Breast Cancer Subtypes and the Risk of Local and Regional Relapse

Voduc, K. David; Cheang, Maggie C.U.; Tyldesley, Scott; Gelmon, Karen; Nielsen, Torsten O.; Kennecke, Hagen F.

doi:10.1200/jco.2009.24.9284

Cited by 1,101 publications

(824 citation statements)

References 39 publications

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“…Nguyen et al (2008) also showed a higher local recurrence rate of 7% in triple negative group when compared with recurrence rates for luminal type A (0.8%) and type B (1.5%) subgroups. Variable results were reported in other studies on TNBC managed with BCT (Nguyen et al, 2008;Freedman et al, 2009;Miller et al, 2009;Voduc et al, 2010). In a recent meta-analysis, Lowery et al (2012) included 12, 592 patients from 15 studies who either received BCT (n=7176) or mastectomy (n=5416).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Triple-Negative Versus Non-Triple-Negative Breast Cancers Managed with Breast-Conserving Therapy

Bhatti

Khan

Siddiqui

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Section: Discussionmentioning

confidence: 99%

Outcomes of Triple-Negative Versus Non-Triple-Negative Breast Cancers Managed with Breast-Conserving Therapy

Bhatti

Khan

Siddiqui

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Luminal A breast cancers are associated with the most favorable short‐term prognosis due to favorable responses to endocrine therapy 4, 5. However, assessment of long‐term prognosis demonstrates similar or worse overall survival for Luminal A cases as compared to other subtypes 26.…”

Section: Discussionmentioning

confidence: 99%

“…Recommended treatment for Luminal B tumors includes anthracycline‐based trastuzumab‐containing multimodality chemotherapy, followed by a 1‐year course of trastuzumab and 5 years of endocrine therapy 2. Together, luminal breast cancer subtypes are associated with the best short‐term prognoses for patients, attributable to favorable responses to hormonal therapy 4, 5.…”

Section: Introductionmentioning

confidence: 99%

HER2 status and disparities in luminal breast cancers

et al. 2016

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National Comprehensive Care Network guidelines for adjuvant treatment of invasive breast cancer are based on HER2 and hormone receptor (HR) status, where HR+ disease encompasses all estrogen receptor (ER)+ and/or progesterone receptor (PR)+ tumors. We sought to explore clinical and demographic differences among patients with HR+ breast cancer subtypes, and the role of HER2 status, age, race/ethnicity, and socioeconomic status (SES) in disease risk. We evaluated breast cancer subtype distribution, defined by HR and HER2 status, using patient clinical, demographic, and socioeconomic characteristics. Differences in HR categories by demographic and tumor characteristics were examined using chi‐squared tests. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) to quantify associations between breast cancer HR status and demographic factors. We found that differences in HR+ (ER−/PR+ vs. ER+/PR− or ER+/PR+) tumor biology are likely clinically significant and may play a role in breast cancer, regardless of HER2 status. While clinical and patient characteristics differed within each luminal subtype, we found disparities in SES only among Luminal A (HR+/HER2−) tumors. Among HR+/HER2− cases, we observed that ER−/PR+ patients tend to live in areas of higher poverty (OR = 1.20, 95% CI = 1.03–1.40) and are 70% more likely to be aged 50 years or older. However, this pattern was not found in women with Luminal B (HR+/HER2+) disease (Poverty OR = 0.98, 95% CI = 0.76–1.27; Age OR = 1.01, 95% CI = 0.81–1.26). Racial/ethnic disparities among non‐Hispanic black and Hispanic women persisted across HR+/HER2− cases compared to non‐Hispanic white women. Our findings suggest that while race/ethnicity and SES are correlated, each plays an independent role in contributing to disease among Luminal A tumors. Further study is needed to investigate how tumor biology, race/ethnicity, and socioeconomic disparities among HR+/HER2− cases may contribute to poorer patient prognosis.

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“…[2][3][4][5][6] Subsequent studies have confirmed that the five intrinsic molecular subtypes (luminal A, luminal B, HER2-enriched, basal-like and normal-like) possess distinct etiologies and clinicopathologic features with implications for treatment selection. 1,[7][8][9][10][11][12] Of particular relevance to patient management, the 'basallike' subtype comprises B15% of all invasive breast cancers and is responsible for a disproportionately high number of metastatic breast cancer cases and breast cancer-related deaths. 13,14 This aggressive subtype is also associated with early age of onset, [15][16][17][18] BRCA-related hereditary cancers [19][20][21][22] and has a particularly high incidence in women of African ethnicity.…”

mentioning

confidence: 99%

A survey of immunohistochemical biomarkers for basal-like breast cancer against a gene expression profile gold standard

et al. 2013

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Gene expression profiling of breast cancer delineates a particularly aggressive subtype referred to as 'basallike', which comprises B15% of all breast cancers, afflicts younger women and is refractory to endocrine and anti-HER2 therapies. Immunohistochemical surrogate definitions for basal-like breast cancer, such as the clinical ER/PR/HER2 triple-negative phenotype and models incorporating positive expression for CK5 (CK5/6) and/or EGFR are heavily cited. However, many additional biomarkers for basal-like breast cancer have been described in the literature. A parallel comparison of 46 proposed immunohistochemical biomarkers of basal-like breast cancer was performed against a gene expression profile gold standard on a tissue microarray containing 42 basal-like and 80 non-basal-like breast cancer cases. Ki67 and PPH3 were the most sensitive biomarkers (both 92%) positively expressed in the basal-like subtype, whereas CK14, IMP3 and NGFR were the most specific (100%). Among biomarkers surveyed, loss of INPP4B (a negative regulator of phosphatidylinositol signaling) was 61% sensitive and 99% specific with the highest odds ratio (OR) at 108, indicating the strongest association with basal-like breast cancer. Expression of nestin, a common marker of neural progenitor cells that is also associated with the triple-negative/basal-like phenotype and poor breast cancer prognosis, possessed the second highest OR at 29 among the 46 biomarkers surveyed, as well as 54% sensitivity and 96% specificity. As a positively expressed biomarker, nestin possesses technical advantages over INPP4B that make it a more ideal biomarker for identification of basal-like breast cancer. The comprehensive immunohistochemical biomarker survey presented in this study is a necessary step for determining an optimized surrogate immunopanel that best defines basal-like breast cancer in a practical and clinically accessible way.

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Breast Cancer Subtypes and the Risk of Local and Regional Relapse

Abstract: Luminal A tumors are associated with a low risk of local or regional recurrence. Molecular subtyping of breast tumors using a six-marker immunohistochemical panel can identify patients at increased risk of local and regional recurrence.

Cited by 1,101 publications

References 39 publications

Outcomes of Triple-Negative Versus Non-Triple-Negative Breast Cancers Managed with Breast-Conserving Therapy

Outcomes of Triple-Negative Versus Non-Triple-Negative Breast Cancers Managed with Breast-Conserving Therapy

HER2 status and disparities in luminal breast cancers

A survey of immunohistochemical biomarkers for basal-like breast cancer against a gene expression profile gold standard

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