Breast Cancer Subtypes Identified by the ER, PR and HER-2 Status in Thai Women

  • Chuthapisith, Suebwong (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Permsapaya, Watthanasak (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Warnnissorn, Malee (Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Akewanlop, Charuwan (Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Sirivatanauksorn, Vorapan (Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Osoth, Poramaporn Prasarttong (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University)
  • Published : 2012.02.29


Expression of estrogen-receptor (ER), progesterone-receptor (PR) and HER-2 has recently been linked with various breast cancer subtypes identified by gene microarray. This study aimed to document breast cancer subtypes based on ER, PR and HER-2 status in Thai women, where expression of these subtypes may not be similar to those evident in Western women. During 2009 to 2010, histological findings from 324 invasive ductal carcinomas (IDC) at Siriraj Hospital were studied. Various subtypes of IDC were identified according to expression of ER, PR and HER-2: luminal-A (ER+;PR+/-;HER-2-), luminal-B (ER+;PR+/-;HER-2 +), HER-2 (ER-;PR- ;HER-2+) and basal-like (ER-;PR-;HER-2-). As well, associations of tumor size, tumor grade, nodal status, angiolymphatic invasion (ALI), multicentricity and multifocality with different breast cancer subtypes were studied. Of 324 IDCs, 143 (44.1%), 147 (45.4%), 15 (4.6%) and 12 (3.7%) were T1, T2, T3 and T4, respectively. Most tumors were grade 2 (54.9%) and had no nodal involvement (53.4%). According to ER, PR and HER-2 status, 192 (59.3%), 40 (12.3%), 43 (13.3%) and 49 (15.1%) tumors were luminal-A, luminal-B, HER-2 and basal-like subtypes. HER-2 subtype presented with large tumor (p=0.04, ANOVA). Luminal-A IDC was associated with single foci (p<0.01, ${\chi}^2$). HER-2 and basal-like subtypes were likely to have high tumor grade (p<0.01, ${\chi}^2$). In addition, HER-2 subtype had higher number of nodal involvement (p=0.048, ${\chi}^2$). In conclusion, the luminal-A subtype accounted for the majority of IDCs in Thai women. Percentages of HER-2 and basal-like IDCs were high, compared with a recent study from the USA. The HER-2 subtype was related with high nodal invasion. The findings may highlight biological differences between IDCs occurring in Asian and Western women.


Breast cancer subtype;ER;PR;HER 2;Thai cases


  1. Carey LA, Perou CM, Livasy CA, et al (2006). Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA, 295, 2492-502.
  2. Goldhirsch A, Ingle JN, Gelber RD, et al (2009). Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009. Ann Oncol, 20, 1319-29.
  3. Goldhirsch A, Wood WC, Coates AS, et al (2011). Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol, 22, 1736-47.
  4. Hudis CA, Gianni L (2011). Triple-negative breast cancer: an unmet medical need. Oncologist, 16, 1-11.
  5. Ihemelandu CU, Naab TJ, Mezghebe HM, et al (2008). Treatment and survival outcome for molecular breast cancer subtypes in black women. Ann Surg, 247, 463-9.
  6. Kostopoulou E, Vageli D, Kaisaridou D, et al (2007) Comparative evaluation of non-informative HER-2 immunoreactions (2+) in breast carcinomas with FISH, CISH and QRT-PCR. Breast, 16, 615-24.
  7. Kyndi M, Sorensen FB, Knudsen H, et al (2008). Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group. J Clin Oncol, 26, 1419-26.
  8. Nguyen PL, Taghian AG, Katz MS, et al (2008). 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, 26, 2373-8.
  9. Sorlie T, Perou CM, Tibshirani R, et al (2001). Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA, 98, 10869-74.
  10. Sorlie T, Tibshirani R, Parker J, et al (2003). Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA, 100, 8418-23.
  11. Sotiriou C, Neo SY, McShane LM, et al (2003). Breast cancer classification and prognosis based on gene expression profiles from a population-based study. Proc Natl Acad Sci USA, 100, 10393-8.
  12. Voduc KD, Cheang MC, Tyldesley S, et al (2010). Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol, 28, 1684-91.
  13. Wiechmann L, Sampson M, Stempel M, et al (2009). Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol, 16, 2705-10.

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