Ankara University, Turkey
Ankara University, Turkey
Ankara University, Turkey
* Corresponding author
Ankara University, Turkey

Article Main Content

Purpose: Today, racial/ethnic differences in the incidence and prognosis of breast cancer (BC) are a well-known fact. This study aimed to examine the distribution of BC molecular subtypes in Turkish women and their relationship with other prognostic clinicopathological variables.

Methods: In our surgical oncology clinic, the database of 480 BC cases was retrospectively scanned between January 2008 and December 2020, and the demographic and histopathological results of the patients were recorded. Patients were classified into five main molecular subtypes. Survival curves were estimated using the Kaplan – Meier method. The relationship between categorical variables was analyzed using the chisquare test.

Results: The mean age of the patients at the time of diagnosis was 54.5 years, 46.3% were premenopausal, the mean tumor size was 28.7 mm, most of them were T1 (54%), ER, PR, HER-2 positivity rates were 79.6%, 73.1%, 38.3%, respectively and Ki-67 index average was 31.6. The most common molecular subtype was Luminal B Her2B-(33.5%). During a mean follow-up period of 56.9 months, 5 and 10-year overall survival (OS) rates were 89.5%, 79.6%, respectively, and disease-free survival (DFS) rates were 86.9%, 70.5%, respectively. The recurrence rate was 12.3%, distribution by molecular subtypes was significant (p=0.02). Luminal A and Luminal B/Her2- were in relation with Lobular Carcinoma (p=0.005), low histological grade (p=0.00), small tumor size (p=0.00), absence of lymphovascular invasion (LVI) (p=0.00), breast conserving surgery (p=0.022), presence of menopause (p =0.005) and local disease (p =0.013).

Conclusions: This study showed that there are differences in molecular subtyping for symptomatic BC in Turkish women.

