Oncotype DX 21‑gene test has a low recurrence score in both pure and mixed mucinous breast carcinoma

Chen,Rui; Wang,Yun; Li,Taolang; Lv,Junyuan; Feng,Guoli; Tan,Na; Wang,Jinjing; Cheng,Xiaoming

doi:10.3892/ol.2021.13032

November-2021 Volume 22 Issue 5

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November-2021 Volume 22 Issue 5

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Article Open Access

Oncotype DX 21‑gene test has a low recurrence score in both pure and mixed mucinous breast carcinoma

Authors:
- Rui Chen
- Yun Wang
- Taolang Li
- Junyuan Lv
- Guoli Feng
- Na Tan
- Jinjing Wang
- Xiaoming Cheng
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Affiliations: Department of Thyroid and Breast Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China, Department of Pathology, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China

Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 771
|
Published online on: September 9, 2021

https://doi.org/10.3892/ol.2021.13032
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Abstract

The Oncotype DX 21‑gene test can be used to predict chemotherapy efficacy in patients with estrogen receptor (ER)‑positive and HER2‑negative breast cancer; however, the data on the 21‑gene recurrence score (RS) for mucinous breast carcinoma (MBC) are limited. The present study aimed to evaluate the distribution pattern and clinical value of the 21‑gene RS in patients with MBC. A total of 38 pure MBC (PMBC) and 11 mixed MBC (MMBC) cases were retrospectively analyzed, and a total of 29 ER‑positive and HER2‑negative MBCs underwent the Oncotype DX 21‑gene test. There were no statistically significant differences between the PMBCs and MMBCs in age, tumor size and molecular subtype; however, patients with MMBC showed a significantly higher incidence rate of nodal metastases compared with that in patients with PMBC (72.7 vs. 16.2%, respectively). Following surgery, 87.8 and 59.2% of the enrolled patients received endocrine therapy and chemotherapy, respectively. With a median follow‑up of 65.6 months, the 5‑year disease‑free survival and overall survival rates were 97.0 and 100.0%, respectively. The 21‑gene test revealed that the proportions of patients with MBC categorized into low (RS <18), intermediate (RS ≥18‑30) and high (RS ≥30) risk groups were 51.7, 44.8 and 3.5%, respectively, and there was no statistically significant difference between the PMBC and MMBC cases. Notably, among the genes in the 21‑gene RS testing, the expression levels of cathepsin V, progesterone receptor (PR) and CD68 were significantly higher in the PMBC group compared with that in the MMBC group. In conclusion, the current study demonstrated that patients with MBC had a favorable prognosis, and both PMBC and MMBC cases had a low‑ and intermediate‑risk RS, which suggests that a considerable proportion of patients may be able to avoid chemotherapy. In addition, the high expression level of PR, based on the 21‑gene test in PMBCs, indicated that they may have a more favorable response to endocrine therapy than MMBCs.

