title: The inconsistency of molecular subtypes between primary foci and metastatic axillary lymph nodes in Luminal A breast cancer patients among Chinese women, an indication for chemotherapy?
abstract: Patients with Luminal A breast cancer often have favorable prognosis, but some of these patients still have lymph node metastases, it remains unclear what the role of adjuvant chemotherapy is in Luminal A subtype with lymph node metastases. The aim of this study was to find a new method to distinguish which Luminal A patient can be benefited from chemotherapy. We retrospectively investigated the inconsistency of molecular subtypes between primary foci and metastatic axillary lymph nodes in Luminal A breast cancer patients, and analyzed the clinicopathologic characteristics, Recurrence score (RS), disease-free survival (DFS), and overall survival (OS) in 146 Luminal A breast cancer patients. The discordance of molecular subtypes between primary foci and metastatic lymph nodes were explored by univariate and multivariate logistic regression. The DFS and OS were calculated by the Kaplan-Meier survival curves, and the Cox regression analyses were performed to identify independent prognostic factors for DFS and OS. In our results, the inconsistency was found in 55 patients (55/146, 37.67 %). Lymphatic vascular invasion (OR 6.402, 95 % CI 2.371-17.287, P < 0.001), lymph node stage (OR 2.147, 95 % CI 1.095-4.209, P = 0.026), and histological grade (OR 3.319, 95 % CI 1.101-8.951, P = 0.032) were significantly related to the inconsistency. The inconsistent group (non-Luminal A variations) had a poor prognosis compared with the consistent group, the DFS between the two groups was significantly different (P = 0.022), but the OS did not have obvious difference (P = 0.140). Moreover, the inconsistency was associated with high RS (P = 0.036). In conclusion, more aggressive molecular subtypes in metastatic lymph nodes, which associated with poor prognosis, were observed in Luminal A breast cancer patients, which indicate that chemotherapy is necessary for these patients.
authors.affiliation: Department of Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.|Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Yadong
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of breast, Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, 210004, People's Republic of China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Shude
authors.initials: S
authors.lastname: Cui
authors.affiliation: Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Lianfang
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Peiqi
authors.initials: P
authors.lastname: Tian
authors.affiliation: Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Shanqing
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Yin
authors.affiliation: Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Chongjian
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China.
authors.forename: Qixin
authors.initials: Q
authors.lastname: Mao
authors.affiliation: Department of Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China. jia-xiang.wang@outlook.com.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Wang
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D044466:Asian People; D001365:Axilla / Q000473:pathology*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; Luminal A; Lymph node metastases; Molecular subtype