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010; 127(12): 2893-917.
     Google Scholar
  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394-424.
     Google Scholar
  3. Porter PL. “Westernizing” women’s risks? Breast cancer in lower-income countries. N Engl J Med. 2008; 17(358(3): 213-216.
     Google Scholar
  4. DeSantis C, Ma J, Bryan L, Jemal A. Breast cancer statistics, 2013. CA Cancer J Clin. 2014; 64(1): 52-62.
     Google Scholar
  5. Viale G. The current state of breast cancer classification. Ann Oncol. 2012; 23(10): 207-210.
     Google Scholar
  6. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thürlimann B, Senn HJ. Strategies for subtypes-dealing with the diversity of breast cancer: Highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2011. Ann Oncol. 2011; 22(8): 1736-1747.
     Google Scholar
  7. Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B, et al. Personalizing the treatment of women with early breast cancer: Highlights of the st Gallen international expert consensus on the primary therapy of early breast Cancer 2013. Ann Oncol. 2013; 24(9): 2206-2223.
     Google Scholar
  8. Andre F, Pusztai L. Molecular classification of breast cancer: implications for selection of adjuvant chemotherapy. Nat Clin Pr Oncol. 2006; 3(11): 621-632.
     Google Scholar
  9. Cleator S, Heller W, Charles Coombes R. Triple-negative breast cancer: therapeutic options. Lancet Oncol. 2007; 8(1): 235-244.
     Google Scholar
  10. Lumachi F, Chiara GB, Foltran L, Basso SMM. Proteomics as a guide for personalized adjuvant chemotherapy in patients with early breast cancer. Cancer Genomics and Proteomics. 2015;12(6):385–90.
     Google Scholar
  11. Ozmen V. Breast cancer in the World and Turkey. J Breast Heal. 2008; 4(2): 7-12.
     Google Scholar
  12. Ozmen V, Ozmen T, Dogru V. Breast Cancer in Turkey; An Analysis of 20.000 Patients with Breast Cancer. Eur J Breast Heal. 2019; 15(3): 141-146.
     Google Scholar
  13. Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. J Am Med Assoc. 2006; 295(21): 2492-24502.
     Google Scholar
  14. Al-Kuraya K, Schraml P, Sheikh S, Amr S, Torhorst J, Tapia C, et al. Predominance of high-grade pathway in breast cancer development of Middle East women. Mod Pathol. 2005; 18(7): 891-897.
     Google Scholar
  15. Chlebowski RT, Chen Z, Anderson GL, Rohan T, Aragaki A, Lane D, et al. Ethnicity and breast cancer: Factors influencing differences in incidence and outcome. J Natl Cancer Inst. 2005; 97(6): 439-447.
     Google Scholar
  16. Setyawati Y, Rahmawati Y, Widodo I, Ghozali A, Purnomosari D. The association between molecular subtypes of breast cancer with histological grade and lymph node metastases in Indonesian woman. Asian Pacific J Cancer Prev. 2018; 19(5): 1263-1268.
     Google Scholar
  17. Al-thoubaity FK. Molecular classification of breast cancer: A retrospective cohort study. Ann Med Surg. 2020; 2019: 44-48.
     Google Scholar
  18. Warner ET, Tamimi RM, Hughes ME, Ottesen RA, Wong YN, Edge SB, et al. Racial and ethnic differences in breast cancer survival: Mediating effect of tumor characteristics and sociodemographic and treatment factors. J Clin Oncol. 2015; 33(20): 2254-2261.
     Google Scholar
  19. Giuliano AE, Connolly JL, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, et al. Breast Cancer- Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67(4): 290-303.
     Google Scholar
  20. Wiechmann L, Sampson M, Stempel M, Jacks LM, Patil SM, King T, et al. Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol. 2009; 16(10): 2705-2710.
     Google Scholar
  21. Ozmen V. Breast Cancer in Turkey: Clinical and Histopathological Characteristics (Analysis of 13.240 Patients). J Breast Heal. 2014; 10(2): 98-105.
     Google Scholar
  22. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016; 66(1): 7-30.
     Google Scholar
  23. Al Tamimi DM, Shawarby MA, Ahmed A, Hassan AK, AlOdaini AA. Protein expression profile and prevalence pattern of the molecular classes of breast cancer - a Saudi population based study. BMC Cancer. 2010; 10: 1-13.
     Google Scholar
  24. Park S, Koo JS, Kim MS, Park HS, Lee JS, Lee JS, et al. Characteristics and outcomes according to molecular subtypes of breast cancer as classified by a panel of four biomarkers using immunohistochemistry. Breast. 2012; 21(1): 50-57.
     Google Scholar
  25. Dawood S, Hu R, Homes MD, Collins LC, Schnitt SJ, Connolly J, et al. Defining breast cancer prognosis based on molecular phenotypes: Results from a large cohort study. Breast Cancer Res Treat. 2011; 126(1): 185-192.
     Google Scholar
  26. Widodo I, Dwianingsih EK, Triningsih E, Utoro T, Soeripto S. Clinicopathological features of Indonesian breast cancers with different molecular subtypes. Asian Pacific J Cancer Prev. 2014; 15(15): 6109-6113.
     Google Scholar
  27. Puig-Vives M, Sánchez MJ, Sánchez-Cantalejo J, Torrella-Ramos A, Martos C, Ardanaz E, et al. Distribution and prognosis of molecular breast cancer subtypes defined by immunohistochemical biomarkers in a Spanish population-based study. Gynecol Oncol. 2013; 130(3): 609-614.
     Google Scholar
  28. Zhang HM, Zhang BN, Xuan LX ZP. Clinical characteristics and survival in the operable breast cancer patients with different molecular subtypes. Zhonghua Zhong liu za zhi [Chinese Journal of Oncology]. 2009; 31(6): 447-451.
     Google Scholar
  29. Mazouni C, Rimareix F, Mathieu MC, Uzan C, Bourgier C, André F, et al. Outcome in breast molecular subtypes according to nodal status and surgical procedures. Am J Surg. 2013; 205(6): 662-667.
     Google Scholar
  30. Kim J, Lee S, Bae S, Choi MY, Lee J, Jung SP, et al. Comparison between screen-detected and symptomatic breast cancers according to molecular subtypes. Breast Cancer Res Treat. 2012; 131(2): 527-540.
     Google Scholar
  31. Focke CM, Bürger H, van Diest PJ, et al. Interlaboratory variability of Ki67 staining in breast cancer. Eur J Cancer. 2017; 84: 219-227.
     Google Scholar
  32. Minicozzi P, Bella F, Toss A, Giacomin A, Fusco M, Zarcone M, et al. Relative and disease-free survival for breast cancer in relation to subtype: A population-based study. J Cancer Res Clin Oncol. 2013; 139(9): 1569-1577.
     Google Scholar
  33. Maki DD, Grossman RI. Patterns of disease spread in metastatic breast carcinoma: Influence of estrogen and progesterone receptor status. Am J Neuroradiol. 2000; 21(6): 1064-1066.
     Google Scholar
  34. Altundag K, Bondy ML, Mirza NQ, Kau SW, Broglio K, Hortobagyi GN, et al. Clinicopathologic characteristics and prognostic factors in 420 metastatic breast cancer patients with central nervous system metastasis. Cancer. 2007; 110(12): 2640-2647.
     Google Scholar
  35. Buonomo OC, Caredda E, Portarena I, Vanni G, Orlandi A, Bagni C, et al. New insights into the metastatic behavior after breast cancer surgery, according to well-established clinicopathological variables and molecular subtypes. PLoS One. 2017; 12(9): 1-17.
     Google Scholar
  36. Kurian AW, Fish K, Shema SJ, Clarke CA. Lifetime risks of specific breast cancer subtypes among women in four racial/ethnic groups. Breast Cancer Res. 2010; 12(6): 1-9.
     Google Scholar