Jean and others--for certain bc subtypes size and no. of lymph nodes , prognosis not

[Lani]

directly related ie, smaller tumors and ones with less or no nodes involved do not necessarily do better ie, it is the molecular make-up of the tumor and not what size it is that may determine prognosis in some subgroups of breast cancer

This article shows for BRCA1 bc, basal (group within triple negative bc)...hope they study her2 next...

Breast Cancer Res Treat. 2008 Jul 4. [Epub ahead of print]

Tumor size is an unreliable predictor of prognosis in basal-like breast cancers and does not correlate closely with lymph node status.

Foulkes WD, Grainge MJ, Rakha EA, Green AR, Ellis IO.
Program in Cancer Genetics, Departments of Oncology and Human Genetics, McGill University, 546 Pine Ave West, Montreal, QC, Canada, H2W 126, william.foulkes@mcgill.ca.
Larger breast tumors tend to be associated with a greater number of axillary lymph nodes involved with metastatic tumor than are smaller tumors. This rule may not fully apply in BRCA1-related breast cancers. We hypothesized that the rule also might not apply in basal-like breast cancers (BLBC), and further, that disruption of this relationship would impact on prognosis. In 1,324 non-BLBC (87.1% of 1520 tumors), after adjustment for grade, a strongly positive correlation between increasing tumor size and increasing number of lymph nodes involved by tumor was observed (P for trend <.001). The correlation was much weaker in 196 BLBC (12.9%) (P for trend = 0.58). Similarly, a worsening breast cancer-specific survival with increasing tumor size was observed in non-BLBC (P for trend <.001) but not in BLBC (P for trend = 0.43). The "size-nodes" relationship in BLBC is distinct and is similar to that seen in BRCA1-related breast cancer, further suggesting biological similarities between these sub-types of breast cancer. Moreover, tumor size is not a strong indicator of prognosis in BLBC.
PMID: 18600446 [PubMed - as supplied by publisher

[Lani]

that whether size, lymph node status portended worse prognosis differed between her2+er+ and her2+ er- , but they only had 60 of the later and 107 of the former. (perhaps not enough to draw conclusions).

Bottom-line is that classical determinants of prognosis are undergoing reevaluation especially as we start realizing the subtypes of bc are different diseases with different behaviors.

Recommendations for treatment should be getting more and more individualized and less cookie-cutter like as molecular subtyping becomes more common.

Less hope this leads to more people getting just the treatment most likely to help them and lessens both over and undertreatment.

thanks for your hard work Lani,
But this leaves me hanging. Maybe you could explain further.

of the hormone neg her2 pos (I know just 60) was it more likely to be a better or worse prognosis?

[Alice]

Hi Lani,
Thanks for all the research you do.Can you put a link to this article? I would love to read it.
Thanks, Alice

[chicagoetc]

Also, what is a "basal-like breast cancer"?

Melanie

[Janelle]

I think "basal-like" cancer is typically triple negative. In other words, the cancer cells do not have estrogen or progesterone receptors on the surface (hormones don't fuel the cancer) and it does not over-express Her2.

I think Her2 positive cancers are referred to as the "Luminal B" subtype of breast cancers.

[chicagoetc]

Ok, thanks. That helps.

[Lani]

rather put "ENTREZ PUBMED" into google

Then put the PUBMEDID number(PMID, in this case 18600446) at the bottom of the abstract into the rectangular address bar and press return...voila!

Whether or not you can only get the abstract vs the whole article depends on whether it is open access or restricted.

Basal type breast cancer is a type of triple negative bc (ER-PR-her2-) which closely resembles cancer stem cells by being CD44+, CD24- and/or ALDH1+)

There are some triple negatives which are not basal and have better prognoses.

The HR (hazard ratio) for her2+ER+ vs her2+ er- were not entirely consistent
ie following a pattern you would expect probably because of the relatively small numbers. I will try to post part of the chart if I can manage it so you can.

