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Treatment and Survival Outcome for Molecular Breast Cancer Subtypes in Black Women

Ihemelandu, Chukwuemeka U. MD*; Naab, Tammey J. MD†; Mezghebe, Haile M. MD*; Makambi, Kepher H. PhD‡; Siram, Suryanarayana M. MD*; Leffall, LaSalle D. Jr MD*; DeWitty, Robert L. Jr MD*; Frederick, Wayne A. MD*‡

doi: 10.1097/SLA.0b013e31815d744a
Original Articles

Objective: To analyze whether the local-regional surgical treatments (breast-conserving therapy, mastectomy) resulted in different overall survival, distant metastasis-free survival, and locoregional recurrence-free survival rates for the various molecular breast cancer subtypes.

Summary Background Data: Molecular gene expression profiling has been proposed as a new classification and prognostication system for breast cancer. Current recommendation for local-regional treatment of breast cancer is based on traditional clinicopathologic variables.

Methods: Retrospective analysis of 372 breast cancer cases with assessable immunohistochemical data for ER, PR, and Her-2/neu receptor status, diagnosed from 1998 to 2005. Molecular subtypes analyzed were luminal A, luminal B, basal like, and Her-2/neu.

Results: No substantial difference was noted in overall survival, and locoregional recurrence rate between the local-regional treatment modalities as a function of the molecular breast cancer subtypes. The basal cell-like subtype was an independent predictor of a poorer overall survival (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.28–4.97, P < 0.01) and a shorter distant metastasis-free survival time (HR = 3.61, 95% CI 1.27–10.2, P < 0.01), and showed a tendency toward statistical significance as an independent predictor of locoregional recurrence (HR = 3.57, 95% CI 0.93–13.6, P = 0.06).

Conclusions: The basal cell-like subtype is associated with a worse prognosis, a higher incidence of distant metastasis, and may be more prone to local recurrence when managed with breast-conserving therapy.

Basal cell-like breast cancers have a worse prognosis in black women, and the basal cell-like subtype may have increased local recurrence after breast-conserving therapy.

From the Departments of *Surgery and †Pathology, Howard University College of Medicine, Washington, DC; and ‡Howard University Cancer Center, Washington, DC.

Supported in part by a research grant from the Susan G. Komen for the Cure Foundation.

Reprints: Wayne A. Frederick, MD, Department of Surgery, Howard University Hospital, 2041 Georgia Ave., N.W., Washington, DC 20060. E-mail: w_frederick@Howard.edu; melands70@gmail.com

© 2008 Lippincott Williams & Wilkins, Inc.