DOI QR코드

DOI QR Code

Survival Time and Molecular Subtypes of Breast Cancer after Radiotherapy in Thailand

  • Kongsiang, Apichat (Department of Epidemiology, Faculty of Public Health, Khon Kaen University) ;
  • Tangvoraphonkchai, Vorachai (Department of Radiology, Faculty of Medicine, Khon Kaen University) ;
  • Jirapornkul, Chananya (Department of Epidemiology, Faculty of Public Health, Khon Kaen University) ;
  • Promthet, Supannee (Department of Epidemiology, Faculty of Public Health, Khon Kaen University) ;
  • Kamsa-ard, Siriporn (Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University) ;
  • Suwanrungruang, Krittika (Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University)
  • Published : 2015.01.06

Abstract

Background: Breast cancer is an important cause of death among women. One way of classifying different forms of breast cancer is by molecular features, usually in terms of the four subtypes: luminal A, luminal B, HER2-enriched, and triple negative. Objectives: This study aimed to investigate the association between molecular subtypes and survival among breast cancer patients treated with radiotherapy. Materials and Methods: A retrospective cohort study was conducted. The subjects were 272 breast cancer patients who had received treatment in the radiotherapy unit at Srinagarind Hospital, Thailand, between 1 January, 1999, and 31 May, 2009. The end of the study was 1 June, 2014. Overall survival was defined as the time elapsing between initial registration at the radiotherapy unit and death or the end of the study. Survival curves were estimated by the Kaplan-Meier method, and a multivariate analysis was performed using Cox's proportional hazard regression model. Results: The patient mean age was $47.5{\pm}10.4$ at the time of diagnosis. Of the 272 patients, 146 (53.7%) were classified as luminal A, 12 (4.4%) as luminal B, 30 (11.0%) as HER2-enriched, and 84 (30.9%) as triple negative. The overall survival rates at 1, 3 and 5 years were 87.1%, 68.4% and 59.2%, respectively. According to molecular subtypes, HER2-enriched patients had the lowest 5-year survival rate (30.0 %, 95%CI: 15.02-46.55). The median follow-up time was 8.37 years. In the Cox model analysis a higher risk of death was found for patients with HER2-enriched ($HR_{adj}=3.34$, 95%CI:1.96-5.67), triple negative ($HR_{adj}=2.17$, 95%CI: 1.44-3.27), and stage IIlB ($HR_{adj}=2.20$, 95%CI: 1.16-4.17) cancers. Conclusions: The worst survival rates were among patients classified as HER2-enriched, triple negative and at stage IIIB. Early detection and an advanced treatment modality are needed to help these patients.

