World Journal of Surgery

, 35:2196 | Cite as

Prognostic Factors Affecting Postmastectomy Locoregional Recurrence in Patients with Early Breast Cancer: Are Intrinsic Subtypes Effective?

  • Hakan Mersin
  • Kaptan Gülben
  • Uğur Berberoğlu
  • Mete Yazι
  • Gökçe Acun
  • Volkan Kιnaş
  • Şükrü Erdoğan
Article
First Online:

Abstract

Background

Many studies have investigated the association between the molecular subtypes of breast cancer and survival. The aim of this study was to identify the effects of intrinsic subtypes of breast cancer and the other clinicopathological factors on postmastectomy locoregional recurrence (LRR) in patients with early breast cancer.

Methods

The records of 1,195 consecutive early breast cancer patients treated with modified radical mastectomy between 2004 and 2008 were retrospectively evaluated. The effects of intrinsic subtypes of the tumor (luminal A, luminal B, HER2-overexpressing, and triple-negative) and classical clinicopathological factors on LRR were identified by univariate and multivariate statistical analyses.

Results

The median follow-up time was 44 months, and 16 (1.3%) patients experienced a LRR during this period. In univariate analysis, the intrinsic subtypes of breast cancer had a significant effect on LRR (p = 0.002). In multivariate analysis, only extranodal invasion and estrogen receptor (ER) status were significant predictors of LRR (p = 0.003 and 0.0001, respectively), whereas intrinsic subtypes did not reveal a significant relationship with LRR (p = 0.57; hazard ratio, 2.9; 95% confidence interval, 0.2–4.7).

Conclusions

The results of this study suggest that the extranodal invasion and negative ER status should potentially be considered when evaluating the risk of LRR. The predictive power of intrinsic subtypes for LRR is less than that of classical pathological indicators. This information may be useful in planning management of LRR in early breast cancer patients treated with mastectomy.

