Limits...
Impact of Breast Cancer Subtype Defined by Immunohistochemistry Hormone Receptor and HER2 Status on the Incidence of Immediate Postmastectomy Reconstruction

View Article: PubMed Central - PubMed

ABSTRACT

Immediate postmastectomy reconstruction has become an increasingly popular choice for breast cancer patients recently. However, whether molecular subtype of cancer impacts the incidence of breast reconstruction is unclear. We aimed to investigate the association between breast cancer subtype defined by immunohistochemistry hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status and recent rates of immediate postmastectomy reconstruction in the United States.

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database was used to evaluate stage I–III breast cancer patients with different subtypes who underwent either mastectomy alone or mastectomy plus reconstruction between 2010 and 2012. Univariate and multivariate analyses were conducted to identify factors influencing the incidence of immediate reconstruction.

Of 47,123 women included, 33.1% (10,712/32,376) of HR+/HER2−, 33.1% (1912/5768) of HR+/HER2+, 29.6% (850/2875) of HR−/HER2+, and 27.7% (1689/6104) of triple negative breast cancer patients received immediate breast reconstruction (chi-square test, P < 0.001), respectively. Thus, HER2-overexpressing and triple negative breast cancer patients received significantly less breast reconstruction. After adjusting for demographic, socioeconomic, geographic, or clinicopathologic factors, HER2-overexpressing (OR 0.896, 95% CI 0.817–0.984) and triple negative (OR 0.806, 95% CI 0.751–0.866) breast cancer patients remained less likely to undergo immediate postmastectomy reconstruction compared with HR+/HER2− or HR+/HER2+ patients. No significant difference was found in the type of reconstruction among different subtypes. Subgroup analysis showed that the difference of breast reconstruction rates among distinct subtypes varied with different grade and stage groups, and the association between breast cancer subtype and the reconstruction rate was not significant in low grade and early stage patients.

This population-based study determined that breast cancer subtype was an independent predictor for the utilization of immediate postmastectomy reconstruction. Patients with HER2-overexpressing or triple negative breast cancer subtype that has relatively higher risk of local recurrence, were less likely to receive immediate breast reconstruction than those with luminal tumors. Further studies are needed to disclose more underlying reasons of different reconstruction incidences for distinct subtypes of breast cancer.

No MeSH data available.


Related in: MedlinePlus

The difference of immediate breast reconstruction rates among breast cancer subtypes by distinct histologic grade and AJCC stage groups. AJCC = American Joint Committee on Cancer.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998276&req=5

Figure 2: The difference of immediate breast reconstruction rates among breast cancer subtypes by distinct histologic grade and AJCC stage groups. AJCC = American Joint Committee on Cancer.

Mentions: Of patients with HR+/HER2−, HR+/HER2+, HR−/HER2+ (HER2-overexpressing), and HR−/HER2− (triple negative) breast cancer, 33.1% (10,712/32,376), 33.1% (1912/5768), 29.6% (850/2875), and 27.7% (1689/6104) received immediate breast reconstruction surgery (chi-square test, P < 0.001), respectively. And the distribution of reconstruction surgery type among these 4 breast cancer subtypes was quite similar: the most common type was implant reconstruction, followed by tissue reconstruction, and the reconstruction combined by tissue and implant was the rarest (Figure 1). Univariate analysis showed that breast cancer subtype was significantly associated with utilization of immediate postmastectomy reconstruction (Table 2). Other factors found to be significant for the frequency of immediate breast reconstruction by univariate analysis were age, race, county type, marital status, insurance status, family income, education level, histologic grade, T-stage, N-stage, AJCC stage, and utilization of radiotherapy (P < 0.001 for all, Table 2). After adjusting for all these factors, we still identified that HER2-overexpressing and triple negative breast cancer patients were less likely to be treated with postmastectomy reconstruction compared with HR+/HER2− or HR+/HER2+ patients (HER2-overexpressing: OR (95% CI) 0.896 (0.817–0.984), P = 0.021; triple negative: OR (95% CI) 0.806 (0.751–0.866), P < 0.001, Table 2). Univariate and multivariate analyses defined no statistical difference of reconstruction rate between patients with HER2-overexpressing and triple negative breast cancer (chi-square test: P = 0.063; logistic regression: HER-overexpressing vs triple negative OR 1.106, 95% CI 0.995–1.230). Other predictors remained associated with higher immediate reconstruction rate by multivariate analysis were: diagnostic age< 40 years, white race, metropolitan area, married status, presence of health insurance, higher family income, higher education level, well or moderately histologic grade, earlier tumor or node stage, and lack of postmastectomy radiotherapy (P < 0.01 for all, Table 2). Subgroup analysis showed that the difference of breast reconstruction incidence among distinct subtypes varied with different histologic grade and AJCC stage groups (Figure 2). HER2-overexpressing and triple negative breast cancer women received less reconstruction surgery than luminal ones, in patients with high-grade tumor (poorly or undifferentiated) and advanced stage disease (AJCC stage III) (P=0.011), whereas there was no significant difference in reconstruction rates among the 4 subtypes in patients with low-grade tumor (well differentiated) and early stage disease (AJCC stage I) (P = 0.286, Figure 2).


