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Histological grade provides significant prognostic information in addition to breast cancer subtypes defined according to St Gallen 2013.
Acta Oncol. 2017 Jan; 56(1):68-74.AO

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 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.

Authors+Show Affiliations

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.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.a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden.d Department of Histopathology , Nottingham University Hospitals NHS Trust , Nottingham , UK.e Department of Surgery , Helsingborg Hospital , Helsingborg , Sweden.a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden.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.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.i Division of Oncology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences , Linköping University , Linköping , Sweden.a Division of Oncology and Pathology, Department of Clinical Sciences , Lund Cancer Center at Medicon Village, Lund University , Lund , Sweden.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

27762648

Citation

Ehinger, Anna, et al. "Histological Grade Provides Significant Prognostic Information in Addition to Breast Cancer Subtypes Defined According to St Gallen 2013." Acta Oncologica (Stockholm, Sweden), vol. 56, no. 1, 2017, pp. 68-74.
Ehinger A, Malmström P, Bendahl PO, et al. Histological grade provides significant prognostic information in addition to breast cancer subtypes defined according to St Gallen 2013. Acta Oncol. 2017;56(1):68-74.
Ehinger, A., Malmström, P., Bendahl, P. O., Elston, C. W., Falck, A. K., Forsare, C., Grabau, D., Rydén, L., Stål, O., & Fernö, M. (2017). Histological grade provides significant prognostic information in addition to breast cancer subtypes defined according to St Gallen 2013. Acta Oncologica (Stockholm, Sweden), 56(1), 68-74. https://doi.org/10.1080/0284186X.2016.1237778
Ehinger A, et al. Histological Grade Provides Significant Prognostic Information in Addition to Breast Cancer Subtypes Defined According to St Gallen 2013. Acta Oncol. 2017;56(1):68-74. PubMed PMID: 27762648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Histological grade provides significant prognostic information in addition to breast cancer subtypes defined according to St Gallen 2013. AU - Ehinger,Anna, AU - Malmström,Per, AU - Bendahl,Pär-Ola, AU - Elston,Christopher W, AU - Falck,Anna-Karin, AU - Forsare,Carina, AU - Grabau,Dorthe, AU - Rydén,Lisa, AU - Stål,Olle, AU - Fernö,Mårten, AU - ,, Y1 - 2016/10/20/ PY - 2016/10/21/pubmed PY - 2017/1/18/medline PY - 2016/10/21/entrez SP - 68 EP - 74 JF - Acta oncologica (Stockholm, Sweden) JO - Acta Oncol VL - 56 IS - 1 N2 - 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. SN - 1651-226X UR - https://www.unboundmedicine.com/medline/citation/27762648/Histological_grade_provides_significant_prognostic_information_in_addition_to_breast_cancer_subtypes_defined_according_to_St_Gallen_2013_ L2 - https://www.tandfonline.com/doi/full/10.1080/0284186X.2016.1237778 DB - PRIME DP - Unbound Medicine ER -