title: 4-IHC classification of breast cancer subtypes in a large cohort of a clinical cancer registry: use in clinical routine for therapeutic decisions and its effect on survival.
abstract: The aim of the present study was to evaluate to what extent the combination of standard histopathological parameters determines the biology of breast cancer and the effect on therapy and prognosis. The Clinical Cancer Registry Regensburg (Bavaria, Germany) included n = 4,480 female patients with primary, non-metastatic (M0) invasive breast cancer diagnosed between 2000 and 2012. Immuno-histochemical analyses, i.e., estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 (4-IHC), defined the tumor biological subtypes Luminal A, Luminal B, HER2-like, and Basal-like. Subtype-related differences in therapies and overall survival (OS) were analyzed using multivariable statistical methods. 4344 patients (97.0 %) could be classified into the four common tumor biological subtypes. The two most frequent entities were Luminal A (48.4 %), Luminal B (24.8 %), HER2-like (17.8 %), and Basal-like subtype (9.0 %). A multivariable Cox regression model showed that the best 7-year OS was seen in Luminal A patients and that OS of Luminal B and HER2-like patients was comparable (HR = 1.59, P < 0.001 versus HR = 1.51, P = 0.03). Lowest OS was seen in patients with Basal-like tumors (HR = 2.18, P < 0.001). In conclusion, the classification of tumor biological subtypes by the ER, PR, HER2, and Ki-67 biomarkers is practical in routine clinical work. Providing that quality assurance of these markers is ensured, this classification is useful for making therapy decisions in the routine clinical management of breast cancer patients.
authors.affiliation: Department of Gynecology and Obstetrics, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany. elisabeth.inwald@klinik.uni-regensburg.de.
authors.forename: Elisabeth Christine
authors.initials: EC
authors.lastname: Inwald
authors.affiliation: Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Koller
authors.affiliation: Tumor Center Regensburg e.V., University of Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Klinkhammer-Schalke
authors.affiliation: Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Johannes Kepler University Linz, Linz, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Hofstädter
authors.affiliation: Tumor Center Regensburg e.V., University of Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gerstenhauer
authors.affiliation: Department of Gynecology and Obstetrics, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Brockhoff
authors.affiliation: Department of Gynecology and Obstetrics, University of Regensburg, Caritas Krankenhaus St. Josef, Landshuter Straße 65, 93053, Regensburg, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Ortmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality / Q000628:therapy; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor
keywords: 4-IHC; Breast cancer; Cancer registry; Overall survival; Tumor biological subtypes