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1	Kim HS, Yoo TK, Park WC and Chae BJ: The prognostic value of HER2 status and efficacy of anti-HER2 therapy in patients with HR-positive mucinous breast cancer: A nationwide study from the Korean Breast Cancer Society. Breast Cancer Res Treat. 180:461–470. 2020. View Article : Google Scholar : PubMed/NCBI
2	Di Saverio S, Gutierrez J and Avisar E: A retrospective review with long term follow up of 11,400 cases of pure mucinous breast carcinoma. Breast Cancer Res Treat. 111:541–547. 2008. View Article : Google Scholar : PubMed/NCBI
3	Bae SY, Choi MY, Cho DH, Lee JE, Nam SJ and Yang JH: Mucinous carcinoma of the breast in comparison with invasive ductal carcinoma: Clinicopathologic characteristics and prognosis. J Breast Cancer. 14:308–313. 2011. View Article : Google Scholar : PubMed/NCBI
4	Barkley CR, Ligibel JA, Wong JS, Lipsitz S, Smith BL and Golshan M: Mucinous breast carcinoma: A large contemporary series. Am J Surg. 196:549–551. 2008. View Article : Google Scholar : PubMed/NCBI
5	Cao AY, He M, Liu ZB, Di GH, Wu J, Lu JS, Liu GY, Shen ZZ and Shao ZM: Outcome of pure mucinous breast carcinoma compared to infiltrating ductal carcinoma: A population-based study from China. Ann Surg Oncol. 19:3019–3027. 2012. View Article : Google Scholar : PubMed/NCBI
6	Hanagiri T, Ono K, Baba T, So T, Yamasaki M, Nagata Y, Uramoto H, Takenoyama M and Yasumoto K: Clinicopathologic characteristics of mucinous carcinoma of the breast. Int Surg. 95:126–129. 2010.PubMed/NCBI
7	Lei L, Yu X, Chen B, Chen Z and Wang X: Clinicopathological characteristics of mucinous breast cancer: A retrospective analysis of a 10-year study. PLoS One. 11:e01551322016. View Article : Google Scholar : PubMed/NCBI
8	Skotnicki P, Sas-Korczynska B, Strzepek L, Jakubowicz J, Blecharz P, Reinfuss M and Walasek T: Pure and mixed mucinous carcinoma of the breast: A comparison of clinical outcomes and treatment results. Breast J. 22:529–534. 2016. View Article : Google Scholar : PubMed/NCBI
9	Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, Baehner FL, Walker MG, Watson D, Park T, et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351:2817–2826. 2004. View Article : Google Scholar : PubMed/NCBI
10	Green N, Al-Allak A and Fowler C: Benefits of introduction of oncotype DX^® testing. Ann R Coll Surg Engl. 101:55–59. 2019. View Article : Google Scholar : PubMed/NCBI
11	Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE, Dees EC, Goetz MP, Olson JA, et al: Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 379:111–121. 2018. View Article : Google Scholar : PubMed/NCBI
12	Goldstein LJ, Gray R, Badve S, Childs BH, Yoshizawa C, Rowley S, Shak S, Baehner FL, Ravdin PM, Davidson NE, et al: Prognostic utility of the 21-gene assay in hormone receptor-positive operable breast cancer compared with classical clinicopathologic features. J Clin Oncol. 26:4063–4071. 2008. View Article : Google Scholar : PubMed/NCBI
13	Albain KS, Barlow WE, Shak S, Hortobagyi GN, Livingston RB, Yeh IT, Ravdin P, Bugarini R, Baehner FL, Davidson NE, et al: Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: A retrospective analysis of a randomised trial. Lancet Oncol. 11:55–65. 2010. View Article : Google Scholar : PubMed/NCBI
14	Wang W, Chen X, Lin L, Fei X, Garfield DH, Hong J, Gao W, Zhu S, Wu J, Huang O, et al: Distribution and clinical utility of the 21-gene recurrence score in pure mucinous breast cancer patients: A case-control study. J Cancer. 9:3216–3224. 2018. View Article : Google Scholar : PubMed/NCBI
15	Wu J, Ding S, Lin L, Fei X, Lin C, Andriani L, Goh C, Huang J, Hong J, Gao W, et al: Comparison of the distribution pattern of 21-gene recurrence score between mucinous breast cancer and infiltrating ductal carcinoma in Chinese population: A retrospective single-center study. Cancer Res Treat. 52:671–679. 2020. View Article : Google Scholar : PubMed/NCBI
16	Lebeau A and Denkert C: Updated WHO classification of tumors of the breast: The most important changes. Pathologe. 42:270–280. 2021.(In German). View Article : Google Scholar : PubMed/NCBI
17	Kashiwagi S, Onoda N, Asano Y, Noda S, Kawajiri H, Takashima T, Ohsawa M, Kitagawa S and Hirakawa K: Clinical significance of the sub-classification of 71 cases mucinous breast carcinoma. Springerplus. 2:4812013. View Article : Google Scholar : PubMed/NCBI
18	Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, et al: American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 28:2784–2795. 2010. View Article : Google Scholar : PubMed/NCBI
19	Dowsett M, Nielsen TO, A'Hern R, Bartlett J, Coombes RC, Cuzick J, Ellis M, Henry NL, Hugh JC, Lively T, et al: Assessment of Ki67 in breast cancer: Recommendations from the international Ki67 in Breast Cancer working group. J Natl Cancer Inst. 103:1656–1664. 2011. View Article : Google Scholar : PubMed/NCBI
