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Randomized Controlled Trial
. 2017 Jan;56(1):68-74.
doi: 10.1080/0284186X.2016.1237778. Epub 2016 Oct 20.

Histological grade provides significant prognostic information in addition to breast cancer subtypes defined according to St Gallen 2013

Anna Ehinger  1   2 , Per Malmström  1   3 , Pär-Ola Bendahl  1 , Christopher W Elston  4 , Anna-Karin Falck  5 , Carina Forsare  1 , Dorthe Grabau  1   6 , Lisa Rydén  7   8 , Olle Stål  9 , Mårten Fernö  1 ; South and South-East Swedish Breast Cancer Groups
Affiliations
Randomized Controlled Trial

Histological grade provides significant prognostic information in addition to breast cancer subtypes defined according to St Gallen 2013

Anna Ehinger et al. Acta Oncol. 2017 Jan.

Abstract

Background: The St Gallen surrogate definition of the intrinsic subtypes of breast cancer consist of five subgroups based on estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor type 2 (HER2), and Ki-67. PgR and Ki-67 are used for discriminating between the 'Luminal A-like' and 'Luminal B-like (HER2-negative)' subtypes. Histological grade (G) has prognostic value in breast cancer; however, its relationship to the St Gallen subtypes is not clear. Based on a previous pilot study, we hypothesized that G could be a primary discriminator for ER-positive/HER2-negative breast cancers that were G1 or G3, whereas Ki-67 and PgR could provide additional prognostic information specifically for patients with G2 tumors. To test this hypothesis, a larger patient cohort was examined.

Patients and methods: Six hundred seventy-one patients (≥35 years of age, pT1-2, pN0-1) with ER-positive/HER2-negative breast cancer and complete data for PgR, Ki-67, G, lymph node status, tumor size, age, and distant disease-free survival (DDFS; median follow-up 9.2 years) were included.

Results: 'Luminal A-like' tumors were mostly G1 or G2 (90%) whereas 'Luminal B-like' tumors were mostly G2 or G3 (87%) and corresponded with good and poor DDFS, respectively. In 'Luminal B-like' tumors that were G1 (n = 23), no metastasis occurred, whereas 14 of 40 'Luminal A-like' tumors that were G3 metastasized. In the G2 subgroup, low PgR and high Ki-67 were associated with an increased risk of distant metastases, hazard ratio (HR) and 95% confidence interval (CI) 1.8 (0.95-3.4) and 1.5 (0.80-2.8), respectively.

Conclusions: Patients with ER-positive/HER2-negative/G1 breast cancer have a good prognosis, similar to that of 'Luminal A-like', while those with ER-positive/HER2-negative/G3 breast cancer have a worse prognosis, similar to that of 'Luminal B-like', when assessed independently of PgR and Ki-67. Therapy decisions based on Ki-67 and PgR might thus be restricted to the subgroup G2.

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