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Impact of the 21-gene recurrence score on outcome in patients with invasive lobular carcinoma of the breast

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Abstract

Purpose

Invasive lobular carcinoma (ILC) of the breast has unique clinicopathologic characteristics, compared to invasive ductal carcinoma. The role of the 21-gene Recurrence Score (RS) has not been clearly defined for ILC. We sought to determine the prognostic value of RS and the impact of adjuvant chemotherapy on long-term survival in patients with ILC.

Methods

Utilizing the Surveillance, Epidemiology and End Results database from 2004 to 2013, we identified records of women aged 18–74 years, diagnosed with estrogen receptor (ER)-positive ILC (stage I to III) with RS available. We categorized patients into risk groups based on the traditional RS cutoffs and into those of the Trial Assigning Individualized Options for Treatment (TAILORx). Five-year breast cancer-specific survival (BCSS) was analyzed using the Kaplan–Meier method and Cox proportional hazards models.

Results

Of the 7316 women included, 21% were in the low-risk; 71%, intermediate-risk; and 8%, high-risk groups as per TAILORx RS cutoffs. The 5-year BCSS was 99% in the low-risk, 99% in the intermediate-risk, and 96% in the high-risk groups. A high-risk RS as per TAILORx cutoff was independently associated with increased mortality (hazard ratio [HR] of death 2.37, 95% confidence interval [CI] 1.14–4.95) when compared to a low-risk RS. In both the high-risk and intermediate-risk groups, adjuvant chemotherapy was not significantly associated with the HR of death (high-risk, HR 1.14, 95% CI 0.55–2.38; intermediate-risk, HR 1.08, 95% CI 0.62–1.87).

Conclusion

For patients with ER-positive ILC, 8% were in the high-risk and 72% were in the intermediate-risk groups as per the TAILORx RS cutoffs. In the high-risk group, the RS predicted a lower 5-year BCSS. Adjuvant chemotherapy did not seem to confer a survival benefit for either the intermediate- or the high-risk cohorts.

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Fig. 1

Abbreviations

BCSS:

Breast cancer-specific survival

CI:

Confidence interval

ER:

Estrogen receptor

HER:

Human epidermal growth factor receptor

HR:

Hazard ratio

IDC:

Invasive ductal carcinoma

ILC:

Invasive lobular carcinoma

OS:

Overall survival

PR:

Progesterone receptor

RS:

Recurrence score

SEER:

Surveillance, epidemiology, and end results

TAILORx:

Trial assigning individualized options for treatment

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Acknowledgments

The authors would like to thank Dr. Mary Knatterud for her assistance in editing this manuscript. Dr. Todd Tuttle reports a potential conflict of interest in holding an advisory board position for Genomic Health. There are no other conflicts of interest to disclose.

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Author notes

  1. Scott Kizy and Jing Li Huang have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, University of Minnesota, Mayo Mail Code 195, 420 Delaware Street SE, Minneapolis, MN, 55455, USA

    Scott Kizy, Jing Li Huang, Schelomo Marmor, Todd M. Tuttle & Jane Yuet Ching Hui

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  1. Scott Kizy
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  2. Jing Li Huang
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  3. Schelomo Marmor
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  4. Todd M. Tuttle
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Corresponding author

Correspondence to Jane Yuet Ching Hui.

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Kizy, S., Huang, J.L., Marmor, S. et al. Impact of the 21-gene recurrence score on outcome in patients with invasive lobular carcinoma of the breast. Breast Cancer Res Treat 165, 757–763 (2017). https://doi.org/10.1007/s10549-017-4355-9

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  • DOI: https://doi.org/10.1007/s10549-017-4355-9

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