Marijn A Vermeulen1, Leen Slaets2, Fatima Cardoso3, Sharon H Giordano4, Konstantinos Tryfonidis2, Paul J van Diest1, Nizet H Dijkstra5, Carolien P Schröder6, Christi J van Asperen7, Barbro Linderholm8, Kim Benstead9, Renee Foekens10, John W M Martens11, John M S Bartlett12, Carolien H M van Deurzen13. 1. Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands. 2. EORTC Headquarters, Brussels, Belgium. 3. Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal. 4. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 5. BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands. 6. BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands; Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands. 7. BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands. 8. Swedish Association of Breast Oncologists (SABO), Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden. 9. Department of Oncology, Cheltenham General Hospital, Gloucestershire, UK. 10. Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands. 11. Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands. 12. Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Canada; Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Scotland, UK. 13. BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands; Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: c.h.m.vandeurzen@erasmusmc.nl.
Abstract
AIM: Several prognostic histological features have been established in female breast cancer (BC), but it is unknown whether these can be extrapolated to male BC patients. The aim of this study was to evaluate the prognostic value of several histological features in a large series of male BC. METHODS: Central pathology review was performed for 1483 male BCs collected through part 1 of the European Organisation for Research and Treatment of Cancer (EORTC) International Male BC Program. Pathology review included histological subtype, grade, mitotic activity index (MAI), presence of a fibrotic focus and density of tumour-infiltrating lymphocytes (TILs). These features were correlated with clinical outcome. The relationship between these features and surrogate molecular subtypes using immunohistochemistry was also assessed. RESULTS: Median follow-up for overall survival (OS) was 7.1 years. Overall histological grade was not significantly associated with OS (p = 0.129). MAI, the presence of a fibrotic focus and a low TIL density however were correlated with unfavourable OS (p = 0.023, p = 0.004 and p = 0.011, respectively). BC subtype correlated with TIL density (p = 0.015), as we observed a higher density for human epidermal growth factor receptor type 2 (HER2) positive BC compared to luminal HER2-negative subtype. No association was observed between subtype and fibrotic focus. CONCLUSIONS: Histologic grade was not significantly correlated with clinical outcome in this series, unlike what is seen in female patients. These results contribute to our understanding of male BC and indicate the importance of further research on the optimisation of risk stratification and treatment decisions for male BC patients.
AIM: Several prognostic histological features have been established in female breast cancer (BC), but it is unknown whether these can be extrapolated to male BC patients. The aim of this study was to evaluate the prognostic value of several histological features in a large series of male BC. METHODS: Central pathology review was performed for 1483 male BCs collected through part 1 of the European Organisation for Research and Treatment of Cancer (EORTC) International Male BC Program. Pathology review included histological subtype, grade, mitotic activity index (MAI), presence of a fibrotic focus and density of tumour-infiltrating lymphocytes (TILs). These features were correlated with clinical outcome. The relationship between these features and surrogate molecular subtypes using immunohistochemistry was also assessed. RESULTS: Median follow-up for overall survival (OS) was 7.1 years. Overall histological grade was not significantly associated with OS (p = 0.129). MAI, the presence of a fibrotic focus and a low TIL density however were correlated with unfavourable OS (p = 0.023, p = 0.004 and p = 0.011, respectively). BC subtype correlated with TIL density (p = 0.015), as we observed a higher density for human epidermal growth factor receptor type 2 (HER2) positive BC compared to luminal HER2-negative subtype. No association was observed between subtype and fibrotic focus. CONCLUSIONS: Histologic grade was not significantly correlated with clinical outcome in this series, unlike what is seen in female patients. These results contribute to our understanding of male BC and indicate the importance of further research on the optimisation of risk stratification and treatment decisions for male BC patients.
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