The Association Between Biological Subtype and Isolated Regional Nodal Failure After Breast-Conserving Therapy

Wo, Jennifer Y.; Taghian, Alphonse G.; Nguyen, Paul L.; Raad, Rita Abi; Sreedhara, Meera; Bellon, Jennifer R.; Wong, Julia S.; Gadd, Michele A.; Smith, Barbara L.; Harris, Jay R.

doi:10.1016/j.ijrobp.2009.04.059

Cited by 33 publications

(19 citation statements)

References 38 publications

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“…Recent studies have shown that molecular subtypes are prognostic for LR and DR after BCS, and immunohistochemical staining is often used to approximately identify these subtypes [18,19,53]. In this review, we take both single-molecular and triple-molecular typing into evaluation (Table 2).…”

Section: Discussionmentioning

confidence: 99%

The efficacy of molecular subtyping in predicting postoperative recurrence in breast-conserving therapy: a 15-study meta-analysis

et al. 2014

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BackgroundRecent research displays that breast cancer (BC) is a heterogeneous disease and distinct molecular subtypes yield different prognostic outcomes.MethodsWe conducted a meta-analysis to clarify the role of molecular subtypes in recurrence risk after breast-conserving therapy (BCT). Eligible studies of single- (ER, PR, Her-2, and p53) and triple-molecular (Luminal A, Luminal B, Her-2, triple-negative) subtypes were identified through multiple search strategies. Pooled hazard ratios with 95% confidence intervals were calculated to assess this research topic.ResultsFifteen studies involving 21,645 participants were included in the meta-analysis. Her-2 positive patients had a significantly higher recurrence risk in both overall merge (HR = 1.97, 95% CI: 1.41-2.75) and subtotal merge of local recurrence (LR) (HR = 1.93, 95% CI: 1.34-2.78). Significantly higher risk of recurrence was also observed in p53 positive patients by overall merge (HR = 1.78, 95% CI: 1.49 -2.12) and subtotal merge of LR (HR = 1.73, 95% CI: 1.44-2.07). When setting Luminal A as a baseline, Luminal B, Her-2, and triple-negative all showed significantly increased risk for both LR and distant recurrence (DR). Comparing triple-negative and non-triple-negative subtypes showed the biggest risk for overall recurrence (HR = 3.19, 95% CI: 1.91-5.31) and LR (HR = 3.31, 95% CI: 1.69-6.45).ConclusionsOur meta-analysis showed significant differences in recurrence risk among various molecular subtypes after BCT. Although Her-2 and p53 positive subtypes can be considered independent prognostic biomarkers for indicating high LR risk, triple-molecular biomarkers showed higher clinical value. Triple-negative subtype showed the highest recurrence risk among all subtypes, and adjuvant chemotherapy should be considered for it.

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Section: Discussionmentioning

confidence: 99%

The efficacy of molecular subtyping in predicting postoperative recurrence in breast-conserving therapy: a 15-study meta-analysis

et al. 2014

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“…Four molecular subtypes are identified: Luminal A, Luminal B, HER2 positive, and Triple Negative (3). Different subtypes present with distinct epidemiological risk factors, distinct disease prognoses, and different responses to systemic and local therapy (4)(5)(6)(7)(8). This knowledge has opened a new door in disease management toward personalized therapy.…”

Section: Introductionmentioning

confidence: 99%

Background Parenchymal Enhancement and Fibroglandular Tissue Proportion on Breast MRI: Correlation with Hormone Receptor Expression and Molecular Subtypes of Breast Cancer

et al. 2017

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IntroductionBreast cancer is the most common malignancy of women with a life-time risk up to 12% in USA (1). It is the second most common cause of death from cancer in women (2). In recent years, advancement in the knowledge of the biology of breast cancer has contributed to better understanding the nature of the disease. For therapeutic reasons, breast cancer is divided into four different molecular subtypes using molecular biomarkers: estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor 2 (HER2). Four molecular subtypes are identified: Luminal A, Luminal B, HER2 positive, and Triple Negative (3). Different subtypes present with distinct epidemiological risk factors, distinct disease prognoses, and different responses to systemic and local therapy (4)(5)(6)(7)(8). This knowledge has opened a new door in disease management toward personalized therapy. For example, luminal A cancers require hormonotherapy whereas triple negative tumors respond better to chemotherapy (3). Trastuzumab, which is directed against the HER2-neu receptor, is considered in the treatment of HER2 positive tumors (3). Luminal A and luminal B subtypes are more likely to develop bone metastases whereas triple negative subtypes are more likely to develop lung and brain metastases (9).Breast MRI is a common diagnostic tool in the management of breast diseases. It can be used for screening in a high-risk population, for determining the disease extent, or for problem solving to contribute in discordant results of mammography, ultrasonography or clinical findings. FGT proportion, which refers to the proportion of FGT to fat tissue of the breast, and BPE, which refers to the enhancement of normal breast parenchyma after contrast agent administration, are two imaging features of breast MRI. Breast density which reflects FGT composition is a well-known risk factor for breast malignancy. Women having a high amount of FGT content are also more likely to develop breast cancer (10). Similarly, a recent study reported that moderate or marked BPE is associated with a greater risk of developing breast cancer than minimal or mild BPE (11). Considering those known risk factors and the spectrum of breast cancers, one may suspect that FGT proportion and BPE of the same molecular subtypes may have some common properties. Breast Health 2017; 13: 27-33 DOI: 10.5152/tjbh.2016.3247 27 ABSTRACT Objective: To assess the relationship between background parenchymal enhancement (BPE) and fibroglandular tissue (FGT) proportion on breast magnetic resonance imaging (MRI) and hormone receptor expression and molecular subtypes in invasive breast cancer. Materials and Methods:This retrospective study enrolled 75 breast cancer patients who underwent breast MRI before treatment. T1-weighted images were reviewed to determine the FGT proportion, and contrast-enhanced fat-suppressed T1-weighted images were reviewed to determine BPE. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2-neu (HER2) status, and mole...

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“…Every fourth case of death is due to the development of local recurrences [5]. Although studies have shown a considerable increase in the quality of radiotherapy (RT) after BCT [2], there is still no consensus about the necessity of periclavicular lymph node irradiation (PCL-NI) in case of up to three involved lymph nodes (pN+) [14,21,33,48]. Guidelines recommend radiotherapy (RT) of the supraclavicular lymph nodes in case of 4 or more pN+, but possibly, subgroups of women at intermediate risk with 1-3 pN+ or extracapsular spread (ECS) of the axillary lymph nodes could benefit from additional PCLNI [3,9,23,40].…”

Section: Postoperative Periclavicular Radiotherapy In Breast Cancer Pmentioning

confidence: 99%

“…Thus, several authors do not recommend prophylactic irradiation of the periclavicular fossa [17,29,30,34,48]. But according to a recent phase III study with 1,832 patients and 85% with 1-3 pN+, there was a statistically significant decrease in the rate of locoregional failure (LRF) and an increase in DFS for patients with locoregional RT [46].…”

Section: Periclavicular Irradiationmentioning

confidence: 99%

Postoperative periclavicular radiotherapy in breast cancer patients with 1–3 positive axillary lymph nodes

et al. 2012

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The Association Between Biological Subtype and Isolated Regional Nodal Failure After Breast-Conserving Therapy

Cited by 33 publications

References 38 publications

The efficacy of molecular subtyping in predicting postoperative recurrence in breast-conserving therapy: a 15-study meta-analysis

The efficacy of molecular subtyping in predicting postoperative recurrence in breast-conserving therapy: a 15-study meta-analysis

Background Parenchymal Enhancement and Fibroglandular Tissue Proportion on Breast MRI: Correlation with Hormone Receptor Expression and Molecular Subtypes of Breast Cancer

Postoperative periclavicular radiotherapy in breast cancer patients with 1–3 positive axillary lymph nodes

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