Ki-Tae Hwang1, Eun-Kyu Kim2, Sung Hoo Jung3, Eun Sook Lee4, Seung Il Kim5, Seokwon Lee6, Heung Kyu Park7, Jongjin Kim8, Sohee Oh9, Young A Kim10. 1. Department of Surgery, Seoul National University Boramae Medical Center, 39, Boramae-Gil, Dongjak-Gu, Seoul, 156-707, Republic of Korea. kiterius@snu.ac.kr. 2. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 3. Department of Surgery, Chonbuk National University Medical School, Jeonju, Republic of Korea. 4. Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. 5. Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea. 6. Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea. 7. Department of Surgery, Gachon University, Gil Hospital, Incheon, Republic of Korea. 8. Department of Surgery, Seoul National University Boramae Medical Center, 39, Boramae-Gil, Dongjak-Gu, Seoul, 156-707, Republic of Korea. 9. Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea. 10. Department of Pathology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Abstract
PURPOSE: To determine the prognostic role of tamoxifen therapy for patients with ductal carcinoma in situ (DCIS) according to molecular subtypes. METHODS: Data of 14,944 patients with DCIS were analyzed. Molecular subtypes were classified into four categories based on expression of estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). Kaplan-Meier estimator was used for overall survival analysis while Cox proportional hazards model was used for univariate and multivariate analyses. RESULTS: Luminal A subtype (ER/PR+, HER2-) showed higher (P = .009) survival rate than triple-negative (TN) subtype. Tamoxifen therapy group showed superior (P < .001) survival than no-tamoxifen therapy group. It had survival benefit only for luminal A subtype (P = .001). Tamoxifen therapy resulted in higher survival rate in subgroups with positive ER (P = .006), positive PR (P = .009), and negative HER2 (P < .001). In luminal A subtype, tamoxifen therapy showed lower hazard ratio (HR) compared to no-tamoxifen therapy (HR, 0.420; 95% CI 0.250-0.705; P = .001). Tamoxifen therapy was a significant independent factor by multivariate analysis (HR, 0.538; 95% CI 0.306-0.946; P = .031) as well as univariate analysis. CONCLUSION: Tamoxifen therapy group showed superior prognosis than the no-tamoxifen therapy group. Its prognostic influence was only effective for luminal A subtype. Patients with luminal A subtype showed higher survival rate than those with TN subtype. Active tamoxifen therapy is recommended for DCIS patients with luminal A subtype, and routine tests for ER, PR, and HER2 should be considered for DCIS.
PURPOSE: To determine the prognostic role of tamoxifen therapy for patients with ductal carcinoma in situ (DCIS) according to molecular subtypes. METHODS: Data of 14,944 patients with DCIS were analyzed. Molecular subtypes were classified into four categories based on expression of estrogen receptor (ER)/progesterone receptor (PR) and humanepidermal growth factor receptor 2 (HER2). Kaplan-Meier estimator was used for overall survival analysis while Cox proportional hazards model was used for univariate and multivariate analyses. RESULTS: Luminal A subtype (ER/PR+, HER2-) showed higher (P = .009) survival rate than triple-negative (TN) subtype. Tamoxifen therapy group showed superior (P < .001) survival than no-tamoxifen therapy group. It had survival benefit only for luminal A subtype (P = .001). Tamoxifen therapy resulted in higher survival rate in subgroups with positive ER (P = .006), positive PR (P = .009), and negative HER2 (P < .001). In luminal A subtype, tamoxifen therapy showed lower hazard ratio (HR) compared to no-tamoxifen therapy (HR, 0.420; 95% CI 0.250-0.705; P = .001). Tamoxifen therapy was a significant independent factor by multivariate analysis (HR, 0.538; 95% CI 0.306-0.946; P = .031) as well as univariate analysis. CONCLUSION:Tamoxifen therapy group showed superior prognosis than the no-tamoxifen therapy group. Its prognostic influence was only effective for luminal A subtype. Patients with luminal A subtype showed higher survival rate than those with TN subtype. Active tamoxifen therapy is recommended for DCIS patients with luminal A subtype, and routine tests for ER, PR, and HER2 should be considered for DCIS.
Entities:
Keywords:
Breast neoplasms; Molecular subtype; Prognosis; Survival analysis; Tamoxifen therapy
Authors: Leya Groysman; Lindsey Carlsen; Kelsey E Huntington; Wen H Shen; Lanlan Zhou; Wafik S El-Deiry Journal: Am J Cancer Res Date: 2021-12-15 Impact factor: 6.166
Authors: Ki-Tae Hwang; Young Jin Suh; Chan-Heun Park; Young Joo Lee; Jee Ye Kim; Jin Hyang Jung; Seeyeong Kim; Junwon Min Journal: Oncologist Date: 2021-09-02