Histological grade provides significant prognostic information in addition to breast cancer subtypes defined according to St Gallen 2013.

Autor: Ehinger A; a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden.; b Department of Pathology and Cytology , Blekinge County Hospital , Karlskrona , Sweden., Malmström P; a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden.; c Department of Oncology , Skåne University Hospital , Lund , Sweden., Bendahl PO; a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden., Elston CW; d Department of Histopathology , Nottingham University Hospitals NHS Trust , Nottingham , UK., Falck AK; e Department of Surgery , Helsingborg Hospital , Helsingborg , Sweden., Forsare C; a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden., Grabau D; a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden.; f Department of Pathology , Skåne University Hospital , Lund , Sweden., Rydén L; g Division of Surgery, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden.; h Department of Surgery , Skåne University Hospital , Lund , Sweden., Stål O; i Division of Oncology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences , Linköping University , Linköping , Sweden., Fernö M; a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden.
Jazyk: angličtina
Zdroj: Acta oncologica (Stockholm, Sweden) [Acta Oncol] 2017 Jan; Vol. 56 (1), pp. 68-74. Date of Electronic Publication: 2016 Oct 20.
DOI: 10.1080/0284186X.2016.1237778
Abstrakt: 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.
Databáze: MEDLINE
Externí odkaz: