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Molecular Profiling Using Breast Cancer Subtype to Plan for Breast Reconstruction

Sandberg, Lars Johan M.D.; Clemens, Mark W. M.D.; Symmans, W. F. M.D.; Valero, Vicente M.D.; Caudle, Abigail S. M.D.; Smith, Benjamin M.D.; Kuerer, Henry M. M.D., Ph.D.; Hsu, Limin M.A.; Kronowitz, Steven J. M.D.

Plastic & Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 586e–596e
doi: 10.1097/PRS.0000000000003050
Breast: Original Articles
Discussion

Background: Molecular profiling using breast cancer subtype has an increasing role in the multidisciplinary care of the breast cancer patient. The authors sought to determine the role of breast cancer subtyping in breast reconstruction and specifically whether breast cancer subtyping can determine the need for postmastectomy radiation therapy and predict recurrence-free survival to plan for the timing and technique of breast reconstruction.

Methods: The authors reviewed prospectively collected data from 1931 reconstructed breasts in breast cancer patients who underwent mastectomy between November of 1999 and December of 2012. Reconstructed breasts were grouped by breast cancer subtype and examined for covariates predictive of recurrence-free survival and need for postmastectomy radiation therapy.

Results: Of the reconstructed breasts, 753 (39 percent) were luminal A, 538 (27.9 percent) were luminal B, 224 (11.6 percent) were luminal HER2, 143 (7.4 percent) were HER2-enriched, and 267 (13.8 percent) were triple-negative breast cancer. Postmastectomy radiation therapy was delivered in 69 HER2-enriched patients (48.3 percent), 94 luminal HER2 patients (42 percent), 200 luminal B patients (37.2 percent), 99 triple-negative breast cancer patients (37.1 percent), and 222 luminal A patients (29.5 percent) (p < 0.0001). Luminal A cases had better recurrence-free survival than HER2-enriched cases, and triple-negative breast cancer cases had worse recurrence-free survival than HER2-enriched cases. Luminal B and luminal HER2 cases had recurrence-free survival similar to that for HER2-enriched cases. Luminal A subtype was associated with the best recurrence-free survival. Subtyping may have improved the breast surgery planning for 33.1 percent of delayed reconstructions that did not require postmastectomy radiation therapy and 37 percent of immediate reconstructions that did require postmastectomy radiation therapy.

Conclusion: This study is the first publication in the literature to evaluate breast cancer subtype to stratify risk for decision making in breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Houston, Texas

From the Departments of Plastic and Reconstructive Surgery, Biostatistics, Pathology, Breast Medical Oncology, Surgical Oncology, and Radiation Oncology, The University of Texas M. D. Anderson Cancer Center.

Received for publication July 23, 2015; accepted September 2, 2016.

Disclosure: The authors have no financial interests to declare in relation to the context of this article.

Steven J. Kronowitz, M.D., Kronowitz Plastic Surgery, PLLC, 1200 Binz, Suite 380, Houston, Texas 77004, steven@kronowitzplasticsurgery.com

©2017American Society of Plastic Surgeons