title: A five-gene molecular grade index and HOXB13:IL17BR are complementary prognostic factors in early stage breast cancer.
abstract: OBJECTIVE
  Histologic tumor grade is a well-established prognostic factor for breast cancer, and tumor grade-associated genes are the common denominator of many prognostic gene signatures. The objectives of this study are as follows: (a) to develop a simple gene expression index for tumor grade (molecular grade index or MGI), and (b) to determine whether MGI and our previously described HOXB13:IL17BR index together provide improved prognostic information.
  
  
  METHODS
  From our previously published list of genes whose expression correlates with both tumor grade and tumor stage progression, we selected five cell cycle-related genes to build MGI and evaluated MGI in two publicly available microarray data sets totaling 410 patients. Using two additional cohorts (n = 323), we developed a real-time reverse transcription PCR assay for MGI, validated its prognostic utility, and examined its interaction with HOXB13:IL17BR.
  
  
  RESULTS
  MGI performed consistently as a strong prognostic factor and was comparable with a more complex 97-gene genomic grade index in multiple data sets. In patients treated with endocrine therapy, MGI and HOXB13:IL17BR modified each other's prognostic performance. High MGI was associated with significantly worse outcome only in combination with high HOXB13:IL17BR, and likewise, high HOXB13:IL17BR was significantly associated with poor outcome only in combination with high MGI.
  
  
  CONCLUSIONS
  We developed and validated a five-gene reverse transcription PCR assay for MGI suitable for analyzing routine formalin-fixed paraffin-embedded clinical samples. The combination of MGI and HOXB13:IL17BR outperforms either alone and identifies a subgroup ( approximately 30%) of early stage estrogen receptor-positive breast cancer patients with very poor outcome despite endocrine therapy.
authors.affiliation: AviaraDx, Inc., San Diego, California, USA.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Ma
authors.forename: Ranelle
authors.initials: R
authors.lastname: Salunga
authors.forename: Sonika
authors.initials: S
authors.lastname: Dahiya
authors.forename: Wilson
authors.initials: W
authors.lastname: Wang
authors.forename: Erin
authors.initials: E
authors.lastname: Carney
authors.forename: Virginie
authors.initials: V
authors.lastname: Durbecq
authors.forename: Adrian
authors.initials: A
authors.lastname: Harris
authors.forename: Paul
authors.initials: P
authors.lastname: Goss
authors.forename: Christos
authors.initials: C
authors.lastname: Sotiriou
authors.forename: Mark
authors.initials: M
authors.lastname: Erlander
authors.forename: Dennis
authors.initials: D
authors.lastname: Sgroi
mesh_terms: D001324:Autoantigens / Q000235:genetics; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D000076247:Centromere Protein A; D002868:Chromosomal Proteins, Non-Histone / Q000235:genetics; D015331:Cohort Studies; D020869:Gene Expression Profiling; D052138:Genes, Neoplasm; D018398:Homeodomain Proteins / Q000235:genetics; D006801:Humans; D053208:Kaplan-Meier Estimate; D000072379:NIMA-Related Kinases; D011379:Prognosis; D016016:Proportional Hazards Models; D017346:Protein Serine-Threonine Kinases / Q000235:genetics; D018123:Receptors, Interleukin / Q000235:genetics; D053722:Receptors, Interleukin-17; D012262:Ribonucleoside Diphosphate Reductase / Q000235:genetics
chemical_list: D001324:Autoantigens; D000076247:Centromere Protein A; D002868:Chromosomal Proteins, Non-Histone; C484414:HOXB13 protein, human; D018398:Homeodomain Proteins; C408922:IL17RB protein, human; D018123:Receptors, Interleukin; D053722:Receptors, Interleukin-17; C093713:ribonucleotide reductase M2; D012262:Ribonucleoside Diphosphate Reductase; C090464:Bub1 spindle checkpoint protein; C089441:NEK2 protein, human; D000072379:NIMA-Related Kinases; D017346:Protein Serine-Threonine Kinases