Skip to main content

Advertisement

SpringerLink
Log in

Basal vs. luminal a breast cancer subtypes: a matched case-control study using estrogen receptor, progesterone receptor, and HER-2 as surrogate markers

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Breast cancer is a heterogeneous disease that encompasses several distinct entities with different biological characteristics and clinical behavior. Basal subtype is considered as a prognostically unfavorable subset. The purpose of this study is to compare the clinico-pathological characteristics and outcome of basal vs. luminal A subtype, as approximated by ER, PR, and HER-2. Sixty-four patients with basal breast cancer were matched for age, stage, and year of diagnosis with 64 patients having luminal A disease. Basal tumors were immunohistochemically defined by a lack of expression of estrogen receptor (ER), progesterone receptor (PR), and HER-2, while luminal A cancers were ER+ or PR+, and HER-2−. As compared with luminal A, basal subtype patients had significantly larger primary tumor size, higher percentage of grade III tumor, more tumor that showed lymphovascular invasion, less presence of non-invasive disease, and higher proportion of extranodal extension. There was no statistically significant difference in metastatic sites, pathology type, or in the axillary lymph nodal status. A few patients received neoadjuvant chemotherapy—13 and 9 patients in basal and luminal A groups, respectively). The complete pathological response was 20% and 14%, respectively (not significant). At a median follow-up of approximately 2 years, there was no statistically significant difference in the overall survival rate between basal and luminal A patients. Analysis of disease-free survival (DFS) for stage I–III (53 patients in each group) showed that the median DFS for basal patients was 41.4 months (95% CI, 26.5–55.3 months), whereas the DFS for the luminal A patients was not reached (P = 0.014). After adjusting for several significant prognostics variables identified in a univariate analysis, a multivariate conditional logistic regression analysis identified the negative effect of lymphovascular invasion and the favorable influence of the use of neoadjuvant and/or adjuvant chemotherapy. This matched case–control study confirmed the poor clinical and pathological characteristics of patients with basal subtype and their unfavorable outcome compared with luminal A disease. Management of basal tumors remains a challenging task, and new therapeutic strategies are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Perou CM, Sorlie T, Eisen MB, et al. Molecular portraits of human breast tumours. Nature. 2000;406:747–52. doi:10.1038/35021093.

    Article  PubMed  CAS  Google Scholar 

  2. Sorlie T, Tibshirani R, Parker J, et al. Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA. 2003;100:8418–23. doi:10.1073/pnas.0932692100.

    Article  PubMed  CAS  Google Scholar 

  3. Sorlie T, Perou CM, Tibshirani R, et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA. 2001;98:10869–74. doi:10.1073/pnas.191367098.

    Article  PubMed  CAS  Google Scholar 

  4. Brenton JD, Carey LA, Ahmed AA, Caldas C. Molecular classification and molecular forecasting of breast cancer: ready for clinical application? J Clin Oncol. 2005;23:7350–60. doi:10.1200/JCO.2005.03.3845.

    Article  PubMed  CAS  Google Scholar 

  5. Fulford LG, Reis-Filho JS, Ryder K, et al. Basal-like grade III invasive ductal carcinoma of the breast: patterns of metastasis and long-term survival. Breast Cancer Res. 2007;9:R4. doi:10.1186/bcr1636.

    Article  PubMed  Google Scholar 

  6. Rouzier R, Perou CM, Symmans WF, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 2005;11:5678–85. doi:10.1158/1078-0432.CCR-04-2421.

    Article  PubMed  CAS  Google Scholar 

  7. Carey LA, Dees EC, Sawyer L, et al. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res. 2007;13:2329–34. doi:10.1158/1078-0432.CCR-06-1109.

    Article  PubMed  CAS  Google Scholar 

  8. Dent R, Trudeau M, Pritchard KI, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007;13:4429–34. doi:10.1158/1078-0432.CCR-06-3045.

    Article  PubMed  Google Scholar 

  9. Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry. Cancer. 2007;109:1721–8. doi:10.1002/cncr.22618.

    Article  PubMed  Google Scholar 

  10. Bartelink H, van de Vijver MJ. Gene expression profiling and histopathological characterization of triple negative/basal like breast carcinomas. Breast Cancer Res. 2007;9:R65. doi:10.1186/bcr1771.

    Article  PubMed  Google Scholar 

  11. Livasy CA, Karaca G, Nanda R, et al. Phenotypic evaluation of the basal-like subtype of invasive breast carcinoma. Mod Pathol. 2006;19:264–71. doi:10.1038/modpathol.3800528.

