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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Genet. | doi: 10.3389/fgene.2018.00638

The distribution and outcomes of the 21-gene recurrence score in T1-T2N0 estrogen receptor-positive breast cancer with different histologic subtypes

 Jun Wang1,  Zhen-Yu He2, Yong Dong3, Jia-Yuan Sun2,  Wen-Wen Zhang2 and  San-Gang Wu1*
  • 1First Affiliated Hospital of Xiamen University, China
  • 2Sun Yat-sen University Cancer Center (SYSUCC), China
  • 3Dongguan Third People's Hospital, China

Background: The clinical value of 21-gene recurrence score (RS) in various breast cancer histologic subtypes is not well established.
Aims: To assess the distribution and outcomes of the 21-gene RS among various T1-T2N0 estrogen receptor-positive breast cancer histologic subtypes.
Methods: Using the Surveillance, Epidemiology and End Results database, we investigated the distribution and outcomes of the 21-gene RS among various breast cancer histologic subtypes between 2004 and 2015. The histologic subtypes with 200 or more cases were further analyzed.
Results: We identified 83,665 patients including 8 histologic subtypes. The most common subtype was invasive ductal carcinoma not otherwise specified (IDC NOS) (77.9%), followed by lobular carcinoma NOS, mixed infiltrating duct and lobular carcinoma (IDC-L), mucinous adenocarcinoma, tubular adenocarcinoma, micropapillary ductal carcinoma, cribriform carcinoma NOS, and intraductal papillary adenocarcinoma with invasion with 10.8%, 7.7%, 2.1%, 0.6%, 0.3%, 0.2%, and 0.2%, respectively. The 5-year breast cancer specific survival (BCSS) was 98.8%, 98.8%, 98.9%, 99.6%, 100%, 100%, 100%, and 100%, respectively (P=0.011). Patients with IDC NOS (8.9%), micropapillary ductal carcinoma (8.8%), and intraductal papillary adenocarcinoma with invasion (8.2%) had significantly higher percentage of high-risk RS compared to other histologic subtypes (1.0-3.8%) (P<0.001). The mean RS was higher in IDC NOS, lobular carcinoma NOS, and IDC-L compared to other subtypes. In multivariate analysis, 21-gene RS was the independent prognostic factor in patients with IDC NOS (P<0.001), lobular carcinoma NOS (P<0.001), and IDC-L (P<0.001), patients with a higher RS was associated with poor BCSS.
Conclusion: Our results demonstrate that there is a significant difference in distribution of 21-gene RS in T1-T2N0 estrogen receptor-positive breast cancer with different histologic subtypes. Long-term studies with larger series are needed to confirm the role of the 21-gene RS array in prognosis assessment and chemotherapy decision-making in special histologic subtypes with favorable prognosis.

Keywords: breast cancer, Oncotype Dx, Histologic subtypes, Survival, SEER

Received: 30 Sep 2018; Accepted: 27 Nov 2018.

Edited by:

Ingrid A. Hedenfalk, Lund University, Sweden

Reviewed by:

Sarah D. Diermeier, University of Otago, New Zealand
Yadi Zhou, Ohio University, United States  

Copyright: © 2018 Wang, He, Dong, Sun, Zhang and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. San-Gang Wu, First Affiliated Hospital of Xiamen University, Xiamen, China, unowu12345@hotmail.com