Ann Surg Treat Res.  2016 Jan;90(1):1-9. 10.4174/astr.2016.90.1.1.

Biologic subtype is a more important prognostic factor than nodal involvement in patients with stages I and II breast carcinoma

• Kim H
• Cho J
• Kwon SY
• Kang SH

• KMID: 2149925
• DOI: http://doi.org/10.4174/astr.2016.90.1.1

Abstract

PURPOSE
Nodal infiltration has been one of the most important prognostic factors in breast cancer. In recent decades, risk stratification has greatly changed, and is applied in accordance with hormone receptor and human epidermal growth factor receptor 2 (HER2) status. We compared the prognostic power of tumor subtype to nodal involvement in early breast cancer.
METHODS
We reviewed the medical records of 505 patients who had curative surgery for stage I or II breast cancer. We analyzed clinicopathologic factors according to tumor subtype and nodal involvement. Tumors were classified into 4 subtypes according to immunohistochemical status of estrogen receptor, progesterone receptor, HER2, and Ki67 labeling index. Disease-free survival (DFS) and overall survival were analyzed.
RESULTS
There were 363 node-negative patients (71.9%) and 142 node-positive patients (28.1%). Luminal A, Luminal B, HER2, and triple-negative breast cancer subtypes were composed of 207 (41.0%), 147 (29.1%), 42 (8.3%), and 109 patients (21.6%), respectively. The median follow-up period was 89.5 months. Node negative-luminal A subtype showed the best prognosis with regard to 5-year DFS, and the pN1-triple negative subtype was associated with the shortest DFS (95.1% vs. 67.8%; hazard ratio, 9.554; P < 0.001). However, the node negative-triple negative subtype was associated with a worse 5-year DFS than the pN1-luminal A subtype ([86.4%; hazard ratio, 2.647; P = 0.048] vs. [93.2%; hazard ratio, 2.061; P = 0.194]).
CONCLUSION
Node negative-triple negative breast cancer was associated with a poorer prognosis than pN1-luminal A subtype. Tumor subtype has greater prognostic power compared to nodal status in early breast cancer.

Keyword

Breast neoplasms; Lymphatic metastasis; Prognosis; Triple negative breast neoplasms

MeSH Terms

Breast Neoplasms*
Breast*
Disease-Free Survival
Estrogens
Follow-Up Studies
Humans
Lymphatic Metastasis
Medical Records
Phenobarbital
Prognosis
Receptor, Epidermal Growth Factor
Receptors, Progesterone
Triple Negative Breast Neoplasms
Estrogens
Phenobarbital
Receptor, Epidermal Growth Factor
Receptors, Progesterone

Figure

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  Fig. 1 Description of study population. DCIS, ductal carcinoma in situ; LCIS, lobular carcinoma in situ.

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  Fig. 2 Disease-free survival (DFS) of total patients according to nodal status (A) and intrinsic subtype (B). HER2, human epidermal growth factor receptor 2; TNBC, triple negative breast cancer.

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  Fig. 3 (A-D) Subgroup analysis of disease-free survival (DFS) according to intrinsic subtype and nodal status. HER2, human epidermal growth factor receptor 2; TNBC, triple negative breast cancer.

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  Fig. 4 Progression hazard rate for recurrence between luminal A type with pN1 and triple negative type with pN0. DFS, disease-free survival; TNBC, triple negative breast cancer.

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