20	Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thürlimann B and Senn HJ; Panel members, : 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. 24:2206–2223. 2013. View Article : Google Scholar : PubMed/NCBI
21	Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS, Bilous M, Ellis IO, Fitzgibbons P, Hanna W, et al: Human epidermal growth factor receptor 2 testing in breast cancer: American society of clinical Oncology/College of American pathologists clinical practice guideline focused update. J Clin Oncol. 36:2105–2122. 2018. View Article : Google Scholar : PubMed/NCBI
22	Livak KJ and Schmittgen TD: Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) method. Methods. 25:402–408. 2001. View Article : Google Scholar : PubMed/NCBI
23	Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE, Dees EC, Perez EA, Olson JA, et al: Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med. 373:2005–2014. 2015. View Article : Google Scholar : PubMed/NCBI
24	Abdulrahman G, Opeyemi R and Ganiyu A: Epidemiology of breast cancer in Europe and Africa. J Cancer Epidemiol. 2012:9156102012. View Article : Google Scholar : PubMed/NCBI
25	Yim HE, Kim JH, Ahn MS, Jung Y, Roh J, Park SH, Kim TG, Choi JK and Kang SY: Clinicopathological and molecular analysis of 45 cases of pure mucinous breast cancer. Front Oncol. 10:5587602020. View Article : Google Scholar : PubMed/NCBI
26	Ranade A, Batra R, Sandhu G, Chitale RA and Balderacchi J: Clinicopathological evaluation of 100 cases of mucinous carcinoma of breast with emphasis on axillary staging and special reference to a micropapillary pattern. J Clin Pathol. 63:1043–1047. 2010. View Article : Google Scholar : PubMed/NCBI
27	Erhan Y, Ciris M, Zekioglu O, Erhan Y, Kapkac M, Makay O and Ozdemir N: Do clinical and immunohistochemical findings of pure mucinous breast carcinoma differ from mixed mucinous breast carcinoma. Acta Chir Belg. 109:204–208. 2009. View Article : Google Scholar : PubMed/NCBI
28	Wang J, He ZY, Dong Y, Sun JY, Zhang WW and Wu SG: The Distribution and Outcomes of the 21-gene recurrence score in T1-T2N0 Estrogen receptor-positive breast cancer with different histologic subtypes. Front Genet. 9:6382018. View Article : Google Scholar : PubMed/NCBI
29	Turashvili G, Brogi E, Morrow M, Hudis C, Dickler M, Norton L and Wen HY: The 21-gene recurrence score in special histologic subtypes of breast cancer with favorable prognosis. Breast Cancer Res Treat. 165:65–76. 2017. View Article : Google Scholar : PubMed/NCBI
30	Paik S, Tang G, Shak S, Kim C, Baker J, Kim W, Cronin M, Baehner FL, Watson D, Bryant J, et al: Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 24:3726–3734. 2006. View Article : Google Scholar : PubMed/NCBI
31	Sparano JA, Gray RJ, Ravdin PM, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CE Jr, Dees EC, Goetz MP, et al: Clinical and genomic risk to guide the use of adjuvant therapy for breast cancer. N Engl J Med. 380:2395–2405. 2019. View Article : Google Scholar : PubMed/NCBI
32	Toss M, Miligy I, Gorringe K, Mittal K, Aneja R, Ellis I, Green A and Rakha E: Prognostic significance of Cathepsin V (CTSV/CTSL2) in breast ductal carcinoma in situ. J Clin Pathol. 73:76–82. 2020. View Article : Google Scholar : PubMed/NCBI
33	Mohammed H, Russell IA, Stark R, Rueda OM, Hickey TE, Tarulli GA, Serandour AA, Serandour AA, Birrell SN, Bruna A, et al: Progesterone receptor modulates ERα action in breast cancer. Nature. 523:313–317. 2015. View Article : Google Scholar : PubMed/NCBI
34	Gluz O, Nitz UA, Christgen M, Kates RE, Shak S, Clemens M, Kraemer S, Aktas B, Kuemmel S, Reimer T, et al: West German study group phase III planB trial: First prospective outcome data for the 21-gene recurrence score assay and concordance of prognostic markers by central and local pathology assessment. J Clin Oncol. 34:2341–2349. 2016. View Article : Google Scholar : PubMed/NCBI
35	de Groot AF, Blok EJ, Charehbili A, Engels CC, Smit VTHBM, Dekker-Ensink NG, Putter H, Meershoek-Klein Kranenbarg E, van de Velde CJH, Liefers GJ, et al: Strong CD8+ lymphocyte infiltration in combination with expression of HLA class I is associated with better tumor control in breast cancer patients treated with neoadjuvant chemotherapy. Breast Cancer Res Treat. 175:605–615. 2019. View Article : Google Scholar : PubMed/NCBI
36	Pelekanou V, Villarroel-Espindola F, Schalper KA, Pusztai L and Rimm DL: CD68, CD163, and matrix metalloproteinase 9 (MMP-9) co-localization in breast tumor microenvironment predicts survival differently in ER-positive and -negative cancers. Breast Cancer Res. 20:1542018. View Article : Google Scholar : PubMed/NCBI