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Factors That Predict Biological Aggressiveness in Estrogen Receptor-Positive / Human Epidermal Growth Factor Receptor
Lauren E Arthur1, Ashley H McMann2, Lauren N Slattery1
1The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA.
Ochsner Journal
|January 7, 2021
Summary
Tumor size may not predict breast cancer aggressiveness. Progesterone receptor-negative tumors with higher recurrence scores, regardless of size, indicate potential for chemotherapy benefit, challenging traditional staging.
Area of Science:
- Oncology
- Genomics
- Breast Cancer Research
Background:
- Traditional breast cancer staging relies on TNM criteria (tumor size, nodal status, metastasis).
- The Oncotype DX assay provides a genomic Recurrence Score (RS) for estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-)/lymph node-negative (LN-) tumors.
- RS predicts the likelihood of distant recurrence in specific breast cancer subtypes.
Purpose of the Study:
- To evaluate the correlation between Oncotype DX Recurrence Score (RS) and tumor size in ER+/HER2-/LN- breast cancer.
- To identify factors, including progesterone receptor (PR) status and tumor grade, that independently predict recurrence risk.
- To reassess the association between tumor size and biological aggressiveness.
Main Methods:
- Retrospective review of 296 ER+/HER2-/LN- breast cancer patient records (2007-2017) who underwent Oncotype DX testing.
- Comparison of Oncotype DX RS with tumor size, patient age, PR status, and tumor grade.
- Statistical analysis to determine correlations and significance (t-tests, Pearson correlation coefficients).
Main Results:
- No significant correlation was found between patient age and RS (P=0.208).
- Progesterone receptor-negative (PR-) tumors exhibited significantly higher RS compared to PR-positive (PR+) tumors (mean RS 30.8 vs. 16.3, P<0.0001).
- A significant negative correlation between tumor size and RS was observed in the PR- subgroup (r=-0.343, P=0.017), but not in the overall cohort or PR+ subgroup.
Conclusions:
- Tumor size may not be a reliable indicator of biological aggressiveness in ER+/HER2-/LN- breast cancer.
- PR- status is a significant predictor of higher recurrence risk, irrespective of tumor size.
- Genomic testing (Oncotype DX RS) is recommended for all ER+/PR-/LN- tumors, regardless of size, to guide chemotherapy decisions.
Keywords:
Breast neoplasmsimmunohistochemistryneoplasm stagingreceptors–estrogenreceptors–progesteronerecurrencesentinel lymph nodeMore Related Videos
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