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Influence of the subtype on local recurrence risk of breast cancer with or without radiation therapy
Orebro Univ, Fac Med & Hlth, Dept Surg, Orebro, Sweden.
Orebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, Orebro, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery. Kings Coll, London, UK.
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Univ Oslo, Clin Effectiveness Res Grp, Oslo, Norway.
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2018 (English)In: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 42, p. 54-60Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate if intrinsic subtypes of breast cancer predict different risks of ipsilateral breast tumor recurrence (IBTR) following breast-conserving surgery (BCS) with and without postoperative radiation therapy. Patients and methods: We randomized 381 women with a unifocal T1N0M0 breast cancer to BCS alone (197 women) or BCS plus postoperative radiation therapy (XRT) (184 women). All available histopathological material was re-analyzed with modern immunohistochemical methods (223 women). After 20 years of complete follow-up we analyzed the risk of IBTR by intrinsic breast cancer subtypes (luminal A, luminal B/HER2-negative, luminal B/HER2-positive, HER2-positive and triple negative). We used Cox regression analyses to estimate hazard ratios (HR) with 95% confidence intervals (CI). Results: In a multivariate analysis the luminal B/HER2-negative subtype, compared with the luminal A subtype, was associated with a higher risk of IBTR overall (HR 3.04; 95% CI 1.38-6.71) and in both the XRT-group (HR 5.08 95% CI 1.31-19.7) and the non-XRT-group (HR 2.58 95%CI 1.07-6.20); (p for interaction 0.37). The risk of IBTR in the XRT- and non-XRT group, stratified by intrinsic subtype, revealed an absolute risk difference at 20 years to the benefit of XRT of 14% (95% CI 1.0%-26%) for luminal A, 17% (95% CI -6.0% to 39%) for luminal B/HER2 negative and 22% (95% CI -7.0-51%) for the high-risk group. Conclusions: Among breast cancer patients treated with BCS, the luminal B/HER2-negative subtype predicts an about 3-fold higher risk for IBTR compared to other intrinsic subtypes independent of postoperative radiation therapy. (C) 2018 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE , 2018. Vol. 42, p. 54-60
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Cancer and Oncology
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URN: urn:nbn:se:uu:diva-369386DOI: 10.1016/j.breast.2018.08.097ISI: 000448315600010PubMedID: 30176553OAI: oai:DiVA.org:uu-369386DiVA, id: diva2:1278728
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-01-15Bibliographically approved

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