Clinical and morphological factors associated with two groups of concordant breast cancer immunophenotypes
a cross-sectional study of 24-year historical series
DOI:
https://doi.org/10.31686/ijier.vol9.iss10.3438Keywords:
Invasive Breast Cancer, Immunohistochemical, Immunophenotypes, HER2, Oestrogen ReceptorAbstract
This study aimed to describe the prevalence of invasive breast cancer (IBC) in women assisted in a public hospital in Brazil and to establish a correlation between two models of classification by immunophenotypes, one of them based on the 13th St. Gallen Conference classification and the other on biomarker-defined subtypes based on HER2 and oestrogen receptor status, as described in World Health Organization (WHO). We selected IBC of 1335 cases between 1994 and 2018. Univariate frequencies and associations were estimated using chi-square tests. The concordance between the two immunohistochemical analysis models above mentioned using Cohen's kappa coefficients. The most prevalent subtype was luminal B/HER2, and the frequency of tumours with a worse prognosis was 62.7%. Has been identified an association between histological grade 3 (G3) and the worst prognostic subtypes: non-luminal A, Triple Negative Breast Cancer (TNBC), non-ER+/HER2- and ER-/HER2-. A similar association was found in nuclear G3 tumours. The results showed agreement between 99.48% and 100% when we compared the two immunohistochemical analysis models. Furthermore, there was an absolute agreement between the two models of immunohistochemical analysis. These results can contribute to institutions that do not have a molecular investigation, enabling accessible routine practice tools. Among the most important questions addressed in this work is the association between histological and nuclear G3 with the worst prognostic subtypes. Using the St. Gallen Conference classification and HER2 and ER status based on subtypes verified the feasibility of selecting IBC with different prognoses and correlated them with recognized predictive and prognostic factors.
References
WHO Classification of Tumors Editorial Board. Breast Cancer. Lyon: International Agency for Research on Cancer; 2019.
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 May 14-20;365(9472):1687-717. doi: 10.1016/S0140-6736(05)66544-0. PMID: 15894097. DOI: https://doi.org/10.1016/S0140-6736(05)66544-0
Trudeau M, Charbonneau F, Gelmon K, Laing K, Latreille J, Mackey J, “et al”. Selection of adjuvant chemotherapy for treatment of node-positive breast cancer. Lancet Oncol. 2005 Nov;6(11):886-98. doi: 10.1016/S1470-2045(05)70424-1. PMID: 16257797. DOI: https://doi.org/10.1016/S1470-2045(05)70424-1
Ahn SG, Kim SJ, Kim C, Jeong J. Molecular Classification of Triple-Negative Breast Cancer. J Breast Cancer. 2016 Sep;19(3):223-230. doi: 10.4048/jbc.2016.19.3.223. Epub 2016 Sep 23. PMID: 27721871; PMCID: PMC5053306. DOI: https://doi.org/10.4048/jbc.2016.19.3.223
Simon R, Mirlacher M, Sauter G. Tissue microarrays in cancer diagnosis. Expert Rev Mol Diagn. 2003 Jul;3(4):421-30. doi: 10.1586/14737159.3.4.421. PMID: 12877382. DOI: https://doi.org/10.1586/14737159.3.4.421
Hanahan D, Weinberg RA. The hallmarks of cancer. Cell. 2000 Jan 7;100(1):57-70. doi: 10.1016/s0092-8674(00)81683-9. PMID: 10647931. DOI: https://doi.org/10.1016/S0092-8674(00)81683-9
Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011 Mar 4;144(5):646-74. doi: 10.1016/j.cell.2011.02.013. PMID: 21376230. DOI: https://doi.org/10.1016/j.cell.2011.02.013
Sørlie T. Molecular portraits of breast cancer: tumour subtypes as distinct disease entities. Eur J Cancer. 2004 Dec;40(18):2667-75. doi: 10.1016/j.ejca.2004.08.021. PMID: 15571950. DOI: https://doi.org/10.1016/j.ejca.2004.08.021
Perou CM, Sørlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, “et al”. Molecular portraits of human breast tumours. Nature. 2000 Aug 17;406(6797):747-52. doi: 10.1038/35021093. PMID: 10963602. DOI: https://doi.org/10.1038/35021093
Prat A, Perou CM. Deconstructing the molecular portraits of breast cancer. Mol Oncol. 2011 Feb;5(1):5-23. doi: 10.1016/j.molonc.2010.11.003. Epub 2010 Nov 24. PMID: 21147047; PMCID: PMC5528267. DOI: https://doi.org/10.1016/j.molonc.2010.11.003
Vuong D, Simpson PT, Green B, Cummings MC, Lakhani SR. Molecular classification of breast cancer. Virchows Arch. 2014 Jul;465(1):1-14. doi: 10.1007/s00428-014-1593-7. Epub 2014 May 31. PMID: 24878755. DOI: https://doi.org/10.1007/s00428-014-1593-7
Bertucci F, Birnbaum D, Goncalves A. Proteomics of breast cancer: principles and potential clinical applications. Mol Cell Proteomics. 2006 Oct;5(10):1772-86. doi: 10.1074/mcp.R600011-MCP200. Epub 2006 May 29. PMID: 16733261. DOI: https://doi.org/10.1074/mcp.R600011-MCP200
Shak S. Overview of the trastuzumab (Herceptin) anti-HER2 monoclonal antibody clinical program in HER2-overexpressing metastatic breast cancer. Herceptin Multinational Investigator Study Group. Semin Oncol. 1999 Aug;26(4 Suppl 12):71-7. PMID: 10482196.
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 Sep;24(9):2206-23. doi: 10.1093/annonc/mdt303. Epub 2013 Aug 4. PMID: 23917950; PMCID: PMC3755334. DOI: https://doi.org/10.1093/annonc/mdt303
Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, “et al”. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017 Mar;67(2):93-99. doi: 10.3322/caac.21388. Epub 2017 Jan 17. PMID: 28094848.. DOI: https://doi.org/10.3322/caac.21388
Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 1991 Nov;19(5):403-10. doi: 10.1111/j.1365-2559.1991.tb00229.x. PMID: 1757079.. DOI: https://doi.org/10.1111/j.1365-2559.1991.tb00229.x
Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS, “et al”. Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. Arch Pathol Lab Med. 2018 Nov;142(11):1364-1382. doi: 10.5858/arpa.2018-0902-SA. Epub 2018 May 30. PMID: 29846104.. DOI: https://doi.org/10.5858/arpa.2018-0902-SA
Soliman NA, Yussif SM. Ki-67 as a prognostic marker according to breast cancer molecular subtype. Cancer Biol Med. 2016 Dec;13(4):496-504. doi: 10.20892/j.issn.2095-3941.2016.0066. PMID: 28154782; PMCID: PMC5250608.. DOI: https://doi.org/10.20892/j.issn.2095-3941.2016.0066
Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, “et al”. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst. 2009 May 20;101(10):736-50. doi: 10.1093/jnci/djp082. Epub 2009 May 12. PMID: 19436038; PMCID: PMC2684553.. DOI: https://doi.org/10.1093/jnci/djp082
Vieira DSC, Dufloth RM, Schmitt FCL, Zeferino LC. Carcinoma de mama: novos conceitos na classificação. Revista Brasileira de Ginecologia e Obstetrícia [online]. 2008, v. 30, n. 1 [Acessado 1 Setembro 2021] , pp. 42-47. Disponível em: <https://doi.org/10.1590/S0100-72032008000100008>. Epub 07 Abr 2008. ISSN 1806-9339. https://doi.org/10.1590/S0100-72032008000100008. DOI: https://doi.org/10.1590/S0100-72032008000100008
