03) resulted prognostic factors of breast cancer specific survival; axillary node status (P = 0.00001) and breast cancer subtypes (P = 0.00001) had an impact on distant metastases. Age (P = 0.003), tumor size (P = 0.0001), positive or close surgical margin (P = 0.00001) and tumor grade 3 (P = 0.049) resulted prognostic factors of local relapse.

Conclusions

In our study, breast cancer subtype seems a prognostic factor of breast cancer specific survival and distant metastases rates, but not of local relapse rate. Patients could be submitted to conservative surgery, if feasible, but considering the differences in survivals, patients with worse prognosis should receive more aggressive adjuvant treatments.

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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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

Abstract

Aim

Patients and methods

Results

Conclusions

Introduction

Section snippets

Patients and methods

BCSS, DM and LR rates based on patient characteristics

ER and PR status and BCSS and DM rates

Conclusions

Conflict of interest statement

Funding source

Acknowledgments

Human Pathol

Radiother Oncol

Eur J Surg Oncol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Molecular profiling of breast cancer: clinical implications

Br J Cancer

Repeated observation of breast tumor subtypes in independent gene expression data sets

Proc Natl Acad Sci U S A

Breast cancer revisited DNA array-based gene expression profiling

Int J Cancer

Breast cancer subtypes as defined by the estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) among women with invasive breast cancer in California, 1999–2004

Breast J

Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy

J Clin Oncol

Protein expression profiling identifies subclasses of breast cancer and predicts prognosis

Cancer Res

Molecular classification of breast carcinomas using tissue microarrays

Diagn Mol Pathol

Intrinsic molecular signature of breast cancer in a population-based cohort of 412 patients

Breast Cancer Res