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Brouckaert O, Laenen A, Vanderhaegen J, Wildiers H, Leunen K, Amant F, Berteloot P, Smeets A, Paridaens R, Christiaens MR, Floris G, Moerman P, Van Limbergen E, Peeters S, Weltens C, Vergote I, Neven P. Applying the 2011 St Gallen panel of prognostic markers on a large single hospital cohort of consecutively treated primary operable breast cancers. Ann Oncol 2012; 23:2578-2584. [PMID: 22492698 DOI: 10.1093/annonc/mds062] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Many easily measurable and readily available factors are now established as being prognostic in primary operable breast cancer. We here applied the 2011 St Gallen surrogate definition for breast cancer subclassification using tumor grade instead of Ki67. PATIENTS AND METHODS Four thousand three hundred and eighteen consecutive patients who had surgery for primary operable breast cancer (1 January 2000 and 31 December 2009) in UZ Leuven excluding primary metastastic male breast cancers and those receiving neoadjuvant therapy. Five different surrogate phenotypes were created using the combined expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 together with tumor grade. Disease-free interval (DFI), distant metastastis-free interval (DMFI), locoregional relapse-free interval (LRRFI), breast cancer-specific survival (BCSS) and overall survival (OS) were calculated. RESULTS Surrogate phenotypes present with significant differences in DFI, DMFI, LRRFI, BCSS and OS. 'Luminal A' tumors presented with the best outcome parameters but the effect weakened at longer follow-up. CONCLUSIONS The four surrogate markers, agreed upon by the 2011 St Gallen consensus, defined five prognostic surrogate phenotypes in a large series of consecutively treated breast cancer patients. Their prognostic value changed with longer follow-up. The added value of gene expression profile over classical pathological assessment remains to be defined.
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Affiliation(s)
- O Brouckaert
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven.
| | - A Laenen
- Department of Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - J Vanderhaegen
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - H Wildiers
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - K Leunen
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - F Amant
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - P Berteloot
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - A Smeets
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - R Paridaens
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - M R Christiaens
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - G Floris
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - P Moerman
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - E Van Limbergen
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - S Peeters
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - C Weltens
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - I Vergote
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
| | - P Neven
- Multidisciplinary Breast Centre, University Hospital Leuven, Leuven
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Van Belle V, Van Calster B, Brouckaert O, Vanden Bempt I, Pintens S, Harvey V, Murray P, Naume B, Wiedswang G, Paridaens R, Moerman P, Amant F, Leunen K, Smeets A, Drijkoningen M, Wildiers H, Christiaens MR, Vergote I, Van Huffel S, Neven P. Qualitative Assessment of the Progesterone Receptor and HER2 Improves the Nottingham Prognostic Index Up to 5 Years After Breast Cancer Diagnosis. J Clin Oncol 2010; 28:4129-34. [DOI: 10.1200/jco.2009.26.4200] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo investigate whether the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) can improve the Nottingham Prognostic Index (NPI) in the classification of patients with primary operable breast cancer for disease-free survival (DFS).Patients and MethodsThe analysis is based on 1,927 patients with breast cancer treated between 2000 and 2005 at the University Hospitals, Leuven. We compared performances of NPI with and without ER, PR and/or HER2. Validation was done on two external data sets containing 862 and 2,805 patients from Oslo (Norway) and Auckland (New Zealand), respectively.ResultsIn the Leuven cohort, median follow-up was 66 months, and 13.7% of patients experienced a breast cancer–related event. Positive staining for ER, PR, and HER2 was detected, respectively, in 86.9%, 75.5%, and 11.9% of patients. Based on multivariate Cox regression modeling, the improved NPI (iNPI) was derived as NPI − PR positivity + HER2 positivity. Validation results showed a risk group reclassification of 20% to 30% of patients when using iNPI with its optimal risk boundaries versus NPI, in a majority of patients to more appropriate risk groups. An additional 10% of patients were classified into the extreme risk groups, where clinical actions are less ambiguous. Survival curves of reclassified patients resembled more closely those for patients in the same iNPI group than those for patients in the same NPI group.ConclusionThe addition of PR and HER2 to NPI increases its 5-year prognostic accuracy. The iNPI can be considered as a clinically useful tool for stratification of patients with breast cancer receiving standard of care.
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Affiliation(s)
- Vanya Van Belle
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Ben Van Calster
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Olivier Brouckaert
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Isabelle Vanden Bempt
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Saskia Pintens
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Vernon Harvey
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Paula Murray
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Björn Naume
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Gro Wiedswang
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Robert Paridaens
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Philippe Moerman
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Frederic Amant
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Karin Leunen
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Ann Smeets
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Maria Drijkoningen
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Hans Wildiers
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Marie-Rose Christiaens
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Ignace Vergote
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Sabine Van Huffel
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
| | - Patrick Neven
- From the Katholieke Universiteit Leuven; Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven; Virga Jesse Hospital, Hasselt, Belgium; Auckland Breast Cancer Registry, Greenlane Clinical Centre; Regional Cancer Centre, Auckland City Hospital, Auckland, New Zealand; Ullevål University; and Norwegian Radium Hospital, Oslo, Norway
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