The inconsistency of molecular subtypes between primary foci and metastatic axillary lymph nodes in Luminal A breast cancer patients among Chinese women, an indication for chemotherapy?
- 153 Downloads
Patients with Luminal A breast cancer often have favorable prognosis, but some of these patients still have lymph node metastases, it remains unclear what the role of adjuvant chemotherapy is in Luminal A subtype with lymph node metastases. The aim of this study was to find a new method to distinguish which Luminal A patient can be benefited from chemotherapy. We retrospectively investigated the inconsistency of molecular subtypes between primary foci and metastatic axillary lymph nodes in Luminal A breast cancer patients, and analyzed the clinicopathologic characteristics, Recurrence score (RS), disease-free survival (DFS), and overall survival (OS) in 146 Luminal A breast cancer patients. The discordance of molecular subtypes between primary foci and metastatic lymph nodes were explored by univariate and multivariate logistic regression. The DFS and OS were calculated by the Kaplan–Meier survival curves, and the Cox regression analyses were performed to identify independent prognostic factors for DFS and OS. In our results, the inconsistency was found in 55 patients (55/146, 37.67 %). Lymphatic vascular invasion (OR 6.402, 95 % CI 2.371–17.287, P < 0.001), lymph node stage (OR 2.147, 95 % CI 1.095–4.209, P = 0.026), and histological grade (OR 3.319, 95 % CI 1.101–8.951, P = 0.032) were significantly related to the inconsistency. The inconsistent group (non-Luminal A variations) had a poor prognosis compared with the consistent group, the DFS between the two groups was significantly different (P = 0.022), but the OS did not have obvious difference (P = 0.140). Moreover, the inconsistency was associated with high RS (P = 0.036). In conclusion, more aggressive molecular subtypes in metastatic lymph nodes, which associated with poor prognosis, were observed in Luminal A breast cancer patients, which indicate that chemotherapy is necessary for these patients.
KeywordsBreast cancer Luminal A Lymph node metastases Molecular subtype
Human epidermal growth factor receptor-2
Fluorescence in situ hybridization assay
Quantitative reverse transcription polymerase chain reaction
This work was supported by the fund of the “Research on Estrogen Receptor Heterogeneity of breast cancer” (project number: 142102410056) and Nanjing Youth Health Talented Person Fund (project number: QRX11111).
We thank Lianfang Li (Department of Breast, Affiliated Cancer Hospital of Zhengzhou University) for his expert technical assistance in indirect study.
YDS carried out the clinical data analyses and prepared the manuscript.
XFL performed the statistical analyses and helped to prepare the manuscript.
JXW conceived of the study and gave administrative support for the manuscript.
Compliance with ethical standards
Conflicts of interest
- 2.Webster DJT, Bronn DG, Minton JP. Estrogen variability of oestrogen and progesterone receptor status between primary breast cancer and nodal metastases: preliminary communication. J R Soc Med. 1982;75(9):719–22.Google Scholar
- 3.Simmons C, Miller N, Geddie W, et al. Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases? Annal Oncol, 2009: mdp028.Google Scholar
- 4.NCCN clinical practice guidelines in oncology (NCCN Guidelines). Breast cancer version 2. 2012, http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf; 2012.
- 5.Cardoso F, Senkus-Konefka E, Fallowfield L, Costa A, Castiglione M, ESMO Guidelines Working Group. Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. 2010;21(suppl 5):v15-9.Google Scholar
- 6.Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn H-J. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22:1736–7.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Genomic health. Oncotype DX: clinical summary. 2011. Available from: http://www.oncotypedx.com/en-US/Breast/Healthcare Professional/ClinicalSummary.aspx. [Accessed 2 Dec 2011].
- 12.Tang G, Shak S, Paik S, Anderson SJ. Comparison of the prognostic and predictive utilities of the 21-gene recurrence score assay and adjuvant! for women with node-negative, ER-positive breast cancer: results from NSABP B-14 and NSABP B-20. Breast Cancer Res Treat. 2011;127(1):133–42.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Falck AK, Bendahl PO, Chebil G, et al. Biomarker expression and St. Gallen molecular subtype classification in primary tumours, synchronous lymph node metastases and asynchronous relapses in primary breast cancer patients with 10 years’ follow-up. Breast Cancer Res Treat. 2013;140(1):93–104.CrossRefPubMedGoogle Scholar
- 17.Liao GS, Chou YC, Hsu HM, et al. The prognostic value of lymph node status among breast cancer subtypes. Am J Surg. 2015;209(4):717–24.Google Scholar