Prognosis in women with small (T1mic,T1a,T1b) node-negative operable breast cancer by immunohistochemically selected subtypes

Abstract

International audienceKnowledge is limited about prognostic significance of breast cancer subtypes among women with small invasive node-negative breast tumours. We explored patterns of recurrence in 1691 women with pT1mic/T1a/T1b, pN0 and M0 breast cancer according to four immunohistochemically defined tumour subtypes: (i) Luminal A (ER-positive, PgR-positive, HER2-negative and Ki-67 < 14%); (ii) Luminal B (ER-positive and/or PgR-positive, HER2-positive and/or Ki-67 ≥ 14%); (iii) HER2-positive, both endocrine receptors absent; and (iv) Triple Negative. At multivariate analysis, women with the Triple Negative breast cancer subtype had an increased risk of loco-regional relapse (LRR) (Hazards Ratio (HR) 3.58; 95%CI: 1.40-9.13) and breast cancer related events (HR 2.18; 95%CI: 1.04-4.57). Overall, Luminal B subtype was not associated with a statistically significant increased risk of recurrence compared with Luminal A, while patients with Luminal B subtype tumours overexpressing HER2 had a 2 fold risk of reduced breast cancer related survival (BCS), but not an increased risk of LRR and distant metastases. Women with HER2 breast cancer subtype had a statistically significant increased risk of LRR (HR 4.53; 95%CI: 1.56-13.1), distant metastases and reduced BCS (HR 3.22; 95%CI: 1.44-7.18) and overall survival (HR 2.87; 95%CI: 1.05-7.89) when compared with the Luminal A subtype, at multivariate analysis. In conclusion, women with small size, node-negative, breast cancer are at higher risk of relapse if with HER2-positive endocrine receptor absent or Triple Negative disease

Impact of age, intrinsic subtype and local treatment on long-term local-regional recurrence and breast cancer mortality among low-risk breast cancer patients

“…Some studies observed that HER2 þ and/or Basal subtype tumors have a significantly higher risk of local failure than LumA tumors [12,15,16,28,30], whereas others found no such association [19,29,[31][32][33][34]. Only few studies have more than five years of observation time [9,12,19].…”

Analysis in early stage triple‐negative breast cancer treated with mastectomy without adjuvant radiotherapy: Patterns of failure and prognostic factors

“…Multiple studies have indicated a strong prognostic relation between patients with TNBC and increased LRR, and this also applied to early stage breast cancer. [10][11][12][13]18 In patients with ETNBC, Abdulkarim et al 14 recently reported that the LRR risk in the modified radical mastectomy without PMRT group was 2.5 times higher than in the breast-conserving therapy group among those with T1-T2N0 disease (4% vs 10%; P 5 .027). This has sparked an intense debate about re-evaluating the role of PMRT for ETNBC, a subgroup for which it was previously assumed that PMRT was not clearly indicated.…”

“…More studies since have demonstrated that patients who have TNBC are at a higher risk of LRR, 10,11 including those who have very early disease. 12,13 Moreover, in a recent article by Abdulkarim et al 14 reporting exclusively on TNBC, the highest LRR rates were observed in patients who underwent modified radical mastectomy without PMRT compared with those who underwent modified radical mastectomy and received PMRT or breast-conserving therapy. This highlights the need to re-evaluate prognostic factors in early stage TNBC (ETNBC) and the utility of PMRT.…”

Outcomes of her2-positive Early-Stage Breast Cancer in the Trastuzumab Era: A Population-Based Study of Canadian Patients

“…Studies comparing outcomes between the different subtypes have shown that her2 overexpression, which is found in 15%-20% of human breast cancers 3 , is associated with increased risk of locoregional recurrence [4][5][6][7][8][9] and increased breast cancer mortality [9][10] . Overexpression of her2 is thus generally considered to be a negative prognostic feature with an increased adjusted risk of breast cancer mortality that is approximately doubled 11 .…”