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Impact of immunohistological subtypes on the long-term prognosis of patients with metastatic breast cancer

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Abstract

Purpose

Although improved long-term prognoses for patients with metastatic breast cancer (MBC) have been demonstrated, few reports address overall survival (OS) with sufficient follow-up. Furthermore, the relevance of immunohistological subtypes to OS in MBC has not been clarified.

Methods

We evaluated, retrospectively, the OS of patients who had been initiated on systemic therapy for MBC between 2000 and 2008.

Results

The subjects of this study were 527 patients with MBC treated by systemic therapy. The median survival time (MST) was 55.5 months. The MST for each immunohistological subtype was as follows: luminal, 59.9 months; luminal-HER2, not reached; triple-negative, 18.6 months; and HER2-enriched, 49.9 months. According to multivariate analysis, metastasis-free intervals of ≥2 years and treatment with anthracycline for MBC were predictive of better OS. The predictors of shorter OS included disease progression after first-line treatment for MBC, triple-negative, and all histological factors, except papillotubular carcinoma, with liver metastasis, and having three or more initial metastatic sites.

Conclusions

The prognosis of the patients with MBC in this series was better than that reported before 2000, which is probably attributable to the use of novel, improved pharmacological agents. For example, luminal-HER2 tumors can be treated using both aromatase inhibitors and trastuzumab. Because of the lower toxicities, it is now possible to administer these agents for longer periods, resulting in better prognoses.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.

    Article  PubMed  Google Scholar 

  2. Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T, et al. Cancer incidence and incidence rates in Japan in 2005: based on data from 12 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2011;41:139–47.

    Article  PubMed  Google Scholar 

  3. Early Breast Cancer Trialists’ Collaborative Group. (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–717.

    Article  Google Scholar 

  4. Hortobagyi GN. Treatment of breast cancer. N Engl J Med. 1998;339:974–84.

    Article  CAS  PubMed  Google Scholar 

  5. Chia SK, Speers CH, D’yachkova Y, Kang A, Malfair-Taylor S, Barnett J, et al. The impact of new chemotherapeutic and hormone agents on survival in a population-based cohort of women with metastatic breast cancer. Cancer. 2007;110:973–9.

    Article  PubMed  Google Scholar 

  6. Weide R, Mergenthaler U, Pandorf A, Arndt H, Heymanns J, Thomalla J, et al. Improved survival of patients with metastatic breast cancer in routine care: results of a retrospective study in a community-based oncology group practice 1995–2005. Onkologie. 2009;32:107–13.

    Article  PubMed  Google Scholar 

  7. Giordano SH, Buzdar AU, Smith TL, Kau SW, Yang Y, Hortobagyi GN. Is breast cancer survival improving? Cancer. 2004;100:44–52.

    Article  PubMed  Google Scholar 

  8. Gennari A, Conte P, Rosso R, Orlandini C, Bruzzi P. Survival of metastatic breast carcinoma patients over a 20-year period: a retrospective analysis based on individual patient data from six consecutive studies. Cancer. 2005;104:1742–50.

    Article  PubMed  Google Scholar 

  9. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ. 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;22:1736–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol. 2013;24:2206–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bhargava R, Beriwal S, Dabbs DJ, Ozbek U, Soran A, Johnson RR, et al. Immunohistochemical surrogate markers of breast cancer molecular classes predicts response to neoadjuvant chemotherapy. Cancer. 2010;116:1431–9.

    Article  CAS  PubMed  Google Scholar 

  12. Bastien RR, Rodríguez-Lescure Á, Ebbert MT, Prat A, Munárriz B, Rowe L, et al. PAM50 breast cancer subtyping by RT-qPCR and concordance with standard clinical molecular markers. BMC Med Genomics. 2012;5:44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Cheang MC, Voduc D, Bajdik C, Leung S, McKinney S, Chia SK, et al. Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clin Cancer Res. 2008;14:1368–76.

    Article  CAS  PubMed  Google Scholar 

  14. Nielsen TO, Hsu FD, Jensen K, Cheang M, Karaca G, Hu Z, et al. Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res. 2004;10:5367–74.

    Article  CAS  PubMed  Google Scholar 

  15. Calza S, Hall P, Auer G, Bjöhle J, Klaar S, Kronenwett U, et al. Intrinsic molecular signature of breast cancer in a population-based cohort of 412 patients. Breast Cancer Res. 2006;8:R34.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Parker JS, Mullins M, Cheang MC, Leung S, Voduc D, Vickery T, et al. Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol. 2009;27:1160–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F, et al. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res. 2007;13:2329–34.

    Article  CAS  PubMed  Google Scholar 

  18. Sakamoto G, Inaji H, Akiyama F, Haga S, Hiraoka M, Inai K, et al. General rules for clinical and pathological recording of breast cancer 2005. Breast Cancer. 2005;12(Suppl):S1–27.

    PubMed  Google Scholar 

  19. Ihaka R, Gentleman R. R: a language for data analysis and graphics. J Comp Graph Stat. 1996;5:299–314.

    Google Scholar 

  20. Inoue K, Ogawa M, Horikoshi N, Aiba K, Mukaiyama T, Mizunuma N, et al. Evaluation of prognostic factors for 233 patients with recurrent advanced breast cancer. Jpn J Clin Oncol. 1991;21:334–9.

    CAS  PubMed  Google Scholar 

  21. Rivera E. Management of metastatic breast cancer: monotherapy options for patients resistant to anthracyclines and taxanes. Am J Clin Oncol. 2010;33:176–85.

    CAS  PubMed  Google Scholar 

  22. Jones SE. Metastatic breast cancer: the treatment challenge. Clin Breast Cancer. 2008;8:224–33.

    Article  CAS  PubMed  Google Scholar 

  23. Moreno-Aspitia A, Perez EA. Treatment options for breast cancer resistant to anthracycline and taxane. Mayo Clin Proc. 2009;84:533–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Seshadri R, Firgaira FA, Horsfall DJ, McCaul K, Setlur V, Kitchen P. Clinical significance of HER-2/neu oncogene amplification in primary breast cancer. The South Australian Breast Cancer Study Group. J Clin Oncol. 1993;11:1936–42.

    CAS  PubMed  Google Scholar 

  25. Kaufman B, Mackey JR, Clemens MR, Bapsy PP, Vaid A, Wardley A, et al. Trastuzumab plus anastrozole versus anastrozole alone for the treatment of postmenopausal women with human epidermal growth factor receptor 2-positive, hormone receptor-positive metastatic breast cancer: results from the randomized phase III TAnDEM study. J Clin Oncol. 2009;27:5529–37.

    Article  CAS  PubMed  Google Scholar 

  26. Koeberle D, Ruhstaller T, Jost L, Pagani O, Zaman K, von Moos R, et al. Combination of trastuzumab and letrozole after resistance to sequential trastuzumab and aromatase inhibitor monotherapies in patients with estrogen receptor-positive, HER-2-positive advanced breast cancer: a proof-of-concept trial (SAKK 23/03). Endocr Relat Cancer. 2011;18:257–64.

    Article  CAS  PubMed  Google Scholar 

  27. Tanaka K, Tokunaga E, Yamashita N, Taketani K, Akiyoshi S, Morita M, et al. A luteinizing hormone-releasing hormone agonist plus an aromatase inhibitor as second-line endocrine therapy in premenopausal females with hormone receptor-positive metastatic breast cancer. Surg Today. 2014;44:1678–84.

    Article  CAS  PubMed  Google Scholar 

  28. Santinelli A, Pisa E, Stramazzotti D, Fabris G. HER-2 status discrepancy between primary breast cancer and metastatic sites. Impact on target therapy. Int J Cancer. 2008;122:999–1004.

    Article  CAS  PubMed  Google Scholar 

  29. Amir E, Miller N, Geddie W, Freedman O, Kassam F, Simmons C, et al. Prospective study evaluating the impact of tissue confirmation of metastatic disease in patients with breast cancer. J Clin Oncol. 2012;30:587–92.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Chizuko Tsutsumi, Takayo Fukuda, Shinichiro Taira, Yoko Chihara, Nahomi Tokudome, and Masujiro Makita for data collection and assembly.

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Authors and Affiliations

  1. Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Kokoro Kobayashi, Yoshinori Ito, Ippei Fukada & Shunji Takahashi

  2. Division of Cancer Genomics, Cancer Institute of Japanese Foundation for Cancer Research, and Bioinformatics Group, Genome Center of Japanese Foundation for Cancer Research, Tokyo, Japan

    Masaaki Matsuura

  3. Department of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Rie Horii

  4. Department of Pathology, The Cancer Institute of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Futoshi Akiyama

  5. Department of Breast Surgical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Takuji Iwase

  6. Department of Breast Oncology, Jichi Medical University, Shimotsuke, Japan

    Yasuo Hozumi

  7. Department of Gastrointestinal Surgery, Jichi Medical University, Shimotsuke, Japan

    Yoshikazu Yasuda

  8. Department of Hematology and Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Kiyohiko Hatake

Authors
  1. Kokoro Kobayashi
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  2. Yoshinori Ito
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  3. Masaaki Matsuura
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Corresponding author

Correspondence to Kokoro Kobayashi.

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Kokoro Kobayashi and her co-authors have no conflicts of interest.

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Kobayashi, K., Ito, Y., Matsuura, M. et al. Impact of immunohistological subtypes on the long-term prognosis of patients with metastatic breast cancer. Surg Today 46, 821–826 (2016). https://doi.org/10.1007/s00595-015-1252-x

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  • DOI: https://doi.org/10.1007/s00595-015-1252-x

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