Prognosis of breast cancer molecular subtypes in routine clinical care: A large prospective cohort study

Abstract

BackgroundIn Germany, most breast cancer patients are treated in specialized breast cancer units (BCU), which are certified, and routinely monitored. Herein, we evaluate up-to-date oncological outcome of breast cancer (BC) molecular subtypes in routine clinical care of a specialized BCU.MethodsThe study was a prospectively single-center cohort study of 4102 female cases with primary, unilateral, non-metastatic breast cancer treated between 01 January 2003 and 31 December 2012. The five routinely used molecular subtypes (Luminal A-like, Luminal B/HER2 negative-like, Luminal B/HER2 positive-like, HER2-type, Triple negative) were analyzed. The median follow-up time of the whole cohort was 55 months. We calculated estimates for local control rate (LCR), disease-free survival (DFS), distant disease-free survival (DDFS), overall survival (OS), and relative overall survival (ROS).ResultsLuminal A-like tumors were the most frequent (44.7 %) and showed the best outcome with LCR of 99.1 % (95 % CI 98.5; 99.7), OS of 95.1 % (95 % CI 93.7; 96.5), and ROS of 100.0 % (95 % CI 98.5; 101.5). Triple negative tumors (12.3 %) presented the poorest outcome with LCR of 89.6 % (95 % CI 85.8; 93.4), OS of 78.5 % (95 % CI 73.8; 83.3), and ROS of 80.1 % (95 % CI 73.8; 83.2).ConclusionsPatients with a favorable subtype can expect an OS above 95 % and an LCR of almost 100 % over 5 years. On the other hand the outcome of patients with HER2 and Triple negative subtypes remains poor, thus necessitating more intensified research and care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2766-3) contains supplementary material, which is available to authorized users.

Failure patterns according to molecular subtype in patients with invasive breast cancer following postoperative adjuvant radiotherapy: long-term outcomes in contemporary clinical practice

“…A Korean study also demonstrated significant differences in local and [16]. However, the current study was unique in that we exclusively analyzed a study population who completed PORT, while prior investigations included a significant proportion of non-PORT patients [15][16][17][18]. In Haffty et al's analysis of 482 patients who underwent PORT after breastconserving surgery, the TN subtype (n = 117) was associated with a significantly lower 5-year distant metastasis-free rate (P = 0.002) but no significant differences in breast (P = 0.823) or nodal (P = 0.05) relapse-free rates [19].…”

Basal markers and prognosis in luminal breast cancer

“…The Luminal A subtype has the best prognosis followed by the other luminal subtypes [ 5,10,11 ]. However, studies of long http://eproofing.springer.com/journals/printpage.php?token=Rt1BrlQaTyuwuNxVhI_xPYwIUqIuNE6ZG1Tkr_jU9OeXCU3MBNMPbw 3/24 term survival have shown that luminal breast cancers can recur up to decades after primary diagnosis.…”

Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer

“…Another advantage of BCT is that it may allow the patients to avoid axillary dissection if they had a positive lymph node status after sentinel node biopsy and if they are treated according to the ACOSOG Z0011 criteria [51]. More than two-thirds of all primary breast cancer patients are nowadays treated with breast conservation in a routine clinical setting in a specialized breast unit in developed countries [1].…”

“…LRR additionally depends on the immunohistochemical subtype, with the triple-negative type having the highest rates and the hormone receptor-positive and HER2-negative types having the lowest rates of LRR [27]. In a representative routine cohort from Germany with over 70% of the patients treated with BCT, LRR rates of 3.9% over 5 years were seen [1]. Thus, the rates of breast cancer recurrence after BCT are nowadays similar to the rates of local recurrence seen after mastectomy.…”

“…In the context of primary breast cancer with OS and ROS rates higher than 90% over 5 years in unselected cohorts, the usage of surrogate endpoints for OS, such as (distant) disease-free survival, is increasingly common, especially in randomized trials but also in cancer registry outcome analyses [1]. The definitions of several of these endpoints are often imprecisely used; especially endpoints with differing locoregional components have been observed in the comparison of research results [2].…”