Abstract
As a new subtype of breast cancer, molecular apocrine breast cancer (MABC) is estrogen receptor (ER) and progesterone receptor (PR) negative expression, but androgen receptor (AR) positive expression. The prognostic significance and clinical biological behavior of MABC have remained unclear up to now. This study aimed to analysis the distant metastasis behavior and response to adjuvant radiotherapy and chemotherapy of MABC subgroup. The report showed that there were significant differences between early and late distant metastasizing tumors with respect to Ki67, epidermal growth factor receptor 2 (HER2) and vascular endothelial growth factor (VEGF) expressions by a retrospective analysis consisting of 410 invasive breast cancer patients, which included 205 MABC and 205 nonMABC cases. MABC subgroup metastasized earlier than nonMABC subgroup, and MABC showed a tendency for a higher metastasis rate in lung, liver and brain, but lower in bone. HER2-positive or VEGF-positive tumors were more inclined to develop bone metastasis within MABC subgroup. The survival rate was superior for patients undergone both adjuvant radiotherapy and chemotherapy than those undergone chemotherapy alone in nonMABC subgroup, but there was no significant difference in MABC subgroup. Our data suggested that MABC subgroup seemed to develop distant metastasis earlier than nonMABC subgroup, and patients with MABC indicated poor prognosis. This study might also provide a foundation for helping patients receive reasonable treatments according to molecular subtype.
Highlights
In addition to estrogen receptor (ER) and progesterone receptor (PR), there is obvious evidence that the androgen signaling pathway may play a critical role in breast cancer [1, 2]
In 2013, LehmannChe et al [7] initially confirmed a group of breast cancer samples by a molecular apocrine qRT-PCR signature and performed immunohistochemistry, and they reported that only 4 morphological apocrine tumors among 58 molecular apocrine cases, which suggested that molecular apocrine breast cancer (MABC) subgroup could be much broader than initially reported by Farmer et al In 2014, Lakis’s [8] study subtyped tumors into luminal, molecular apocrine (ER-/ PR-/androgen receptor (AR)+) and receptor-negative, and it had proved that AR-related subtype of breast cancer might be prognostic and serve for selecting optimal treatment combinations
The majority of the tumors were classified as invasive carcinoma of no specific type (NST), and the others included invasive lobular carcinoma (ILC), carcinomas with apocrine differentiation, invasive micropapillary carcinoma (IMPC), invasive papillary carcinoma (IPC), carcinomas with medullary features and other invasive carcinomas
Summary
In addition to estrogen receptor (ER) and progesterone receptor (PR), there is obvious evidence that the androgen signaling pathway may play a critical role in breast cancer [1, 2]. Depending on the breast cancer molecular subtype, androgen receptor (AR) and androgen signaling may have either tumor suppressive or oncogenic role on breast cancer growth. The association between AR expression and favorable outcome in ER positive breast cancer had been verified in various studies [3, 4]. Tsang et al [5] showed that in ER positive breast cancers, AR expression was associated with a lower grade disease and a better prognosis, whereas in ER negative breast cancers, AR appeared to be capable of mediating proliferation and acting an oncogenic driver. In 2005, Farmer et al [6] named ER negative and AR positive tumors as molecular apocrine breast cancer (MABC), while these lesions did www.impactjournals.com/oncotarget not meet the strict histopathological criteria for diagnosis as classical apocrine carcinomas. The prognostic significance and clinical biological behavior of MABC were needed to be better understood
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