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. 2016 Dec 9;8(12):e924.
doi: 10.7759/cureus.924.

Pattern of Local Recurrence and Distant Metastasis in Breast Cancer By Molecular Subtype

Xingrao Wu  1 , Ayesha Baig  2 , Goulnar Kasymjanova  3 , Kamran Kafi  2 , Christina Holcroft  4 , Hind Mekouar  2 , Annie Carbonneau  2 , Boris Bahoric  2 , Khalil Sultanem  2 , Thierry Muanza  2
Affiliations

Pattern of Local Recurrence and Distant Metastasis in Breast Cancer By Molecular Subtype

Xingrao Wu et al. Cureus. .

Abstract

Background and purpose: No longer considered a single disease entity, breast cancer is being classified into several distinct molecular subtypes based on gene expression profiling. These subtypes appear to carry prognostic implications and have the potential to be incorporated into treatment decisions. In this study, we evaluated patterns of local recurrence (LR), distant metastasis (DM), and association of survival with molecular subtype in breast cancer patients in the post-adjuvant radiotherapy setting.

Material and methods: The medical records of 1,088 consecutive, non-metastatic breast cancer patients treated at a single institution between 2004 and 2012 were reviewed. Estrogen/progesterone receptors (ER/PR) and human epidermal growth factor receptor-2 (HER2) enrichment were evaluated by immunohistochemistry. Patients were categorized into one of four subtypes: luminal-A (LA; ER/PR+, HER2-, Grade 1-2), luminal-B (LB; ER/PR+, HER2-, Grade > 2), HER2 over-expression (HER2; ER/PR-, HER2+), and triple negative (TN; ER/PR-, HER2-). Results: The median follow-up time was 6.9 years. During the follow-up, 16% (174/1,088) of patients failed initial treatment and developed either LR (48) or DM (126). The prevalence of LR was the highest in TN (12%) and the lowest in LA (2%). Breast or chest wall relapse was the most frequent site (≈80%) of recurrence in LA, LB, and HER2 subtypes, whereas the regional lymph nodes and chest wall were the common sites of relapse in the TN group (50.0%). DM rates were 6.4% in LA, 12.1% in LB, 19.2% in HER2, and 27.4% in TN subgroups. Five-year survival rates were 84%, 83%, 84%, and 77% in the LA, LB, HER2 and TN subgroups, respectively. There was a statistically significant association between survival and molecular subtypes in an univariate analysis. In the adjusted multivariate analysis, the following variables were independent prognostic factors for survival: T stage, N stage, and molecular subtype.

Conclusions: Of the four subtypes, the LA subtype tends to have the best prognosis, fairly high survival, and low recurrent or metastases rates. The TN and HER2 subtypes of breast cancer were associated with significantly poorer overall survival and prone to earlier recurrence and metastases. Our results demonstrate a significant association between molecular subtype and survival. The risk of death and relapse/metastases increases fewfold in TN compared to LA. Future prospective studies are warranted and could ultimately lead to the tailoring of adjuvant radiotherapy treatment fields based on both molecular subtype and the more conventional clinicopathologic characteristics.

Keywords: breast cancer; molecular subtype; pattern; recurrence.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Failure Rate (Local Recurrence + Distal Metastases) Among Different Groups of Molecular Subtypes
Figure 2
Figure 2. Overall Survival by Molecular Subtypes (p
Figure 3
Figure 3. Local Recurrence-Free Survival by Subtypes (p
LRFS = local recurrence-free survival
Figure 4
Figure 4. Distant Metastasis-Free Survival by Molecular Subtypes (p
DMFS = distant metastasis-free survival
Figure 5
Figure 5. Progression-Free Survival by Molecular Subtypes (p
PFS = progression-free survival
See this image and copyright information in PMC

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