By the way, there are different molecular subtypes of her2+ bc. Those that are ER- fall into the her2 subtype. Those that are ER+ are either put within
the title luminal B where they are felt to constitute 40-50% of luminal Bs or
according to Joel Gray,an incredible researcher who has invented at least four seminal research technique, anyone of which should have earned him the Nobel Prize--he was saluted at San Antonio this year, in a category of their own called luminal amplified.--among Dr. Gray's discoveries are the techniques FISH, CGH, rtPCR.

[Lani]

Table 3 Breast tumour size, percentage of positive lymph nodes and outcome–stratification by tumour type*

% of Lymph nodes positive

Relative risk (95% CI)

Hazard ratio (95% CI)

Luminal A (n = 1005)

≤1.5 cm

0.08

1.00

1.00

>1.5–2 cm

0.16

1.66 (1.25–2.19)

2.08 (1.36–3.17)

>2 cm

0.27

2.87 (2.25–3.65)

2.68 (1.79–4.01)

P trend


<0.001

<0.001

Luminal B (n = 66)

≤1.5 cm

0.08

1.00

1.00

>1.5–2 cm

0.09

1.61 (0.49–5.31)

0.74 (0.23–2.32)

>2 cm

0.38

5.46 (2.03–14.6)

1.98 (0.82–4.78)

P trend


<0.001

0.08

ER-/HER2 + (n = 107)

≤1.5 cm

0.16

1.00

1.00

>1.5–2 cm

0.18

0.91 (0.42–1.97)

1.17 (0.45–3.02)

>2 cm

0.34

2.09 (1.23–3.57)

2.24 (0.99–5.07)

P trend


0.002

0.04

ER-/HER2–non-basal (n = 109)

≤1.5 cm

0.04

1.00

1.00

>1.5–2 cm

0.12

3.94 (1.32–11.7)

2.73 (0.77–9.69)

>2 cm

0.25

6.64 (2.49–17.7)

3.26 (1.10–9.64)

P trend


<0.001

0.03

Basal (n = 196)

≤1.5 cm

0.12

1.00

1.00

>1.5–2 cm

0.14

1.40 (0.73–2.68)

1.27 (0.61–2.61)

>2 cm

0.17

1.30 (0.70–2.40)

1.34 (0.68–2.66)

P trend


0.58

0.43

P for interaction**


0.005

0.51

* 37 patients who had missing data for ER and HER2 but whose tumours were definitely non-basal were not included in the above analysis. The relative risk was modelled via Poisson regression and the outcome was modelled via Cox Regression. All results are adjusted for grade. ** The P for interaction is obtained from fitting size as a categorical covariate (≤1.5 cm, >1.5–2 cm, ≥2 cm) and testing whether the effect of size on outcome differs according to tumour subgroup, when size is fitted as a continuous covariate the P-values for the interaction term are 0.002 for the relative risk and 0.48 for the hazard ratio. For the purposes of this analysis, we defined Luminal A as ER+ , HER2− and Luminal B as ER+, HER2+. ER−, HER2− non-basal cases are triple negative patients that are also negative for CK5/6, CK14 and EGFR. Basal is defined as described in the text

[harrie]

Since I am BRCA1, despite the fact that my tumor was small and had no lymph node involvement, according to the article, my prognosis is not any better then one who has a large tumor with node involvement. Is this correct?
Also, to add fuel to the fire, I am HER2.
That sucks..... :-(

If you are er-/her2+ you are neither luminal A or luminal B? How is this type of tumor categorized then?

[Lani]

it includes only her2+er- tumors, not her2+er+ tumors--so you have a type all your own!

As they learn more and more they may subdivide the subtypes into subsubtypes and some researchers think there are as many tumor types as there are people ie, that every person's tumor genetics is different from every
other persons tumor genetics ie, it is as unique as one individual is compared to another.

Those researchers think that finding the most important pathways within each person's tumor's genetic profile and blocking several of these simultaneously will be the way of the future.