Molecular subtype approximated by quantitative estrogen receptor, progesterone receptor and Her2 can predict the prognosis of breast cancer.

AIMS AND BACKGROUND: To investigate the clinicopathological characteristics and prognosis of breast cancer subtypes classified by quantitative estrogen receptor (ER), progesterone receptor (PR), and Her2. METHODS AND STUDY DESIGN: 923 patients with primary breast cancer having a median age of 53 years who were treated at the Cancer Hospital of Fudan University in Shanghai between January 2002 and June 2004 were retrospectively analyzed. Four molecular subtypes were constructed from the immunohistochemical results of quantitative hormone receptor (HR) and Her2 status. HR+ was defined as ER+ and PR+, HR+/- as ER/PR+ at lower levels or lacking either ER or PR, and HR- as both ER- and PR-. The four subtypes were HR+/Her2-, HR+/-/Her2-, HR-/Her2- (triple-negative), and Her2+. Clinical and pathological parameters, disease-free survival (DFS), and overall survival (OS) measurements were compared between patients with different molecular subtypes. RESULTS: The proportions of HR+/Her2-, HR+/-/Her2-, triple-negative, and Her2+ breast cancer were 36.6% (338/923), 22.9% (211/923), 20.6% (190/923), and 19.9% (194/923). The median follow-up was 49.0 months (4-77 months). In 145 cases disease recurrence or death occurred. In multivariate analysis with the HR+/Her2- subtype taken as the reference category, triple-negative and Her2+ subtypes were associated with increased recurrence and death with a hazard ratio (HR) of 2.05 (95% CI 1.31-3.20; P = 0.002) and 1.89 (95% CI 1.20-2.97, P = 0.006) for DFS and 2.84 (95% CI 1.45-5.55; P = 0.002) and 2.95 (95% CI 1.51-5.77, P = 0.002) for OS, respectively; the HR+/-/Her2- subtype was marginally associated with poor prognosis with HR 1.51 (95% CI 0.94-2.43; P = 0.088) and 1.90 (95% CI 0.92-3.94; P = 0.084) for DFS and OS, respectively. CONCLUSIONS: Breast cancer subtypes based on quantitative ER, PR, and Her2 may be predictive of prognosis. Patients whose tumors were not HR+/Her2- had a worse outcome in our study.

Neoadjuvant chemotherapy with vinorelbine-containing regimens in elderly patients with locally advanced breast cancer.

BACKGROUND: The purpose of this study was to evaluate retrospectively the efficacy and safety of neoadjuvant chemotherapy with vinorelbine-containing regimens in elderly patient with locally advanced breast cancer (LABC). PATIENTS AND METHODS: From 2002 to 2006, 14 female elderly patients with LABC underwent neoadjuvant chemotherapy with vinorelbine-containing regimens. Vinorelbine alone or in combination with pirarubicin/epirubicin was administered every 3 weeks (25 mg/m2, i.v., day 1 and day 8). All 14 patients received 2-6 cycles of chemotherapy. RESULTS: The median age was 68.5 years (range 65 to 78 years). Six patients had stage IIIA breast tumor, 7 stage IIIB and 1 stage IIIC. There was 1 complete response and 10 partial responses, with an overall response rate of 78.57%, and stable disease in 3 patients (21.43%); there were no patients with progressive disease before surgery. After a median follow-up of 35 months, the estimated 3-year disease-free and overall survival rates were 57% and 69%, respectively. CONCLUSION: The results of the current study showed that vinorelbine-containing neoadjuvant chemotherapy was effective and well-tolerated in elderly patients with LABC.

[Clinical and pathological characteristics and treatment of elderly patients with breast cancer].

OBJECTIVE: To explore the clinical and pathological characteristics and treatment patterns and the factors influencing treatments of elderly patients with breast cancer. METHODS: From January 2001 to December 2006, 647 female breast cancer patients over 65 years old were treated. The clinical records were reviewed. All patients were divided into three groups according to age, including 65 to 69 years old group, 70 to 74 years old group and 75 years or elder group. These 647 patients accounted for 13.4% of all breast cancer patients undergoing surgery during the same period. Major pathological type was invasive ductal carcinoma (79.3%). The patients who had chronic comorbid diseases of other systems accounted for 54.7%. Five hundred and eighty-six patients underwent modified radical mastectomy, accounting for 90.6%. Two hundred and thirty-three patients underwent postoperative adjuvant chemotherapy, accounting for 36.0%. The differences of clinicopathological characteristics and treatment patterns between three groups were tested by Chi-square test. RESULTS: Older patients had more tumors with mucinous and other pathological types, less over-expression of Her2/Neu(+++), higher probability to have comorbidities, higher probability to undergo relatively conservative surgery, lower probability to receive postoperative chemotherapy, and higher probability to receive postoperative endocrine therapy alone. CONCLUSIONS: Breast cancer in the elderly exhibits distinctive clinical and pathological characteristics. Treatment patterns they received are related to age.

[A study on the relationship between breast cancer molecular classification and prognosis].

OBJECTIVE: To investigate the relationship between breast cancer molecular classification and prognosis. METHODS: From January 2002 to December 2003, 708 female primary breast cancer patients with a mean age of 53 years old were retrospectively analyzed. The classification of breast cancer was according to the immunohistochemical results of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER2) status. Molecular classification definitions included highly endocrine responsive, incompletely endocrine responsive, triple negative, and HER2 positive. The prognosis among different molecular classifications of breast cancer was investigated. The survival rates of different classifications were compared by Log-rank test. RESULTS: The proportion of highly endocrine responsive, incompletely endocrine responsive, HER2 positive and triple-negative breast cancer was 33.2% (235/708), 23.6% (167/708), 21.3% (151/708) and 21.9% (155/708). The follow-up period were from 3 to 68 months with a median of 40.2 months. A total of 100 cases were identified to had disease recurrence or death. Factors affecting the prognosis were tumor size, axillary lymph node status, molecular classification, adjuvant radiotherapy and adjuvant endocrine therapy by univariate analysis. Multivariate analysis revealed that the molecular classification and lymph node status were the independent prognostic factors with the hazard ratio 1.205 (P = 0.047) and 4.512 (P = 0.000), respectively. Survival analysis showed that highly endocrine responsive breast cancer was with superior prognosis versus others. CONCLUSIONS: Molecular classification of breast cancer is an independent predictor of prognosis. Breast cancer patients classified as highly endocrine responsive subtype have the best outcome.

Breast cancer in Chinese elderly women: pathological and clinical characteristics and factors influencing treatment patterns.

The aims of this study are to describe tumor characteristics and treatment patterns of elder breast cancer patients and to determine the factors influencing local and systemic treatments. This retrospective cohort included 866 patients (>or=60 years) referred for surgery between January 2002 and December 2006. The patients were divided into four groups according to age. Elderly women had larger tumors at diagnosis with more mucinous carcinomas, more estrogen/progesterone-positive, lower Ki-67 labeling indices and less c-erbB2 positive tumors. Comorbidities were more often recorded for older patients. They were more likely to undergo simple mastectomy or breast-conserving surgery, less likely to receive adjuvant chemotherapy and radiotherapy, compared with their younger counterparts. Multinomial and binary logistic regression showed that age was independently associated with local and systemic treatments. Our data suggest that the tumors of elderly patients are biologically more favorable, and elderly women appear to receive less aggressive treatments.