Impact of Breast Cancer Subtype Defined by Immunohistochemistry Hormone Receptor and HER2 Status on the Incidence of Immediate Postmastectomy Reconstruction
The difference of immediate breast reconstruction rates among breast cancer subtypes by distinct histologic grade and AJCC stage groups. AJCC = American Joint Committee on Cancer.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998276&req=5

Figure 2: The difference of immediate breast reconstruction rates among breast cancer subtypes by distinct histologic grade and AJCC stage groups. AJCC = American Joint Committee on Cancer.
Mentions: Of patients with HR+/HER2−, HR+/HER2+, HR−/HER2+ (HER2-overexpressing), and HR−/HER2− (triple negative) breast cancer, 33.1% (10,712/32,376), 33.1% (1912/5768), 29.6% (850/2875), and 27.7% (1689/6104) received immediate breast reconstruction surgery (chi-square test, P < 0.001), respectively. And the distribution of reconstruction surgery type among these 4 breast cancer subtypes was quite similar: the most common type was implant reconstruction, followed by tissue reconstruction, and the reconstruction combined by tissue and implant was the rarest (Figure 1). Univariate analysis showed that breast cancer subtype was significantly associated with utilization of immediate postmastectomy reconstruction (Table 2). Other factors found to be significant for the frequency of immediate breast reconstruction by univariate analysis were age, race, county type, marital status, insurance status, family income, education level, histologic grade, T-stage, N-stage, AJCC stage, and utilization of radiotherapy (P < 0.001 for all, Table 2). After adjusting for all these factors, we still identified that HER2-overexpressing and triple negative breast cancer patients were less likely to be treated with postmastectomy reconstruction compared with HR+/HER2− or HR+/HER2+ patients (HER2-overexpressing: OR (95% CI) 0.896 (0.817–0.984), P = 0.021; triple negative: OR (95% CI) 0.806 (0.751–0.866), P < 0.001, Table 2). Univariate and multivariate analyses defined no statistical difference of reconstruction rate between patients with HER2-overexpressing and triple negative breast cancer (chi-square test: P = 0.063; logistic regression: HER-overexpressing vs triple negative OR 1.106, 95% CI 0.995–1.230). Other predictors remained associated with higher immediate reconstruction rate by multivariate analysis were: diagnostic age< 40 years, white race, metropolitan area, married status, presence of health insurance, higher family income, higher education level, well or moderately histologic grade, earlier tumor or node stage, and lack of postmastectomy radiotherapy (P < 0.01 for all, Table 2). Subgroup analysis showed that the difference of breast reconstruction incidence among distinct subtypes varied with different histologic grade and AJCC stage groups (Figure 2). HER2-overexpressing and triple negative breast cancer women received less reconstruction surgery than luminal ones, in patients with high-grade tumor (poorly or undifferentiated) and advanced stage disease (AJCC stage III) (P=0.011), whereas there was no significant difference in reconstruction rates among the 4 subtypes in patients with low-grade tumor (well differentiated) and early stage disease (AJCC stage I) (P = 0.286, Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Immediate postmastectomy reconstruction has become an increasingly popular choice for breast cancer patients recently. However, whether molecular subtype of cancer impacts the incidence of breast reconstruction is unclear. We aimed to investigate the association between breast cancer subtype defined by immunohistochemistry hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status and recent rates of immediate postmastectomy reconstruction in the United States.

The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database was used to evaluate stage I&ndash;III breast cancer patients with different subtypes who underwent either mastectomy alone or mastectomy plus reconstruction between 2010 and 2012. Univariate and multivariate analyses were conducted to identify factors influencing the incidence of immediate reconstruction.

Of 47,123 women included, 33.1% (10,712/32,376) of HR+/HER2&minus;, 33.1% (1912/5768) of HR+/HER2+, 29.6% (850/2875) of HR&minus;/HER2+, and 27.7% (1689/6104) of triple negative breast cancer patients received immediate breast reconstruction (chi-square test, P&#8202;&lt;&#8202;0.001), respectively. Thus, HER2-overexpressing and triple negative breast cancer patients received significantly less breast reconstruction. After adjusting for demographic, socioeconomic, geographic, or clinicopathologic factors, HER2-overexpressing (OR 0.896, 95% CI 0.817&ndash;0.984) and triple negative (OR 0.806, 95% CI 0.751&ndash;0.866) breast cancer patients remained less likely to undergo immediate postmastectomy reconstruction compared with HR+/HER2&minus; or HR+/HER2+ patients. No significant difference was found in the type of reconstruction among different subtypes. Subgroup analysis showed that the difference of breast reconstruction rates among distinct subtypes varied with different grade and stage groups, and the association between breast cancer subtype and the reconstruction rate was not significant in low grade and early stage patients.

This population-based study determined that breast cancer subtype was an independent predictor for the utilization of immediate postmastectomy reconstruction. Patients with HER2-overexpressing or triple negative breast cancer subtype that has relatively higher risk of local recurrence, were less likely to receive immediate breast reconstruction than those with luminal tumors. Further studies are needed to disclose more underlying reasons of different reconstruction incidences for distinct subtypes of breast cancer.

No MeSH data available.


Related in: MedlinePlus