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. 2017 Jun;77(6):651-659.
doi: 10.1055/s-0042-113189. Epub 2017 Jun 28.

Genetic Breast Cancer Susceptibility Variants and Prognosis in the Prospectively Randomized SUCCESS A Study

A Hein  1 , B Rack  2 , L Li  3   4 , A B Ekici  5 , A Reis  5 , M P Lux  1 , J M Cunningham  6 , M Rübner  1 , B L Fridley  7   8 , A Schneeweiss  9 , H Tesch  10 , W Lichtenegger  11 , T Fehm  12 , G Heinrich  13 , M Rezai  14 , M W Beckmann  1 , W Janni  15 , R M Weinshilboum  3 , L Wang  3 , P A Fasching  1   16 , L Häberle  1   17
Affiliations

Genetic Breast Cancer Susceptibility Variants and Prognosis in the Prospectively Randomized SUCCESS A Study

A Hein et al. Geburtshilfe Frauenheilkd. 2017 Jun.

Abstract
in English, German

Large-scale genotyping studies have identified over 70 single nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk. However, knowledge regarding genetic risk factors associated with the prognosis is limited. The aim of this study was therefore to investigate the prognostic effect of nine known breast cancer risk SNPs. BC patients (n = 1687) randomly sampled in an adjuvant, randomized phase III trial (SUCCESS A study) were genotyped for nine BC risk SNPs: rs17468277 (CASP8) , rs2981582 (FGFR2) , rs13281615(8q24), rs3817198 (LSP1) , rs889312 (MAP3K1) , rs3803662 (TOX3) , rs13387042(2q35), rs4973768 (SLC4A7) , rs6504950 (COX11) . Cox proportional hazards models were used to test the SNPs' association with overall survival (OS) and progression-free survival (PFS). Additional analyses were carried out for molecular subgroups. rs3817198 in LSP1 (lymphocyte-specific protein 1) was the only SNP that significantly influenced OS (p = 0.01) and PFS (p < 0.01) in the likelihood ratio test comparing the genetic survival model with the clinical survival model. In the molecular subgroups, triple-negative patients with two minor alleles in rs3817198 had a much better prognosis relative to OS (adjusted HR 0.03; 95% CI 0.002 - 0.279) and PFS (HR 0.09; 95% CI 0.02 - 0.36) than patients with the common alleles. The same effect on PFS was shown for patients with luminal A tumors (HR 0.19; 95% CI 0.05 - 0.84), whereas patients with luminal B tumors had a poorer PFS with two minor alleles (HR 2.13; 95% CI 1.02 - 4.40). The variant in rs3817198 has a prognostic effect particularly in the subgroup of patients with triple-negative BC, suggesting a possible link with immunomodulation and BC.

In verschiedenen großangelegten Studien, in denen umfangreiche Genotypisierungsstudien vorgenommen wurden, wurden bislang über 70 Einzelnukleotid-Polymorphismen (SNPs) identifiziert, die mit einem erhöhten Brustkrebsrisiko einhergehen. Aber das Wissen über die mit der Prognose assoziierten Risikofaktoren wächst weniger schnell. Ziel dieser Studie war es daher, die Auswirkungen von 9 bekannten Brustkrebsrisiko-SNPs auf die Prognose zu untersuchen. In einer adjuvanten randomisierten Phase-III-Studie (SUCCESS A-Studie) wurden Brustkrebspatientinnen (n = 1687) einer Genotypisierung unterzogen. Die Patientinnen waren zuvor nach dem Zufallsprinzip ausgewählt worden. Bei der Genotypisierung standen 9 Brustkrebsrisiko-SNPs im Mittelpunkt: rs17468277 (CASP8) , rs2981582 (FGFR2) , rs13281615(8q24), rs3817198 (LSP1) , rs889312 (MAP3K1) , rs3803662 (TOX3) , rs13387042(2q35), rs4973768 (SLC4A7) , rs6504950 (COX11) . Zur Überprüfung des Zusammenhangs zwischen SNP und Gesamtüberleben (OS) bzw. progressionsfreiem Überleben (PFS) wurde eine Cox-Regressionsanalyse durchgeführt. Molekulare Untergruppen wurden einer weiteren Analyse unterzogen. rs3817198 in LSP1 (Lymphozyten-spezifisches Protein 1) war der einzige SNP, für den im Likelihood-Ratio-Test, der das genetische Überlebensmodell mit dem klinischen Überlebensmodell verglich, eine signifikante Auswirkung auf das Gesamtüberleben (p = 0,01) und das progressionsfreie Überleben (p < 0,01) festgestellt wurde. In den molekularen Untergruppen hatten triple-negative Patientinnen mit 2 seltenen Allelen in rs3817198 eine viel bessere Prognose im Hinblick auf ihr Gesamtüberleben (adjustierte HR 0,03; 95%-KI 0,002 – 0,279) und ihr progressionsfreies Überleben (HR 0,09; 95%-KI 0,02 – 0,36), verglichen mit Patientinnen, welche die häufig vorkommenden Allele aufwiesen. Dieselbe Auswirkung auf das progressionsfreie Überleben fand sich auch bei Patientinnen mit Brustkrebs vom Luminal-A-Typ (HR 0,19; 95%-KI 0,05 – 0,84), während Patientinnen mit Brustkrebs vom Typ Luminal-B und 2 seltenen Allelen ein geringeres progressionsfreies Überleben aufwiesen (HR 2,13; 95%-KI 1,02 – 4,40). Die Variante in rs3817198 hatte besonders auf die Untergruppe von Patientinnen mit triple-negativem Brustkrebs eine prognostische Auswirkung, was auf eine mögliche Assoziation zwischen Immunmodulation und Brustkrebs hindeutet.

Keywords: LSP1; SNP; TNBC; breast cancer; prognosis.

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Conflict of interest statement

Conflict of Interest Peter Fasching has received honoraria from Genomic Health, Teva, Novartis, Amgen, Pfizer and Roche, and he has conducted research for Novartis and Amgen. Brigitte Rack has received research funding from Chugai, Sanofi-Aventis Deutschland GmbH, Lilly, Novartis and AstraZeneca. All other authors have declared no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves for SNP rs3817198, showing overall survival ( a ) and progression-free survival ( b ) relative to the genotypes in the subgroup of triple-negative patients.
See this image and copyright information in PMC

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