Keywords

Breast cancer;survival;molecular subtypes;radiotherapy

Acknowledgement

Supported by : Khon Kaen University

References

  1. Phipps A, Li C (2010). Breast cancer biology and clinical characteristics. In 'Breast Cancer Epidemiology', Eds Springer New York, 21-46
  2. Poum A, Kamsa-ard S, Promthet S (2012). Survival rates of breast cancer: a hospital-based study from northeast of Thailand. Asian Pac J Cancer Prev, 13, 791-4. https://doi.org/10.7314/APJCP.2012.13.3.791
  3. Sriamporn S, Black R, Sankaranarayanan R,et al (1995). Cancer survival in Khon Kaen province, Thailand. Int J Cancer, 61, 296-300. https://doi.org/10.1002/ijc.2910610303
  4. StataCorp LP (2007). Stata Release 10: User's guide. College Station TX: Stata Press.
  5. Suwanrungruang K, Vatanasapt P, Kamsa-Ard S, et al (2011). Cancer survival in Khon Kaen, Thailand, 1993-1997. IARC SciPubl, 162, 211-6
  6. Vatanasapt V, Martin N, Sriplung H,et al (1995). Cancer incidence in Thailand 1988-1991. Cancer Epidemiol, Biomarkers Prev, 4, 475-483.
  7. Karimi A, Delpisheh A, Sayehmiri K, Saboori H, Rahimi E (2014). Predictive factors of survival time of breast cancer in kurdistan province of Iran between 2006-2014: A Cox Regression Approach. Asian Pac J Cancer Prev, 15, 8483-8. https://doi.org/10.7314/APJCP.2014.15.19.8483
  8. Khuhaprema T, Attasara P, Sriplung H, et al (2012). Cancer in Thailand VI 2004-2006, Bangkok, National Cancer Institute.
  9. Abdullah NA, Wan Mahiyuddin WR, Muhammad NA, et al (2013). survival rate of breast cancer patients In Malaysia: a population-based study. Asian Pac J Cancer Prev, 14, 4591-4. https://doi.org/10.7314/APJCP.2013.14.8.4591
  10. Chae YK, Gonzales-Angulo AM (2014). Implications of functional proteomics in breast cancer. The Oncologist, 19, 328-35 https://doi.org/10.1634/theoncologist.2013-0437
  11. Minicozzi P, Bella F, Toss A, et al (2013). Relative and diseasefree survival for breast cancer in relation to subtype: a population-based study. J Cancer Research Clinical Oncol, 139,1569-77. https://doi.org/10.1007/s00432-013-1478-1
  12. Parise CA, Bauer KR, Brown MM, et al (2009). 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. The Breast J, 15, 593-602. https://doi.org/10.1111/j.1524-4741.2009.00822.x
  13. Parise CA, Caggiano V (2014). Breast cancer survival defined by the ER/PR/HER2 subtypes and a surrogate classification according to tumor grade and immunohistochemical biomarkers. J Cancer Epidemiology, 2014, 1-11.
  14. Park S, Koo JS, Kim MS, et al (2012). Characteristics and outcomes according to molecular subtypes of breast cancer as classified by a panel of four biomarkers using immunohistochemistry. Breast, 21, 50-7. https://doi.org/10.1016/j.breast.2011.07.008
  15. Petrelli F, Barni S (2012). Role of HER2-neu as a prognostic factor for survival and relapse in pT1a-bN0M0 breast cancer: a systematic review of the literature with a pooledanalysis. Medical Oncology, 29, 2586-93. https://doi.org/10.1007/s12032-012-0201-4
  16. Wirasorn K, Suwanrungruag K, Wiangnon S, et al (2014). Numbers of new cases and trends of cancer 1993-2012: Srinagarind hospital based population, KhonKaen, North East Thailand. Asian Pac J Cancer Prev, 15, 8423-7. https://doi.org/10.7314/APJCP.2014.15.19.8423
  17. Wong FY, Chin FK, Lee KA, Soong YL, Chua ET. (2011). Hormone receptors and HER2 status as surrogates for breast cancer molecular subtypes prognosticate for disease control in node negative Asian patients treated with breast conservation therapy. Ann Acad Med Singapore, 40, 90-6.
  18. Ziaei JE SZ, Asvadi I, Dastgiri S, Pourzand A, Vaez J. (2013). Survival analysis of breast cancer patients in northwest Iran. Asian Pac J Cancer Prev, 14, 39-42. https://doi.org/10.7314/APJCP.2013.14.1.39
  19. Cheang MCU, Chia SK, Voduc D, et al (2009). Ki67 Index, HER2 status, and prognosis of patients with luminal B breast cancer. J National Cancer Inst, 101, 736-50. https://doi.org/10.1093/jnci/djp082
  20. Chuangsuwanich T, Pongpruttipan T, O-Charoenrat P, et al (2014). Clinicopathologic features of breast carcinomas classified by biomarkers and correlation with microvessel density and VEGF expression: a study from Thailand. Asian Pac J Cancer Prev, 15, 1187-92. https://doi.org/10.7314/APJCP.2014.15.3.1187
  21. Chuthapisith S, Permsapaya W, Warnnissorn M, et al (2012). Breast cancer subtypes identified by the ER, PR and HER2 status in Thai women. Asian Pac J Cancer Prev, 13, 459-62 https://doi.org/10.7314/APJCP.2012.13.2.459
  22. Dedes K, Wilkerson P, Reis-Filho J (2011). Immunohistochemistry and molecular biology of breast cancers: old and new prognostic factors. In 'Breast Cancer, a Heterogeneous Disease Entity', Eds Springer Netherlands, 119-48
  23. Engstrøm MJ, Opdahl S, Hagen AI, et al (2013). Molecular subtypes, histopathological grade and survival in a historic cohort of breast cancer patients. Breast Cancer Research and Treatment, 140, 463-73. https://doi.org/10.1007/s10549-013-2647-2
  24. Ferlay J, Soerjomataram I, Ervik M, et al (2013).GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International agency for research on cancer.
  25. Fritz A. G. (2000). International Classification of diseases for oncology: ICD-O-3, Geneva, Switzerland, World Health Organization.
  26. Ihemelandu CU, Naab TJ, Mezghebe HM, et al (2008). Treatment and survival outcome for molecular breast cancer subtypes in black women. Annals of Surgery, 247,463-9. https://doi.org/10.1097/SLA.0b013e31815d744a
  27. Jung H, Park Y, Kim M, et al (2014). Prognostic relevance of biological subtype overrides that of TNM staging in breast cancer: discordance between stage and biology. Tumor Biology, 1-7.

Cited by

  1. Effect of Ki-67 on Immunohistochemical Classification of Luminal A to Luminal B Subtypes of Breast Carcinoma vol.21, pp.5, 2015, https://doi.org/10.1111/tbj.12441
  2. BMI, reproductive factors, and breast cancer molecular subtypes: A case-control study and meta-analysis vol.27, pp.4, 2017, https://doi.org/10.1016/j.je.2016.05.002
  3. Novel recombinant protein FlaA N/C increases tumor radiosensitivity via NF-κB signaling in murine breast cancer cells vol.12, pp.4, 2016, https://doi.org/10.3892/ol.2016.4957