Abstract
ObjectivesTo assess whether contralateral parenchymal enhancement reproduces as an independent biomarker for patient survival in an independent patient cohort from a different cancer institution.MethodsThis is a HIPAA-compliant IRB approved retrospective study. Patients with ER-positive/HER2-negative operable invasive ductal carcinoma and preoperative dynamic contrast-enhanced MRI were consecutively included between 2005 and 2009. The parenchyma of the breast contralateral to known cancer was segmented automatically on MRI and contralateral parenchymal enhancement (CPE) was calculated. CPE was split into tertiles and tested for association with invasive disease-free survival (IDFS) and overall survival (OS). Propensity score analysis with inverse probability weighting (IPW) was used to adjust CPE for patient and tumour characteristics as well as systemic therapy.ResultsThree hundred and two patients were included. The median age at diagnosis was 48 years (interquartile range, 42-57). Median follow-up was 88 months (interquartile range, 76-102); 15/302 (5%) patients died and 37/302 (13%) had a recurrence or died. In context of multivariable analysis, IPW-adjusted CPE was associated with IDFS [hazard ratio (HR) = 0.27, 95% confidence interval (CI) = 0.05-0.68, p = 0.004] and OS (HR = 0.22, 95% CI = 0.00-0.83, p = 0.032).ConclusionsContralateral parenchymal enhancement on pre-treatment dynamic contrast-enhanced MRI as an independent biomarker of survival in patients with ER-positive/HER2-negative breast cancer has been upheld in this study. These findings are a promising next step towards a practical and inexpensive test for risk stratification of ER-positive/HER2-negative breast cancer.Key points• High parenchymal-enhancement in the disease-free contralateral breast reproduces as biomarker for survival.• This is in patients with ER-positive/HER2-negative breast cancer from an independent cancer centre.• This is independent of patient and pathology parameters and systemic therapy.
Highlights
Breast cancer is a heterogeneous disease with inter- and intratumour heterogeneity
Three hundred and two patients with ER-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer were included in the biomarker-assessment study (Fig. 3); 281 (93%) received endocrine therapy (Table 1)
inverse probability weighting (IPW)-adjusted contralateral parenchymal enhancement (CPE) was significantly associated with invasive disease-free survival (IDFS) and overall survival (OS) after adjustment for age at diagnosis, histological grade, progesterone receptor (PR) status, axillary load and administration of systemic therapy (Tables 2 and 3)
Summary
Breast cancer is a heterogeneous disease with inter- and intratumour heterogeneity. Different molecular subtypes have been defined that are associated with disease-free and overall survival (OS). Immunohistochemical surrogates are used to guide treatment including oestrogen receptor (ER)positive/ human epidermal growth factor receptor 2 (HER2)negative, HER2-positive and triple-negative [1,2,3,4]. Molecular assays have yielded additional tools to predict therapy outcome, helping to optimise strategies for patient-tailored treatment [5,6,7,8]. Using current routine predictive markers in clinical practice, treatment outcome still varies within specific subtypes. An ongoing need for accurate risk stratification exists, where risk markers are correlated with outcome after breast cancer therapy
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