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Triple-negative, basal-like, and quintuple-negative breast cancers: better prediction model for survival.

Choi YL, Oh E, Park S, Kim Y, Park YH, Song K, Cho EY, Hong YC, Choi JS, Lee JE, Kim JH, Nam SJ, Im YH, Yang JH, Shin YK - BMC Cancer (2010)

Bottom Line: The results of this study showed that both TNBCs and BLBCs were associated with high histological and/or nuclear grades.After multivariate analysis of TNBCs, the BLBCs did not have a worse prognosis than the QNBC/5NPs.Interestingly, the patients with BLBCs showed significant adjuvant chemotherapy benefit.

View Article: PubMed Central - HTML - PubMed

Affiliation: Laboratory of Cancer Genomics and Molecular Pathology, Samsung Medical Center, Seoul, Korea.

ABSTRACT

Background: Triple-negative breast cancers (TNBCs) and basal-like breast cancers (BLBCs) are known as poor outcome subtypes with a lack of targeted therapy. Previous studies have shown conflicting results regarding the difference of prognostic significance between TNBCs and BLBCs. In this study, we aimed to characterize the prognostic features of TNBCs, in view of BLBCs and quintuple-negative breast cancers (QNBC/5NPs).

Methods: Using tissue microarray-based immunohistochemical analysis, we categorized 951 primary breast cancers into four or five subtypes according to the expression of ER, PR, HER2, and basal markers (CK5/6, EGFR).

Results: The results of this study showed that both TNBCs and BLBCs were associated with high histological and/or nuclear grades. When the TNBCs are divided into two subtypes by the presence of basal markers, the clinicopathologic characteristics of TNBCs were mainly maintained in the BLBCs. The 5-subgrouping was the better prediction model for both disease free and overall survival in breast cancers than the 4-subgrouping. After multivariate analysis of TNBCs, the BLBCs did not have a worse prognosis than the QNBC/5NPs. Interestingly, the patients with BLBCs showed significant adjuvant chemotherapy benefit. In addition, QNBC/5NPs comprised about 6~8% of breast cancers in publicly available breast cancer datasets

Conclusion: The QNBC/5NP subtype is a worse prognostic subgroup of TNBCs, especially in higher stage and this result may be related to adjuvant chemotherapy benefit of BLBCs, calling for caution in the identification of subgroups of patients for therapeutic classification.

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Related in: MedlinePlus

Association between chemotherapy and four-subtypes of breast cancers. Kaplan-Meier curves of disease-free survival (A and C) and overall survival (B and D). Cases without chemotherapy (A and B) and with chemotherapy (C and D) (Estimated mean survival with 95% CI). *P < 0.001, **P = 0.027
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Figure 2: Association between chemotherapy and four-subtypes of breast cancers. Kaplan-Meier curves of disease-free survival (A and C) and overall survival (B and D). Cases without chemotherapy (A and B) and with chemotherapy (C and D) (Estimated mean survival with 95% CI). *P < 0.001, **P = 0.027

Mentions: When the patients were divided into two groups depending on the adjuvant chemotherapy, the survival analysis revealed that patients with luminal B and TNBCs had overall survival benefit from chemotherapy (P < 0.001 for luminal B, P = 0.027 for TNBCs) (Figure 2). From the five-subtype analysis, the BLBCs without adjuvant chemotherapy had a shortest DFS and OS showing dramatic survival gain after chemotherapy (P = 0.001 for DFS, P < 0.001 for OS) (Figure 3). On the other hand, QNBC/5NP did not show chemotherapy benefit in both DFS and OS. However, this was difficult to interpret due to small numbers etc (only 1 event in the QNBC/5NP group) (Figure 3). Furthermore, multivariate analysis of BLBC patients for DFS and OS including tumor size and lymph node involvement confirmed survival gain of adjuvant chemotherapy (Table 6). The survival gain with anthracycline-based and non-anthracycline-based adjuvant chemotherapy did not show statistical difference in BLBCs (data not shown).


