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4-IHC classification of breast cancer subtypes in a large cohort of a clinical cancer registry: use in clinical routine for therapeutic decisions and its effect on survival.

Inwald EC, Koller M, Klinkhammer-Schalke M, Zeman F, Hofstädter F, Gerstenhauer M, Brockhoff G, Ortmann O - Breast Cancer Res. Treat. (2015)

Bottom Line: The aim of the present study was to evaluate to what extent the combination of standard histopathological parameters determines the biology of breast cancer and the effect on therapy and prognosis.A multivariable Cox regression model showed that the best 7-year OS was seen in Luminal A patients and that OS of Luminal B and HER2-like patients was comparable (HR = 1.59, P < 0.001 versus HR = 1.51, P = 0.03).Providing that quality assurance of these markers is ensured, this classification is useful for making therapy decisions in the routine clinical management of breast cancer patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany. elisabeth.inwald@klinik.uni-regensburg.de.

ABSTRACT
The aim of the present study was to evaluate to what extent the combination of standard histopathological parameters determines the biology of breast cancer and the effect on therapy and prognosis. The Clinical Cancer Registry Regensburg (Bavaria, Germany) included n = 4,480 female patients with primary, non-metastatic (M0) invasive breast cancer diagnosed between 2000 and 2012. Immuno-histochemical analyses, i.e., estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 (4-IHC), defined the tumor biological subtypes Luminal A, Luminal B, HER2-like, and Basal-like. Subtype-related differences in therapies and overall survival (OS) were analyzed using multivariable statistical methods. 4344 patients (97.0 %) could be classified into the four common tumor biological subtypes. The two most frequent entities were Luminal A (48.4 %), Luminal B (24.8 %), HER2-like (17.8 %), and Basal-like subtype (9.0 %). A multivariable Cox regression model showed that the best 7-year OS was seen in Luminal A patients and that OS of Luminal B and HER2-like patients was comparable (HR = 1.59, P < 0.001 versus HR = 1.51, P = 0.03). Lowest OS was seen in patients with Basal-like tumors (HR = 2.18, P < 0.001). In conclusion, the classification of tumor biological subtypes by the ER, PR, HER2, and Ki-67 biomarkers is practical in routine clinical work. Providing that quality assurance of these markers is ensured, this classification is useful for making therapy decisions in the routine clinical management of breast cancer patients.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier plot of overall survival in years based on subtype
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Fig2: Kaplan-Meier plot of overall survival in years based on subtype

Mentions: Depending on various systemic therapies, OS rates within the particular subgroups differed remarkably (Table 8). The application of CHT led to improved survival rates in every subgroup. The best OS was found in Luminal A patients receiving CHT plus ET with a 7-year OS rate of 95.1 %. Depriving Luminal A and Luminal B patients ET and only administering CHT caused lower OS rates in both subgroups (7-year OS of 86.2 % in Luminal A patients versus 78.3 % in Luminal B patients). The worse outcome of HER2-like patients was improved by the application of optimal treatment with CHT plus ET plus trastuzumab. 7-year OS rate of HER2-like patients receiving this therapy was 93.3 %. The lowest OS of patients was found in all subgroups receiving no adjuvant therapy at all and other non-guideline-adherent therapy. The worst OS was analyzed in HER2-like (7-year OS of 46.5 %), Luminal B (7-year OS of 46.8 %), and Basal-like patients (7-year OS of 59.9 %). Even in Basal-like patients which received appropriate treatment with CHT and ET or only CHT led to acceptable 7-year OS rates. However, the low number of events in these groups has to be considered. A Cox regression model (Table 9) provided further evidence that the best OS was seen in Luminal A patients and that OS of Luminal B and HER2-like patients was comparable (HR = 1.59, 95 % CI 1.25–2.02, P < 0.001 versus HR = 1.51, 95 % CI 1.15–1.98, P = 0.03). The lowest OS was seen in patients with Basal-like tumors (HR = 2.18, 95 % CI 1.55–3.08, P < 0.001). Kaplan–Meier plots of OS in years based on subtypes are shown in Figs. 2, 3 and 4.Table 8


4-IHC classification of breast cancer subtypes in a large cohort of a clinical cancer registry: use in clinical routine for therapeutic decisions and its effect on survival.

