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Breast Cancer Subtypes Based on ER/PR and Her2 Expression: Comparison of Clinicopathologic Features and Survival

Adedayo A. Onitilo, MD, MSCR, FACP, Department of Hematology/Oncology, Marshfield Clinic Weston Center, 3501 Cranberry Blvd, Weston, Wisconsin 54401
Jessica M. Engel, MSN, FNP-BC, Department of Hematology/Oncology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, Wisconsin 54449
Robert T. Greenlee, PhD, Epidemiology Research Center, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, Wisconsin 54449
Bickol N. Mukesh, PhD, Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, Wisconsin 54449. Current affiliation: Alcon Laboratories, Inc., 6201 South Freeway, Fort Worth, TX 76134

Reprint Requests: Adedayo A. Onitilo, MD, MSCR, FACP, Marshfield Clinic Weston Center, 3501 Cranberry Boulevard, Weston, WI 54476, Tel: 715-393-1400, Fax: 715-393-1399, Email: onitilo.adedayo{at}marshfieldclinic.org

Objective: To compare the clinicopathologic features and survival in the four breast cancer subtypes defined by immunohistochemistry (IHC) expression of estrogen receptor (ER) or progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2): ER/PR+, Her2+; ER/PR+, Her2–; ER/PR–, Her2+; and ER/PR–, Her2–.

Methods: A 7-year retrospective study of 1134 invasive breast cancer subjects. Clinical and pathologic features and survival of the four subtypes were compared.

Results: Using ER/PR+ and Her2– as a reference, ER/PR–, Her2– had the worst overall survival (hazard ratio, 1.8; 95% confidence interval [CI], 1.06–3.2) and the worst disease-free survival (hazard ratio, 1.5; 95% CI, 0.8–3.0). In ER/PR+, Her2–, chemotherapy conferred significant overall and disease-free survival advantages. Subtype comparison revealed statistically significant differences in outcomes.

Conclusion: The triple negative subtype has the worst overall and disease free survival. Efforts should be directed at standardization of current testing methods and development of more reliable and reproducible testing.

Key Words: Breast cancer subtype • Survival • Treatment • Estrogen/progesterone receptor • Human epidermal growth factor receptor 2 (HER2/neu) • Immunohistochemistry • Triple negative

Disclosure: Presented in part at the American Society of Clinical Oncology meeting, Chicago, IL, May 30-June 3, 2008.

Grant Support: Supported by Marshfield Clinic Research Foundation, Disease Specific Restricted Funds.