title: Axillary lymph node status of operable breast cancers by combined steroid receptor and HER-2 status: triple positive tumours are more likely lymph node positive.
abstract: OBJECTIVE
  To examine the frequency of axillary lymph node (ALN) invasion of operable breast cancers by their combined oestrogen receptor (ER), progesterone receptor (PR) and HER-2 status.
  
  
  METHODS
  2227 recently operated cases in one centre were retrieved from the Multidisciplinary Breast Centre database and stratified according to their combined immunohistochemical (IHC) expression of ER/PR/HER-2 status. An equivocal HER-2 status was further analysed by Fluorescence in situ Hybridisation (FISH). The following 6 groups were considered: ER(-)PR(-)HER-2(-) (NNN; triple negative), ER(-)PR(-)HER-2(+) (NNP), ER(+)PR(-)HER-2(-) (PNN), ER(+)PR(-)HER-2(+) (PNP), ER(+)PR(+)HER-2(- )(PPN), ER(+)PR(+)HER-2(+) (PPP; triple positive). For ALN, the following variables were tested in uni- and multivariate models: age at diagnosis (years), tumour size (mm), tumour grade, ER, PR, HER-2 and the combined steroid receptor and HER-2 status. Likelihood ratio chi(2)-tests were used for univariate analysis and logistic regression for multivariate analysis.
  
  
  RESULTS
  Triple positive tumours had a higher likelihood of being ALN positive than others (56.2% versus 35.7%; P<0.0001). Univariate logistic regression also withheld age, size, grade and HER-2 as predictors of ALN involvement. Final multivariate logistic regression revealed age, size, grade and PPP versus non-PPP to be independent predictors of ALN involvement; the odds ratio (OR) and 95% CI for PPP versus non-PPP tumours was 2.169 (1.490-3.156).
  
  
  CONCLUSIONS
  Our data provide insight into the natural history of triple positive breast carcinomas. Such tumours are more likely ALN positive than those with another steroid receptor and HER-2 status. How these findings correlate with breast cancer prognosis remains to be investigated.
authors.affiliation: Multidisciplinary Breast Centre, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Ben
authors.initials: B
authors.lastname: Van Calster
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vanden Bempt
authors.forename: Maria
authors.initials: M
authors.lastname: Drijkoningen
authors.forename: Nathalie
authors.initials: N
authors.lastname: Pochet
authors.forename: Jiqiu
authors.initials: J
authors.lastname: Cheng
authors.forename: Sabine
authors.initials: S
authors.lastname: Van Huffel
authors.forename: Wouter
authors.initials: W
authors.lastname: Hendrickx
authors.forename: Julie
authors.initials: J
authors.lastname: Decock
authors.forename: Huei-Jean
authors.initials: HJ
authors.lastname: Huang
authors.forename: Karin
authors.initials: K
authors.lastname: Leunen
authors.forename: Frederic
authors.initials: F
authors.lastname: Amant
authors.forename: Patrick
authors.initials: P
authors.lastname: Berteloot
authors.forename: Robert
authors.initials: R
authors.lastname: Paridaens
authors.forename: Hans
authors.initials: H
authors.lastname: Wildiers
authors.forename: Erik
authors.initials: E
authors.lastname: Van Limbergen
authors.forename: Caroline
authors.initials: C
authors.lastname: Weltens
authors.forename: Dirk
authors.initials: D
authors.lastname: Timmerman
authors.forename: Toon
authors.initials: T
authors.lastname: Van Gorp
authors.forename: Ann
authors.initials: A
authors.lastname: Smeets
authors.forename: Walter
authors.initials: W
authors.lastname: Van den Bogaert
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.forename: Marie-Rose
authors.initials: MR
authors.lastname: Christiaens
authors.forename: Patrick
authors.initials: P
authors.lastname: Neven
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D005260:Female; D018734:Genes, erbB-2; D006801:Humans; D016013:Likelihood Functions; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D016017:Odds Ratio; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics*; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human