期刊
BREAST CANCER RESEARCH AND TREATMENT
卷 131, 期 1, 页码 33-40出版社
SPRINGER
DOI: 10.1007/s10549-011-1386-5
关键词
Breast cancer; Prognosis; Histological grade; ER status; Proliferation; Cyclin A
类别
资金
- Swedish Cancer Society
- Swedish Research Council
- Gunnar Nilsson Cancer Foundation
- Mrs. Berta Kamprad Foundation
- Anna and Edwin Bergers Foundation
- Skane County Council's Research and Development Foundation
- Governmental Funding of Clinical Research within the National Health Service
Global gene expression profiles, consisting mainly of genes associated with proliferation, have been shown to subdivide histological grade 2 breast cancers into groups with different prognosis. We raised the question whether this subdivision could be done using a single proliferation marker, cyclin A. Furthermore, we combined cyclin A (CA), histological grade (G), and estrogen receptor-ER (E) into a new variable, CAGE. Our aim was to investigate not only the prognostic importance of cyclin A alone but also the value of the combination variable CAGE. In 219 premenopausal node-negative patients, cyclin A was assessed using immunohistochemistry on tissue microarrays. High cyclin A was defined as above the seventh decile of positive cells. Only 13% of the patients received adjuvant systemic therapy. Cox proportional hazards regression was used to model the impact of the factors on distant disease-free survival (DDFS). Cyclin A divided histological grade 2 tumors into two groups with significantly different DDFS (hazard ratio [HR]: 15, P < 0.001). When stratifying for ER status, cyclin A was a prognostic factor only in the ER positive subgroup. We found that CAGE was an independent prognostic factor for DDFS in multivariate analysis (HR: 4.1, P = 0.002), together with HER2. CAGE and HER2 identified 53% as low-risk patients with a 5-year DDFS of 95%. A new prognostic variable was created by combining cyclin A, histological grade, and ER (CAGE). CAGE together with HER2 identified a large low-risk group for whom adjuvant chemotherapy will have limited efficacy and may be avoided.
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