Ding YC, Steele L, Warden C, Wilczynski S, Mortimer J, Yuan Y, “et al”. Molecular subtypes of triple-negative breast cancer in women of different race and ethnicity. Oncotarget. 2019 Jan 4;10(2):198-208. doi: 10.18632/oncotarget.26559. PMID: 30719214; PMCID: PMC6349443. DOI: https://doi.org/10.18632/oncotarget.26559
Eiermann W, Rezai M, Kümmel S, Kühn T, Warm M, Friedrichs K, “et al”. The 21-gene recurrence score assay impacts adjuvant therapy recommendations for ER-positive, node-negative and node-positive early breast cancer resulting in a risk-adapted change in chemotherapy use. Ann Oncol. 2013 Mar;24(3):618-24. doi: 10.1093/annonc/mds512. Epub 2012 Nov 7. PMID: 23136233; PMCID: PMC3574549. DOI: https://doi.org/10.1093/annonc/mds512
Ahn HJ, Jung SJ, Kim TH, Oh MK, Yoon HK. Differences in Clinical Outcomes between Luminal A and B Type Breast Cancers according to the St. Gallen Consensus 2013. J Breast Cancer. 2015 Jun;18(2):149-59. doi: 10.4048/jbc.2015.18.2.149. Epub 2015 Jun 26. PMID: 26155291; PMCID: PMC4490264. DOI: https://doi.org/10.4048/jbc.2015.18.2.149
Almeida, A. M. P. T. de, Marquini, H. R., Leite, R. M., & Nai, G. A. (2012). PREVALÊNCIA DE CÂNCER DE MAMA E ASSOCIAÇÃO COM SEUS FATORES PROGNÓSTICOS E PREDITIVOS DIAGNOSTICADOS NUM HOSPITAL UNIVERSITÁRIO. Colloquium Vitae. ISSN: 1984-6436, 4(1), 27–37. https://revistas.unoeste.br/index.php/cv/article/view/733. DOI: https://doi.org/10.5747/cv.2012.v04.n1.v059
Williams C, Brunskill S, Altman D, Briggs A, Campbell H, Clarke M, “et al”. Cost-effectiveness of using prognostic information to select women with breast cancer for adjuvant systemic therapy. Health Technol Assess. 2006 Sep;10(34):iii-iv, ix-xi, 1-204. doi: 10.3310/hta10340. PMID: 16959170. DOI: https://doi.org/10.3310/hta10340
Payne SJ, Bowen RL, Jones JL, Wells CA. Predictive markers in breast cancer--the present. Histopathology. 2008 Jan;52(1):82-90. doi: 10.1111/j.1365-2559.2007.02897.x. PMID: 18171419. DOI: https://doi.org/10.1111/j.1365-2559.2007.02897.x
Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer. N Engl J Med. 2010 Nov 11;363(20):1938-48. doi: 10.1056/NEJMra1001389. PMID: 21067385. DOI: https://doi.org/10.1056/NEJMra1001389
Jiang H, Bai X, Zhang C, Zhang X. Evaluation of HER2 gene amplification in breast cancer using nuclei microarray in situ hybridization. Int J Mol Sci. 2012;13(5):5519-27. doi: 10.3390/ijms13055519. Epub 2012 May 8. PMID: 22754312; PMCID: PMC3382781. DOI: https://doi.org/10.3390/ijms13055519
Ng CK, Martelotto LG, Gauthier A, Wen HC, Piscuoglio S, Lim RS, “et al”. Intra-tumor genetic heterogeneity and alternative driver genetic alterations in breast cancers with heterogeneous HER2 gene amplification. Genome Biol. 2015 May 22;16(1):107. doi: 10.1186/s13059-015-0657-6. PMID: 25994018; PMCID: PMC4440518. DOI: https://doi.org/10.1186/s13059-015-0657-6
Braun L, Mietzsch F, Seibold P, Schneeweiss A, Schirmacher P, Chang-Claude J, “et al”. Intrinsic breast cancer subtypes defined by estrogen receptor signalling-prognostic relevance of progesterone receptor loss. Mod Pathol. 2013 Sep;26(9):1161-71. doi: 10.1038/modpathol.2013.60. Epub 2013 Apr 5. PMID: 23558572. DOI: https://doi.org/10.1038/modpathol.2013.60
