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. 2023 May 29:26:e230028.
doi: 10.1590/1980-549720230028. eCollection 2023.

Molecular subtypes as a prognostic breast cancer factor in women users of the São Paulo public health system, Brazil

Stela Verzinhasse Peres  1 , Paola Engelmann Arantes  2 , Marcela de Araújo Fagundes  2 , Alexandre Muxfeldt Ab'Saber  3   4 , Daniel Luiz Gimenes  5 , Maria Paula Curado  2 , René Aloisio da Costa Vieira  6   7
Affiliations

Molecular subtypes as a prognostic breast cancer factor in women users of the São Paulo public health system, Brazil

Stela Verzinhasse Peres et al. Rev Bras Epidemiol. .

Abstract
in English, Portuguese

Objective: This study aimed to analyze the prognosis of women with breast cancer by molecular subtypes, sociodemographic variables, and clinical and treatment characteristics.

Methods: This hospital-based retrospective cohort study analyzed 1,654 women over 18 years of age diagnosed with invasive breast cancer from 2000 to 2018. Data were extracted from Brazil's Oncocenter Foundation of São Paulo. The variables analyzed were age, histology, molecular subtypes, clinical staging, treatment type, and diagnosis-to-treatment time. Cox regression analysis was applied to estimate death risk.

Results: Women with HER-2-positive (nonluminal) and triple-negative molecular subtypes were more than twice more likely to be at risk of death, with adjusted hazard ratio - HRadj=2.30 (95% confidence interval - 95%CI 1.34-3.94) and HRadj=2.51 (95%CI 1.61-3.92), respectively. A delayed treatment associated with an advanced clinical stage at diagnosis increased fourfold the risk of death (HRadj=4.20 (95%CI 2.36-7.49).

Conclusion: In summary, besides that interaction between advanced clinical stage and longer time between diagnosis and treatment, HER-2-positive (nonluminal) and triple-negative phenotypes were associated with a worse prognosis. Therefore, actions to reduce barriers in diagnosis and treatment can provide better outcome, even in aggressive phenotypes.

Objetivo:: O objetivo deste estudo foi analisar o prognóstico de mulheres com câncer de mama de acordo com os subtipos moleculares, variáveis sociodemográficas, características clínicas e de tratamento.

Métodos:: Este foi um estudo de coorte retrospectivo de base hospitalar. Foram analisadas 1.654 mulheres maiores de 18 anos diagnosticadas com câncer de mama invasivo entre 2000 a 2018. Os dados foram extraídos da Fundação Oncocentro de São Paulo, Brasil. As variáveis analisadas foram idade, histologia, subtipo moleculares, estadiamento clínico, tipo de tratamento e tempo entre o diagnóstico e tratamento. A análise de regressão de Cox foi aplicada para estimar o risco de morte.

Resultados:: As mulheres que apresentaram os subtipos moleculares HER-2-positivo (não luminal) e triplo negativo tiveram risco de morte quase duas vezes maior respectivamente, com razão de risco ajustada — HRaj=2,30 (intervalo de confiança de 95% — 95%IC 1,34–3,94) e HRaj=2,51 (95%IC 1,61–3,92). O atraso no tratamento associado ao avanço do estadiamento clínico ao diagnóstico aumentou em quatro vezes o risco de morte (HRaj=4,20 (IC95% 2,36–7,49).

Conclusão:: Os fenótipos HER-2-positivo (não luminal) e triplo negativo, além da interação entre estágio clínico avançado e maior tempo entre o diagnóstico e o tratamento, associaram-se a pior prognóstico. Assim, ações para reduzir as barreiras no diagnóstico e tratamento podem proporcionar melhores resultados, mesmo em fenótipos agressivos.

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Conflict of interest statement

CONFLICT OF INTERESTS: nothing to declare.

Figures

Figure 1.
Figure 1.. Hazard function to molecular subtype (A) and interaction between clinical staging at diagnosis and diagnosis-to-treatment time (B), adjusted by age, year of diagnosis and treatment in patients diagnosed with invasive breast cancer in the public health system of São Paulo, Brazil. Cancer Registry Center, Oncocenter Foundation of São Paulo, 2000–2013.
See this image and copyright information in PMC

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