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Prognostic utility of the breast cancer index and comparison to Adjuvant! Online in a clinical case series of early breast cancer

Jankowitz, RC and Cooper, K and Erlander, MG and Ma, XJ and Kesty, NC and Li, H and Chivukula, M and Brufsky, A (2011) Prognostic utility of the breast cancer index and comparison to Adjuvant! Online in a clinical case series of early breast cancer. Breast Cancer Research, 13 (5). ISSN 1465-5411

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Abstract

© 2011 Jankowitz et al.; licensee BioMed Central Ltd. Introduction: Breast Cancer Index (BCI) combines two independent biomarkers, HOXB13:IL17BR (H:I) and the 5-gene molecular grade index (MGI), that assess estrogen-mediated signalling and tumor grade, respectively. BCI stratifies early-stage estrogen-receptor positive (ER+), lymph-node negative (LN-) breast cancer patients into three risk groups and provides a continuous assessment of individual risk of distant recurrence. Objectives of the current study were to validate BCI in a clinical case series and to compare the prognostic utility of BCI and Adjuvant!Online (AO). Methods: Tumor samples from 265 ER+LN- tamoxifen-treated patients were identified from a single academic institution's cancer research registry. The BCI assay was performed and scores were assigned based on a pre-determined risk model. Risk was assessed by BCI and AO and correlated to clinical outcomes in the patient cohort. Results: BCI was a significant predictor of outcome in a cohort of 265 ER+LN- patients (median age: 56-y; median follow-up: 10.3-y), treated with adjuvant tamoxifen alone or tamoxifen with chemotherapy (32%). BCI categorized 55%, 21%, and 24% of patients as low, intermediate and high-risk, respectively. The 10-year rates of distant recurrence were 6.6%, 12.1% and 31.9% and of breast cancer-specific mortality were 3.8%, 3.6% and 22.1% in low, intermediate, and high-risk groups, respectively. In a multivariate analysis including clinicopathological factors, BCI was a significant predictor of distant recurrence (HR for 5-unit increase = 5.32 [CI 2.18-13.01; P = 0.0002]) and breast cancer-specific mortality (HR for a 5-unit increase = 9.60 [CI 3.20-28.80; P < 0.0001]). AO was significantly associated with risk of recurrence. In a separate multivariate analysis, both BCI and AO were significantly predictive of outcome. In a time-dependent (10-y) ROC curve accuracy analysis of recurrence risk, the addition of BCI+AO increased predictive accuracy in all patients from 66% (AO only) to 76% (AO+BCI) and in tamoxifen-only treated patients from 65% to 81%. Conclusions: This study validates the prognostic performance of BCI in ER+LN- patients. In this characteristically low-risk cohort, BCI classified high versus low-risk groups with ~5-fold difference in 10-year risk of distant recurrence and breast cancer-specific death. BCI and AO are independent predictors with BCI having additive utility beyond standard of care parameters that are encompassed in AO.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Jankowitz, RCrcj8@pitt.eduRCJ8
Cooper, K
Erlander, MG
Ma, XJ
Kesty, NC
Li, H
Chivukula, M
Brufsky, Aadb5@pitt.eduADB5
Centers: Other Centers, Institutes, Offices, or Units > Pittsburgh Cancer Institute
Date: 14 October 2011
Date Type: Publication
Journal or Publication Title: Breast Cancer Research
Volume: 13
Number: 5
DOI or Unique Handle: 10.1186/bcr3038
Schools and Programs: Graduate School of Public Health > Biostatistics
School of Medicine > Medicine
School of Medicine > Pathology
Refereed: Yes
ISSN: 1465-5411
Date Deposited: 26 Oct 2016 17:11
Last Modified: 05 Feb 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/30011

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