Triple-negative, basal-like, and quintuple-negative breast cancers: better prediction model for survival.

Choi YL, Oh E, Park S, Kim Y, Park YH, Song K, Cho EY, Hong YC, Choi JS, Lee JE, Kim JH, Nam SJ, Im YH, Yang JH, Shin YK - BMC Cancer (2010)

Association between chemotherapy and four-subtypes of breast cancers. Kaplan-Meier curves of disease-free survival (A and C) and overall survival (B and D). Cases without chemotherapy (A and B) and with chemotherapy (C and D) (Estimated mean survival with 95% CI). *P < 0.001, **P = 0.027
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2957395&req=5

Figure 2: Association between chemotherapy and four-subtypes of breast cancers. Kaplan-Meier curves of disease-free survival (A and C) and overall survival (B and D). Cases without chemotherapy (A and B) and with chemotherapy (C and D) (Estimated mean survival with 95% CI). *P < 0.001, **P = 0.027
Mentions: When the patients were divided into two groups depending on the adjuvant chemotherapy, the survival analysis revealed that patients with luminal B and TNBCs had overall survival benefit from chemotherapy (P < 0.001 for luminal B, P = 0.027 for TNBCs) (Figure 2). From the five-subtype analysis, the BLBCs without adjuvant chemotherapy had a shortest DFS and OS showing dramatic survival gain after chemotherapy (P = 0.001 for DFS, P < 0.001 for OS) (Figure 3). On the other hand, QNBC/5NP did not show chemotherapy benefit in both DFS and OS. However, this was difficult to interpret due to small numbers etc (only 1 event in the QNBC/5NP group) (Figure 3). Furthermore, multivariate analysis of BLBC patients for DFS and OS including tumor size and lymph node involvement confirmed survival gain of adjuvant chemotherapy (Table 6). The survival gain with anthracycline-based and non-anthracycline-based adjuvant chemotherapy did not show statistical difference in BLBCs (data not shown).

Bottom Line: The results of this study showed that both TNBCs and BLBCs were associated with high histological and/or nuclear grades.After multivariate analysis of TNBCs, the BLBCs did not have a worse prognosis than the QNBC/5NPs.Interestingly, the patients with BLBCs showed significant adjuvant chemotherapy benefit.

View Article: PubMed Central - HTML - PubMed

Affiliation: Laboratory of Cancer Genomics and Molecular Pathology, Samsung Medical Center, Seoul, Korea.

ABSTRACT

Background: Triple-negative breast cancers (TNBCs) and basal-like breast cancers (BLBCs) are known as poor outcome subtypes with a lack of targeted therapy. Previous studies have shown conflicting results regarding the difference of prognostic significance between TNBCs and BLBCs. In this study, we aimed to characterize the prognostic features of TNBCs, in view of BLBCs and quintuple-negative breast cancers (QNBC/5NPs).

Methods: Using tissue microarray-based immunohistochemical analysis, we categorized 951 primary breast cancers into four or five subtypes according to the expression of ER, PR, HER2, and basal markers (CK5/6, EGFR).

Results: The results of this study showed that both TNBCs and BLBCs were associated with high histological and/or nuclear grades. When the TNBCs are divided into two subtypes by the presence of basal markers, the clinicopathologic characteristics of TNBCs were mainly maintained in the BLBCs. The 5-subgrouping was the better prediction model for both disease free and overall survival in breast cancers than the 4-subgrouping. After multivariate analysis of TNBCs, the BLBCs did not have a worse prognosis than the QNBC/5NPs. Interestingly, the patients with BLBCs showed significant adjuvant chemotherapy benefit. In addition, QNBC/5NPs comprised about 6~8% of breast cancers in publicly available breast cancer datasets

Conclusion: The QNBC/5NP subtype is a worse prognostic subgroup of TNBCs, especially in higher stage and this result may be related to adjuvant chemotherapy benefit of BLBCs, calling for caution in the identification of subgroups of patients for therapeutic classification.

Show MeSH
Related in: MedlinePlus