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Breast Cancer Outcomes as Defined by the Estrogen Receptor, Progesterone Receptor, and Human Growth Factor Receptor-2 in a Multi-ethnic Asian Country

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Abstract

Introduction

Breast cancer can be divided into four subtypes based on the expressions of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor-2 (HER2). Each subtype has different clinicopathological features and outcomes.

Objective

To compare the clinicopathological features and survival of ER and/or PR positive HER2 negative (ER+PR+HER2−, ER+PR−HER2− or ER−PR+HER2−), ER and/or PR positive HER2 positive (ER+PR+HER2+, ER+PR−HER2+ or ER−PR+HER2+), ER negative PR negative HER2 positive (ER−PR−HER2+), and ER negative PR negative HER2 negative (ER−PR−HER2−) subtypes.

Methods

1957 patients with Stage 1–3 breast carcinoma diagnosed between Jan 2005 and Dec 2011 were categorized into the four subtypes. The clinicopathological features between the subtypes were compared using χ 2 test. Kaplan–Meier analysis was performed to estimate 5-year overall survival. Multivariate Cox regression was used to determine the association between subtypes and mortality adjusted for age, ethnicity, stage, pathological features, and treatment.

Results

ER−PR−HER2+ and ER−PR−HER2− subtypes were associated with younger age, larger tumors, and higher grade. There was no difference in the 5-year survival of the ER−PR−HER2+ and ER−PR−HER2− subtypes (75.1 and 74.4 %, respectively) and survival was poorer than in the ER and/or PR positive HER2 negative and ER and/or PR positive HER2 positive subtypes (87.1 and 83.1 %, respectively). Only 9.5 % of women with HER2 positive breast cancer had access to trastuzumab.

Conclusion

In a low resource setting with limited access to trastuzumab, there is no difference in survival between the ER−PR−HER2+ and ER−PR−HER2− subtypes of breast cancer.

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Acknowledgments

This paper is supported by HIR Grant UM.C/HIR/MOHE/06 from the Ministry of Education Malaysia.

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Authors and Affiliations

  1. National Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia

    S. Subramaniam

  2. Department of Social and Preventive Medicine, Julius Center University of Malaya, University of Malaya, Kuala Lumpur, Malaysia

    N. Bhoo-Pathy

  3. Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia

    N. A. Taib, G. H. Tan, M. H. See, S. Jamaris & C. H. Yip

  4. Department of Clinical Oncology, University Malaya Medical Centre, Kuala Lumpur, Malaysia

    G. F. Ho

  5. Department of Pathology, University Malaya Medical Centre, Kuala Lumpur, Malaysia

    L. M. Looi

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  1. S. Subramaniam
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  2. N. Bhoo-Pathy
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  3. N. A. Taib
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  4. G. H. Tan
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  9. C. H. Yip
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Corresponding author

Correspondence to C. H. Yip.

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The authors declare that they have no competing interests.

Ethics Approval

This study was approved by the Ethics Review Committee of the University Malaya Medical Centre.

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Subramaniam, S., Bhoo-Pathy, N., Taib, N.A. et al. Breast Cancer Outcomes as Defined by the Estrogen Receptor, Progesterone Receptor, and Human Growth Factor Receptor-2 in a Multi-ethnic Asian Country. World J Surg 39, 2450–2458 (2015). https://doi.org/10.1007/s00268-015-3133-2

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  • DOI: https://doi.org/10.1007/s00268-015-3133-2

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