Inwald EC, Koller M, Klinkhammer-Schalke M, Zeman F, Hofstädter F, Gerstenhauer M, Brockhoff G, Ortmann O - Breast Cancer Res. Treat. (2015)

Kaplan-Meier plot of overall survival in years based on subtype
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4589562&req=5

Fig2: Kaplan-Meier plot of overall survival in years based on subtype
Mentions: Depending on various systemic therapies, OS rates within the particular subgroups differed remarkably (Table 8). The application of CHT led to improved survival rates in every subgroup. The best OS was found in Luminal A patients receiving CHT plus ET with a 7-year OS rate of 95.1 %. Depriving Luminal A and Luminal B patients ET and only administering CHT caused lower OS rates in both subgroups (7-year OS of 86.2 % in Luminal A patients versus 78.3 % in Luminal B patients). The worse outcome of HER2-like patients was improved by the application of optimal treatment with CHT plus ET plus trastuzumab. 7-year OS rate of HER2-like patients receiving this therapy was 93.3 %. The lowest OS of patients was found in all subgroups receiving no adjuvant therapy at all and other non-guideline-adherent therapy. The worst OS was analyzed in HER2-like (7-year OS of 46.5 %), Luminal B (7-year OS of 46.8 %), and Basal-like patients (7-year OS of 59.9 %). Even in Basal-like patients which received appropriate treatment with CHT and ET or only CHT led to acceptable 7-year OS rates. However, the low number of events in these groups has to be considered. A Cox regression model (Table 9) provided further evidence that the best OS was seen in Luminal A patients and that OS of Luminal B and HER2-like patients was comparable (HR = 1.59, 95 % CI 1.25–2.02, P < 0.001 versus HR = 1.51, 95 % CI 1.15–1.98, P = 0.03). The lowest OS was seen in patients with Basal-like tumors (HR = 2.18, 95 % CI 1.55–3.08, P < 0.001). Kaplan–Meier plots of OS in years based on subtypes are shown in Figs. 2, 3 and 4.Table 8

Bottom Line: The aim of the present study was to evaluate to what extent the combination of standard histopathological parameters determines the biology of breast cancer and the effect on therapy and prognosis.A multivariable Cox regression model showed that the best 7-year OS was seen in Luminal A patients and that OS of Luminal B and HER2-like patients was comparable (HR = 1.59, P < 0.001 versus HR = 1.51, P = 0.03).Providing that quality assurance of these markers is ensured, this classification is useful for making therapy decisions in the routine clinical management of breast cancer patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany. elisabeth.inwald@klinik.uni-regensburg.de.

ABSTRACT
The aim of the present study was to evaluate to what extent the combination of standard histopathological parameters determines the biology of breast cancer and the effect on therapy and prognosis. The Clinical Cancer Registry Regensburg (Bavaria, Germany) included n = 4,480 female patients with primary, non-metastatic (M0) invasive breast cancer diagnosed between 2000 and 2012. Immuno-histochemical analyses, i.e., estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 (4-IHC), defined the tumor biological subtypes Luminal A, Luminal B, HER2-like, and Basal-like. Subtype-related differences in therapies and overall survival (OS) were analyzed using multivariable statistical methods. 4344 patients (97.0 %) could be classified into the four common tumor biological subtypes. The two most frequent entities were Luminal A (48.4 %), Luminal B (24.8 %), HER2-like (17.8 %), and Basal-like subtype (9.0 %). A multivariable Cox regression model showed that the best 7-year OS was seen in Luminal A patients and that OS of Luminal B and HER2-like patients was comparable (HR = 1.59, P < 0.001 versus HR = 1.51, P = 0.03). Lowest OS was seen in patients with Basal-like tumors (HR = 2.18, P < 0.001). In conclusion, the classification of tumor biological subtypes by the ER, PR, HER2, and Ki-67 biomarkers is practical in routine clinical work. Providing that quality assurance of these markers is ensured, this classification is useful for making therapy decisions in the routine clinical management of breast cancer patients.

No MeSH data available.


Related in: MedlinePlus