DOI QR코드

DOI QR Code

Clinico-Pathologic Subtypes of Breast Cancer Primary Tumors Are Related to Prognosis after Recurrence

  • Sanchez, Cesar (Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Camus, Mauricio (Department of Surgery, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Medina, Lidia (Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Oddo, David (Department of Pathology, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Artigas, Rocio (Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Sepulveda, Alejandra Perez (Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Domainguez, Francisco (Department of Surgery, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Razmilic, Dravna (Department of Radiology School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Navarro, Maria Elena (Department of Radiology School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Galindo, Hector (Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Catolica de Chile) ;
  • Acevedo, Francisco (Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Catolica de Chile)
  • Published : 2016.12.01

Abstract

Background: Pathological factors, based mainly on immunohistochemistry (IHC) and histological differentiation, are mostly used to differentiate breast cancer (BC) subtypes. Our present aim was to describe the characteristics and survival of a relapsing BC patient cohort based on clinico-pathologic subtypes determined for the primary tumors. Methods: We used a clinico- pathological definition of BC subtypes based on histological grade (HG), estrogen receptor (ER), progesterone receptor (PgR),and epidermal growth factor receptor type 2 (HER2) expression assessed by IHC. We determined variables associated with loco-regional recurrence (LRR), second primaries (SP), systemic recurrence (SR) and post-recurrence survival (PRS). Results: Out of 1,702 patients, 240 (14%) had an event defined as recurrence. Those with recurrent disease were significantly younger than those without,and were initially diagnosed at more advanced stages, with larger tumors, greater lymph nodal involvement and higher HG. With a median follow up of 61 months (1-250), 4.6% of patients without recurrence and 56.6% of patients with an event defined as recurrence had died. The median PRS for the LRR group was 77 months; 75 months for those who developed a SP and 22 months for patients with an SR (p <0.0001). In SR cases, the median PRS was shorter for ER- tumors than for ER+ tumors (15 vs. 26 months, respectively; p = 0.0019, HR 0.44; CI: 0.25-0.44). Conclusions: Subtype, defined through classic histopathologic parameters determined for primary tumors, was found to eb related to type of recurrence and also to prognosis after relapse.

Keywords

References

  1. Acevedo F, Camus M, Sanchez C (2015). Breast Cancer at Extreme Ages - a Comparative Analysis in Chile. Asian Pac J Cancer Prev, 16, 1455-61. https://doi.org/10.7314/APJCP.2015.16.4.1455
  2. Cardoso F, Costa A, Norton L, et al (2014). ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2). Ann Oncol, 25, 1871-88. https://doi.org/10.1093/annonc/mdu385
  3. Cuzick J, Dowsett M, Pineda S, et al (2011). Prognostic value of a combined estrogen receptor, progesterone receptor, Ki-67, and human epidermal growth factor receptor 2 immunohistochemical score and comparison with the Genomic Health recurrence score in early breast cancer. J Clin Oncol, 29, 4273-8. https://doi.org/10.1200/JCO.2010.31.2835
  4. Dowsett M, Sestak I, Lopez-Knowles E, et al (2013). Comparison of PAM50 risk of recurrence score with oncotype DX and IHC4 for predicting risk of distant recurrence after endocrine therapy. J Clin Oncol, 31, 2783-90. https://doi.org/10.1200/JCO.2012.46.1558
  5. Edge SB, Compton CC (2010). The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 17, 1471-4. https://doi.org/10.1245/s10434-010-0985-4
  6. Elston CW, Ellis IO (2002) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term followup. Histopathology, 41, 151-2. https://doi.org/10.1046/j.1365-2559.2002.14691.x
  7. Goldhirsch A, Winer EP, Coates AS, et al (2013). Personalizing the treatment of women with early breast cancer: highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2013. Ann Oncol, 24, 2206-23. https://doi.org/10.1093/annonc/mdt303
  8. Hammond MEH, Hayes DF, Dowsett M, et al (2010). American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol, 28, 2784-95. https://doi.org/10.1200/JCO.2009.25.6529
  9. Harris LN, Ismaila N, McShane LM, et al (2016). Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American society of clinical oncology clinical practice guideline. J Clin Oncol, 34, 1134-50 https://doi.org/10.1200/JCO.2015.65.2289
  10. Jonat W, Arnold N (2011). Is the Ki-67 labelling index ready for clinical use?. Ann Oncol, 22, 500-2. https://doi.org/10.1093/annonc/mdq732
  11. Kennecke H, Yerushalmi R, Woods R, et al (2010). Metastatic behavior of breast cancer subtypes. J Clin Oncol, 28, 3271-7. https://doi.org/10.1200/JCO.2009.25.9820
  12. Pathmanathan N, Balleine RL (2013). Ki67 and proliferation in breast cancer. J Clin Pathol, 66, 512-6. https://doi.org/10.1136/jclinpath-2012-201085
  13. Petric M, Martinez S, Acevedo F, et al (2014). Correlation between Ki67 and histological grade in breast cancer patients treated with preoperative chemotherapy. Asian Pac J Cancer Prev, 15, 10277-80.
  14. Sestak I, Cuzick J, Dowsett M, et al (2015). Prediction of late distant recurrence after 5 years of endocrine treatment: A combined analysis of patients from the Austrian breast and colorectal cancer study group 8 and arimidex, tamoxifen alone or in combination randomized trials using the PAM50 risk. J Clin Oncol, 33, 916-22. https://doi.org/10.1200/JCO.2014.55.6894
  15. Shim HJ, Kim SH, Kang BJ, et al (2014). Breast cancer recurrence according to molecular subtype. Asian Pac J Cancer Prev, 15, 5539-44. https://doi.org/10.7314/APJCP.2014.15.14.5539
  16. Sparano JA, Gray RJ, Makower DF, et al (2015). Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med, 373, 2005-14 https://doi.org/10.1056/NEJMoa1510764
  17. Turner N, Biganzoli L, Malorni L, et al (2013). Adjuvant chemotherapy: which patient? what regimen? Am Soc Clin Oncol Educ Book, 33, 3-8 https://doi.org/10.1200/EdBook_AM.2013.33.3
  18. Wolff AC, Hammond MEH, Hicks DG, et al (2013). Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American society of clinical oncology/college of American pathologists clinical practice guideline update. J Clin Oncol, 31, 3997-4013. https://doi.org/10.1200/JCO.2013.50.9984
  19. Zelnak AB, O'Regan RM (2013). Genomic subtypes in choosing adjuvant therapy for breast cancer. Oncology, 27, 204-10.