Nielsen TO, Parker JS, Leung S, Voduc D, Ebbert M, Vickery T, “et al”. A comparison of PAM50 intrinsic subtyping with immunohistochemistry and clinical prognostic factors in tamoxifen-treated estrogen receptor-positive breast cancer. Clin Cancer Res. 2010 Nov 1;16(21):5222-32. doi: 10.1158/1078-0432.CCR-10-1282. Epub 2010 Sep 13. PMID: 20837693; PMCID: PMC2970720.. DOI: https://doi.org/10.1158/1078-0432.CCR-10-1282
Muftah AA, Aleskandarany MA, Al-Kaabi MM, Sonbul SN, Diez-Rodriguez M, Nolan CC, “et al”. Ki67 expression in invasive breast cancer: the use of tissue microarrays compared with whole tissue sections. Breast Cancer Res Treat. 2017 Jul;164(2):341-348. doi: 10.1007/s10549-017-4270-0. Epub 2017 May 6. PMID: 28478613; PMCID: PMC5487701. DOI: https://doi.org/10.1007/s10549-017-4270-0
Inwald EC, Klinkhammer-Schalke M, Hofstädter F, Zeman F, Koller M, Gerstenhauer M, “et al”. Ki-67 is a prognostic parameter in breast cancer patients: results of a large population-based cohort of a cancer registry. Breast Cancer Res Treat. 2013 Jun;139(2):539-52. doi: 10.1007/s10549-013-2560-8. Epub 2013 May 16. PMID: 23674192; PMCID: PMC3669503. DOI: https://doi.org/10.1007/s10549-013-2560-8
Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, “et al”. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 2004 Dec 30;351(27):2817-26. doi: 10.1056/NEJMoa041588. Epub 2004 Dec 10. PMID: 15591335. DOI: https://doi.org/10.1056/NEJMoa041588
Burstein HJ, Temin S, Anderson H, Buchholz TA, Davidson NE, Gelmon KE, “et al”. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: american society of clinical oncology clinical practice guideline focused update. J Clin Oncol. 2014 Jul 20;32(21):2255-69. doi: 10.1200/JCO.2013.54.2258. Epub 2014 May 27. PMID: 24868023; PMCID: PMC4876310. DOI: https://doi.org/10.1200/JCO.2013.54.2258
Rakha EA, Reis-Filho JS, Baehner F, Dabbs DJ, Decker T, Eusebi V, “et al”. Breast cancer prognostic classification in the molecular era: the role of histological grade. Breast Cancer Res. 2010;12(4):207. doi: 10.1186/bcr2607. Epub 2010 Jul 30. PMID: 20804570; PMCID: PMC2949637. DOI: https://doi.org/10.1186/bcr2607
Lakhani SR, Jacquemier J, Sloane JP, Gusterson BA, Anderson TJ, van de Vijver MJ, “et al”. Multifactorial analysis of differences between sporadic breast cancers and cancers involving BRCA1 and BRCA2 mutations. J Natl Cancer Inst. 1998 Aug 5;90(15):1138-45. doi: 10.1093/jnci/90.15.1138. PMID: 9701363. DOI: https://doi.org/10.1093/jnci/90.15.1138
Sheffield BS, Kos Z, Asleh-Aburaya K, Wang XQ, Leung S, Gao D, “et al”. Molecular subtype profiling of invasive breast cancers weakly positive for estrogen receptor. Breast Cancer Res Treat. 2016 Feb;155(3):483-90. doi: 10.1007/s10549-016-3689-z. Epub 2016 Feb 4. PMID: 26846986. DOI: https://doi.org/10.1007/s10549-016-3689-z
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 Mar 10;27(8):1160-7. doi: 10.1200/JCO.2008.18.1370. Epub 2009 Feb 9. PMID: 19204204; PMCID: PMC2667820. DOI: https://doi.org/10.1200/JCO.2008.18.1370
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Copyright (c) 2021 Daniella Serafin Couto Vieira, Rozany Mucha Dufloth, Laura Otto Walter, Carolina Rabello de Moraes, João Péricles da Silva Jr, Fernando Carlos De Lander Schmitt, Maria Cláudia Santos-Silva
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Accepted 2021-10-10
Published 2021-10-01