Keywords

Breast Cancer Axillary Dissection Breast Cancer Subtype Intrinsic Subtype Danish Breast Cancer Cooperative Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Buchanan CL, Dorn PL, Fey J et al (2006) Locoregional recurrence after mastectomy. J Am Coll Surg 203:469–474PubMedCrossRefGoogle Scholar
  2. 2.
    Carreno G, del Casar JM, Corte MD et al (2007) Local recurrence after mastectomy for breast cancer: analysis of clinicopathological, biological and prognostic characteristics. Breast Cancer Res Treat 102:61–73PubMedCrossRefGoogle Scholar
  3. 3.
    Jager JJ, Volovics L, Schouten LJ et al (1999) Locoregional recurrences after mastectomy in breast cancer: prognostic factors and implications for postoperative irradiation. Radiother Oncol 50:267–275PubMedCrossRefGoogle Scholar
  4. 4.
    Livi L, Saieva C, Detti B et al (2007) Loco-regional recurrence in 2064 patients with breast cancer treated with mastectomy without adjuvant radiotherapy. Eur J Surg Oncol 33:977–981PubMedGoogle Scholar
  5. 5.
    Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high risk premenopausal women with breast cancer who receive adjuvant chemotherapy: Danish Breast Cancer Cooperative Group 82b trial. N Eng J Med 337:949–955CrossRefGoogle Scholar
  6. 6.
    Overgaard M, Jensen MB, Overgaard J et al (1999) Postoperative radiotherapy in high risk postmenopausal breast cancer patients given adjuvant tamoxifen. Danish Breast Cancer Cooperative Group 82c randomised trial. Lancet 353:1641–1648PubMedCrossRefGoogle Scholar
  7. 7.
    Ragaz J, Olivotto IA, Spinelli JJ et al (2005) Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of British Columbia Randomized Trial. J Natl Cancer Inst 97:116–126PubMedCrossRefGoogle Scholar
  8. 8.
    Sorlie T, Tibshirani R, Parker J et al (2003) Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 100:8418–8423PubMedCrossRefGoogle Scholar
  9. 9.
    Perou CM, Sorlie T, Eisen MB et al (2000) Molecular portraits of human breast tumours. Nature 406:747–752PubMedCrossRefGoogle Scholar
  10. 10.
    Paik S, Shak S, Tang G et al (2004) A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 351:2817–2826PubMedCrossRefGoogle Scholar
  11. 11.
    van de Vijver MJ, He YD, van’t Veer LJ et al (2002) A gene-expression signature as a predictor of survival in breast cancer. N Engl J Med 347:1999–2009PubMedCrossRefGoogle Scholar
  12. 12.
    Kwan ML, Kushi LH, Weltzien E et al (2009) Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors. Breast Cancer Res 11:1–13CrossRefGoogle Scholar
  13. 13.
    Bidard FC, Conforti R, Boulet T et al (2007) Does triple-negative phenotype accurately identify basal-like tumour? An immunochemical analysis based on 143 ‘triple-negative’ breast cancers. Ann Oncol 18:1285–1286PubMedCrossRefGoogle Scholar
  14. 14.
    Bertucci F, Finetti P, Cervera N et al (2008) How basal are triple-negative breast cancers? Int J Cancer 123:236–240PubMedCrossRefGoogle Scholar
  15. 15.
    Tan DS, Marchio C, Jones RL et al (2008) Triple negative breast cancer: molecular profiling and prognostic impact in adjuvant anthracycline-treated patients. Breast Cancer Res Treat 111:27–44PubMedCrossRefGoogle Scholar
  16. 16.
    Nielsen TO, Hsu FD, Jensen K et al (2004) Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res 10:5367–5374PubMedCrossRefGoogle Scholar
  17. 17.
    Sorlie T, Perou CM, Tibshirani R et al (2001) Gene expression patterns of breast carcinomas distinguish tumour subclasses with clinical implications. Proc Natl Acad Sci USA 98:10869–10874PubMedCrossRefGoogle Scholar
  18. 18.
    Carey LA, Dees EC, Sawyer L et al (2007) The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 13:2329–2334PubMedCrossRefGoogle Scholar
  19. 19.
    Bauer KR, Brown M, Cress RD et al (2007) Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, so-called triple-negative phenotype: a population-based study from the California Cancer Registry. Cancer 109:1721–1728PubMedCrossRefGoogle Scholar
  20. 20.
    Harris LN, Broadwater G, Lin NU et al (2006) Molecular subtypes of breast cancer in relation to paclitaxel response, outcomes in women with metastatic disease: results from CALGB 9342. Breast Cancer Res 8:R66PubMedCrossRefGoogle Scholar
  21. 21.
    Brown M, Tsodikov A, Bauer KR et al (2008) The role of human epidermal growth factor receptor 2 in the survival of women with estrogen and progesterone receptor-negative, invasive breast cancer: the California Cancer Registry, 1999–2004. Cancer 112:737–747PubMedCrossRefGoogle Scholar
  22. 22.
    Kurebayashi J, Moriya T, Ishida T et al (2007) The prevalence of intrinsic subtypes and prognosis in breast cancer patients of different races. Breast 16(Suppl 2):S72–S77PubMedCrossRefGoogle Scholar
  23. 23.
    Greene FL, Page DL, Fleming ID et al (2002) AJCC cancer staging manual, 6th edn. Springer, New YorkGoogle Scholar
  24. 24.
    Jatoi I, Porschan MA (2005) Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results. Am J Clin Oncol 28:289–294PubMedCrossRefGoogle Scholar
  25. 25.
    Chung CS, Harris JR (2007) Postmastectomy radiation therapy: translating local benefits into improved survival. Breast 16:S78–S83PubMedCrossRefGoogle Scholar
  26. 26.
    Cheng SH, Horng CF, Clarke JH et al (2006) Prognostic index score clinical prediction model of local regional recurrence after mastectomy in breast cancer patients. Int J Radiat Oncol Biol Phys 64:1401–1409PubMedCrossRefGoogle Scholar
  27. 27.
    Vlastos G, Rubio IT, Mirza NQ et al (2000) Impact of multicentricity on clinical outcome in patients with T1-2, N0-1, M0 breast cancer. Ann Surg Oncol 7:581–587PubMedGoogle Scholar
  28. 28.
    Nguyen PL, Taghian AG, Katz MS et al (2008) Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol 26:2373–2378PubMedCrossRefGoogle Scholar
  29. 29.
    Haffty BG, Yang Q, Reiss M et al (2006) Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol 24:5652–5657PubMedCrossRefGoogle Scholar
  30. 30.
    Voduc KD, Cheang M, Tyldesley S et al (2010) Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 28:1684–1691PubMedCrossRefGoogle Scholar
  31. 31.
    Millar EK, Graham PH, O’Toole SA et al (2009) Prediction of local recurrence, distant metastases, and death after breast-conserving therapy in early stage invasive breast cancer using a five-biomarker panel. J Clin Oncol 27:4701–4708PubMedCrossRefGoogle Scholar
  32. 32.
    Dent R, Trudeau M, Pritchard KI et al (2007) Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 13:4429–4434PubMedCrossRefGoogle Scholar
  33. 33.
    Van’t Veer LJ, Dai H, van de Vijver MJ et al (2002) Gene expression profiling predicts clinical outcome of breast cancer. Nature 415:530–536CrossRefGoogle Scholar
  34. 34.
    Carey LA, Perou CM, Livasy CA et al (2006) Race, breast cancer subtypes, and survival in the Caroline Breast Cancer Study. JAMA 295:2492–2502PubMedCrossRefGoogle Scholar
  35. 35.
    Rakha EA, El-Rehim DA, Paish C et al (2006) Basal phenotype identifies a poor prognostic subgroup of breast cancer of clinical importance. Eur J Cancer 42:3149–3156PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Hakan Mersin
    • 1
  • Kaptan Gülben
    • 1
    • 2
  • Uğur Berberoğlu
    • 1
  • Mete Yazι
    • 1
  • Gökçe Acun
    • 1
  • Volkan Kιnaş
    • 1
  • Şükrü Erdoğan
    • 1
  1. 1.Department of SurgeryAnkara Oncology Training and Research HospitalAnkaraTurkey
  2. 2.AnkaraTurkey

Personalised recommendations