Distinct distribution and prognostic significance of molecular subtypes of breast cancer in Chinese women: a population-based cohort study

Abstract

BackgroundMolecular classification of breast cancer is an important prognostic factor. The distribution of molecular subtypes of breast cancer and their prognostic value has not been well documented in Asians.MethodsA total of 2,791 breast cancer patients recruited for a population-based cohort study were evaluated for molecular subtypes of breast cancer by immunohistochemical assays. Data on clinicopathological characteristics were confirmed by centralized pathology review. The average follow-up of the patients was 53.4 months. Overall and disease-free survival by molecular subtypes of breast cancer were evaluated.ResultsThe prevalence of the luminal A, luminal B, human epidermal growth factor receptor 2 (HER2), and triple-negative subtypes were 48.6%, 16.7%, 13.7%, and 12.9%, respectively. The luminal A subtype was more likely to be diagnosed in older women (P = 0.03) and had a stronger correlation with favorable clinicopathological factors (smaller tumor size, lower histologic grade, and earlier TNM stage) than the triple-negative or HER2 subtypes. Women with triple-negative breast cancer had a higher frequency of family history of breast cancer than women with other subtypes (P = 0.048). The 5-year overall/disease-free survival percentages for the luminal A, luminal B, HER2, and triple-negative subtypes were 92.9%/88.6%, 88.6%/85.1%, 83.2%/79.1%, and 80.7%/76.0%, respectively. A similar pattern was observed in multivariate analyses. Immunotherapy was associated with improved overall and disease-free survival for luminal A breast cancer, but reduced disease-free survival (HR = 2.21, 95% CI, 1.09-4.48) for the HER2 subtype of breast cancer.ConclusionsThe triple-negative and HER2 subtypes were associated with poorer outcomes compared with the luminal A subtype among these Chinese women. The HER2 subtype was more prevalent in this Chinese population compared with Western populations, suggesting the importance of standardized HER2 detection and anti-HER2 therapy to potentially benefit a high proportion of breast cancer patients in China.

Clinicopathological Features of Indonesian Breast Cancers with Different Molecular Subtypes

“…The luminal A subtype was the most common cancers. This results were similar with others (Perou et al 2000;Sorlie et al, 2003;Milikan et al, 2008;Jia et al, 2010;Su et al, 2011;Najafi et a., 2012, Chuthapisith et al, 2012. Different result was reported …”

“…The luminal A subtype was significantly higher among 70 years old women, early stage, small size and low grade tumors, and it is reported to have longer survival rate compared to the non luminal one. The triple negative/basal-like subtype was significantly correllated with familial breast cancers (Su et al, 2011). Another research in China found that luminal A cancers have the best prognosis, whereas Her-2+ cancers have the poorest (Jia et al, 2014).…”

Disease Free Survival among Molecular Subtypes of Early Stage Breast Cancer between 2001 and 2010 in Iran

“…The knowledge about periods of risks and common site of disease relapse could be used as a guide for focusing on clinical history and physical exams during the follow up visits and screening tests which provide the most information. Mean age of diagnosis in our study was 47.9±9.6 which was lower comparing to study of Su et al (2010) and Kadivar et al (2012) with a mean age of 53±10.4 years old at the time of diagnosis but Bennis et al (2012) similar to Tunisian study in which the mean age of diagnosis was reported 46.8±12 and Haghighat et al (2012) was higher comparing to Iranian study with a mean age of 45.9±10.5. In our patients 9% were under 35 years old and 63.5% were over 50 years old,similar to other Iranian study, patients under 35 years old were 12% and patients over 50 years old were 42% (Kadivar et al, 2012), with regard to study of Webster et al (2008) patients under 35 years old were 6.2% and patients over 50 years old were 37.8% (Webster et al, 2008), our patients had breast cancer at a younger age,possibily due to ethnic and genetic differences.…”

Diagnostic and Prognostic Importance of the Neutrophil Lymphocyte Ratio in Breast Cancer

“…Based on a high degree of heterogeneity, recently these tumors classify according to molecular characteristics (Perou et al, 2000;Sorlie et al, 2003;Viale, 2012). In the literature several studies have shown that triple negative (ER, PR and HER2 negative; basal like type) and HER2 subtypes were associated with poor prognosis compared with the luminal A subtype (Parise et al, 2009;Zhao et al, 2009;Su et al, 2011;Lv et al, 2011;Rao et al, 2013),. In the present study, positive HER 2 (IHC 3+) and negative ER, PR and HER2 (positive with CK 5/6, basal like type) were associated with high NLR while positive ER and PR related with lower NLR.…”