Advanced

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

Ehinger, Anna LU ; Malmström, Per LU ; Bendahl, Pär Ola LU ; Elston, Christopher W.; Falck, Anna Karin LU ; Forsare, Carina LU ; Grabau, Dorthe LU ; Rydén, Lisa LU ; Stål, Olle and Fernö, Mårten LU (2017) In Acta Oncologica 56(1). p.68-74
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... (More)

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.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Oncologica
volume
56
issue
1
pages
68 - 74
publisher
Taylor & Francis
external identifiers
  • scopus:84992065189
  • wos:000392819600011
ISSN
0284-186X
DOI
10.1080/0284186X.2016.1237778
language
English
LU publication?
yes
id
d79f5d03-c3b6-4b5e-94c8-0ecfa2480d15
date added to LUP
2016-11-08 15:50:47
date last changed
2018-01-07 11:34:20
@article{d79f5d03-c3b6-4b5e-94c8-0ecfa2480d15,
  abstract     = {<p>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.</p>},
  author       = {Ehinger, Anna and Malmström, Per and Bendahl, Pär Ola and Elston, Christopher W. and Falck, Anna Karin and Forsare, Carina and Grabau, Dorthe and Rydén, Lisa and Stål, Olle and Fernö, Mårten},
  issn         = {0284-186X},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {68--74},
  publisher    = {Taylor & Francis},
  series       = {Acta Oncologica},
  title        = {Histological grade provides significant prognostic information in addition to breast cancer subtypes defined according to St Gallen 2013},
  url          = {http://dx.doi.org/10.1080/0284186X.2016.1237778},
  volume       = {56},
  year         = {2017},
}