Anna Ehinger1,2, Per Malmström1,3, Pär-Ola Bendahl1, Christopher W Elston4, Anna-Karin Falck5, Carina Forsare1, Dorthe Grabau1,6, Lisa Rydén7,8, Olle Stål9, Mårten Fernö1. 1. a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden. 2. b Department of Pathology and Cytology , Blekinge County Hospital , Karlskrona , Sweden. 3. c Department of Oncology , Skåne University Hospital , Lund , Sweden. 4. d Department of Histopathology , Nottingham University Hospitals NHS Trust , Nottingham , UK. 5. e Department of Surgery , Helsingborg Hospital , Helsingborg , Sweden. 6. f Department of Pathology , Skåne University Hospital , Lund , Sweden. 7. g Division of Surgery, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden. 8. h Department of Surgery , Skåne University Hospital , Lund , Sweden. 9. i Division of Oncology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences , Linköping University , Linköping , Sweden.
Abstract
BACKGROUND: The St Gallen surrogate definition of the intrinsic subtypes of breast cancer consist of five subgroups based on estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor type 2 (HER2), and Ki-67. PgR and Ki-67 are used for discriminating between the 'Luminal A-like' and 'Luminal B-like (HER2-negative)' subtypes. Histological grade (G) has prognostic value in breast cancer; however, its relationship to the St Gallen subtypes is not clear. Based on a previous pilot study, we hypothesized that G could be a primary discriminator for ER-positive/HER2-negative breast cancers that were G1 or G3, whereas Ki-67 and PgR could provide additional prognostic information specifically for patients with G2 tumors. To test this hypothesis, a larger patient cohort was examined. PATIENTS AND METHODS: Six hundredseventy-one patients (≥35 years of age, pT1-2, pN0-1) with ER-positive/HER2-negative breast cancer and complete data for PgR, Ki-67, G, lymph node status, tumor size, age, and distant disease-free survival (DDFS; median follow-up 9.2 years) were included. RESULTS: 'Luminal A-like' tumors were mostly G1 or G2 (90%) whereas 'Luminal B-like' tumors were mostly G2 or G3 (87%) and corresponded with good and poor DDFS, respectively. In 'Luminal B-like' tumors that were G1 (n = 23), no metastasis occurred, whereas 14 of 40 'Luminal A-like' tumors that were G3 metastasized. In the G2 subgroup, low PgR and high Ki-67 were associated with an increased risk of distant metastases, hazard ratio (HR) and 95% confidence interval (CI) 1.8 (0.95-3.4) and 1.5 (0.80-2.8), respectively. CONCLUSIONS:Patients with ER-positive/HER2-negative/G1 breast cancer have a good prognosis, similar to that of 'Luminal A-like', while those with ER-positive/HER2-negative/G3 breast cancer have a worse prognosis, similar to that of 'Luminal B-like', when assessed independently of PgR and Ki-67. Therapy decisions based on Ki-67 and PgR might thus be restricted to the subgroup G2.
RCT Entities:
BACKGROUND: The St Gallen surrogate definition of the intrinsic subtypes of breast cancer consist of five subgroups based on estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor type 2 (HER2), and Ki-67. PgR and Ki-67 are used for discriminating between the 'Luminal A-like' and 'Luminal B-like (HER2-negative)' subtypes. Histological grade (G) has prognostic value in breast cancer; however, its relationship to the St Gallen subtypes is not clear. Based on a previous pilot study, we hypothesized that G could be a primary discriminator for ER-positive/HER2-negative breast cancers that were G1 or G3, whereas Ki-67 and PgR could provide additional prognostic information specifically for patients with G2 tumors. To test this hypothesis, a larger patient cohort was examined. PATIENTS AND METHODS: Six hundred seventy-one patients (≥35 years of age, pT1-2, pN0-1) with ER-positive/HER2-negative breast cancer and complete data for PgR, Ki-67, G, lymph node status, tumor size, age, and distant disease-free survival (DDFS; median follow-up 9.2 years) were included. RESULTS: 'Luminal A-like' tumors were mostly G1 or G2 (90%) whereas 'Luminal B-like' tumors were mostly G2 or G3 (87%) and corresponded with good and poor DDFS, respectively. In 'Luminal B-like' tumors that were G1 (n = 23), no metastasis occurred, whereas 14 of 40 'Luminal A-like' tumors that were G3 metastasized. In the G2 subgroup, low PgR and high Ki-67 were associated with an increased risk of distant metastases, hazard ratio (HR) and 95% confidence interval (CI) 1.8 (0.95-3.4) and 1.5 (0.80-2.8), respectively. CONCLUSIONS:Patients with ER-positive/HER2-negative/G1 breast cancer have a good prognosis, similar to that of 'Luminal A-like', while those with ER-positive/HER2-negative/G3 breast cancer have a worse prognosis, similar to that of 'Luminal B-like', when assessed independently of PgR and Ki-67. Therapy decisions based on Ki-67 and PgR might thus be restricted to the subgroup G2.
Authors: Zhiyang Liu; Zeyad Sahli; Yongchun Wang; Antonio C Wolff; Leslie M Cope; Christopher B Umbricht Journal: Breast Cancer Res Treat Date: 2018-09-17 Impact factor: 4.872
Authors: Christine Lundgren; Pär-Ola Bendahl; Åke Borg; Anna Ehinger; Cecilia Hegardt; Christer Larsson; Niklas Loman; Martin Malmberg; Helena Olofsson; Lao H Saal; Tobias Sjöblom; Henrik Lindman; Marie Klintman; Jari Häkkinen; Johan Vallon-Christersson; Mårten Fernö; Lisa Rydén; Maria Ekholm Journal: Breast Cancer Res Treat Date: 2019-08-20 Impact factor: 4.872
Authors: Kimberly S Keene; Funda Meric-Bernstam; Tari King; E Shelley Hwang; Bo Peng; Kandace P McGuire; Coya Tapia; Hong Zhang; Sejong Bae; Faina Nakhlis; Nancy Klauber-Demore; Ingrid Meszoely; Michael S Sabel; Shawna C Willey; Agda Karina Eterovic; Cliff Hudis; Antonio C Wolff; Jennifer De Los Santos; Alastair Thompson; Gordon B Mills Journal: NPJ Breast Cancer Date: 2018-10-12