    Article  PubMed  CAS  Google Scholar 

  12. Ihemelandu CU, Leffall LD Jr, Dewitty RL, Naab TJ, Mezghebe HM, Makambi KH, et al. Molecular breast cancer subtypes in premenopausal and postmenopausal. J Surg Res. 2007;143:109–18.

    Article  PubMed  CAS  Google Scholar 

  13. Nguyen PL, Taghian AG, Katz MS, Niemierko A, Abi Raad RF, Boon WL, et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol. 2008;26(14):2373–8.

    Article  PubMed  Google Scholar 

  14. Therasse P, Arbuck SG, Eisenhauer EA, et al. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 2000;92:205–16. doi:10.1093/jnci/92.3.205.

    Article  PubMed  CAS  Google Scholar 

  15. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–80. doi:10.2307/2281868.

    Article  Google Scholar 

  16. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–48.

    PubMed  CAS  Google Scholar 

  17. Cox DR. Regression models and life-tables (with discussion). J Roy Stat Soc (B). 1972;34:187–220.

    Google Scholar 

  18. Reis-Filho JS, Tutt AN. Triple negative tumours: a critical review. Histopathology. 2008;52(1):108–18. Jan.

    PubMed  CAS  Google Scholar 

  19. Fulford LG, Easton DF, Reis-Filho JS, et al. Specific morphological features predictive for the basal phenotype in grade 3 invasive ductal carcinoma of breast. Histopathology. 2006;49:22–34. doi:10.1111/j.1365-2559.2006.02453.x.

    Article  PubMed  CAS  Google Scholar 

  20. Tsuda H, Takarabe T, Hasegawa F, Fukutomi T, Hirohashi S. Large, central acellular zones indicating myoepithelial tumor differentiation in high-grade invasive ductal carcinomas as markers of predisposition to lung and brain metastases. Am J Surg Pathol. 2000;24:197–202. doi:10.1097/00000478-200002000-00005.

    Article  PubMed  CAS  Google Scholar 

  21. Rakha EA, El-Sayed ME, Green AR, Lee AHS, Robertson JF, Ellis IO. Prognostic markers in triple-negative breast cancer. Cancer. 2007;109(1):25–32.

    Article  PubMed  CAS  Google Scholar 

  22. Haffty BG, Yang Q, Reiss M, Kearney T, Higgins SA, Weidhaas J, et al. Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol. 2006;24(36):5652–7. doi:10.1200/JCO.2006.06.5664. Dec 20.

    Article  PubMed  Google Scholar 

  23. Nielsen TO, Hsu FD, Jensen K, et al. Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res. 2004;10:5367–74. doi:10.1158/1078-0432.CCR-04-0220.

    Article  PubMed  CAS  Google Scholar 

  24. Kreike B, van Kouwenhove M, Horlings H, Weigelt B, Peterse H, Bartelink H, et al. Gene expression profiling and histopathological characterization of triple-negative/basal-like breast carcinomas. Breast Cancer Res. 2007;9(5):R65. doi:10.1186/bcr1771.

    Article  PubMed  Google Scholar 

  25. Rodenhuis S, Bontenbal M, van Hoesel QGCM, et al. Efficacy of high-dose alkylating chemotherapy in HER2/neu-negative breast cancer. Ann Oncol. 2006;17:588–96. doi:10.1093/annonc/mdl001.

    Article  PubMed  CAS  Google Scholar 

  26. Nitz UA, Gluz O, Herr A, et al. Retrospective analysis of WSG AM01 tandem high dose chemotherapy trial in high risk primary breast cancer: a hypothesis generating study. Proc Am Soc Clin Oncol. 2006;24:665. (Abstr).

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. King Faisal Hospital and Research Centre, Riyadh, Saudi Arabia

    Ezzeldin Ibrahim, Aboelkhair M. Al-Gahmi, Ahmed A. Zeenelin, Jamal M. Zekri, Tawfik R. Elkhodary, Hussein E. Gaballa, Ehab E. Fawzy, Mohamed E. El sayed & Mohamed S. Alzahrani

Authors
  1. Ezzeldin Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aboelkhair M. Al-Gahmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed A. Zeenelin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jamal M. Zekri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tawfik R. Elkhodary
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hussein E. Gaballa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ehab E. Fawzy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohamed E. El sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mohamed S. Alzahrani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ezzeldin Ibrahim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ibrahim, E., Al-Gahmi, A.M., Zeenelin, A.A. et al. Basal vs. luminal a breast cancer subtypes: a matched case-control study using estrogen receptor, progesterone receptor, and HER-2 as surrogate markers. Med Oncol 26, 372–378 (2009). https://doi.org/10.1007/s12032-008-9131-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12032-008-9131-6

Keywords

Search

Navigation