Abstract
Lymphovascular invasion (LVI) and Black race are associated with poorer prognosis in early breast cancer (EBC). We evaluated the association between LVI and race, and whether LVI adds prognostic benefit to the 21-gene recurrence score (RS) in EBC. Women with ER+ HER2− EBC measuring up to 5 cm, with 0–3 involved axillary nodes, diagnosed between 1 January 2010 and 1 January 2014, who underwent surgery as first treatment and had available RS, were identified in the NCDB database. Bivariate associations between two categorical variables were examined using chi-square test. Multivariate Cox proportional hazards model were used to assess the association of LVI, race, and other covariates with overall survival (OS). 77,425 women, 65,018 node-negative (N0), and 12,407 with 1–3 positive (N+) nodes, were included. LVI was present in 12.7%, and associated with poor grade, RS 26–100, and N+ (all p < 0.0001), but not Black race. In multivariate analysis, LVI was associated with worse OS in N0 [HR 1.37 (95% CI 1.27, 1.57], but not N+ EBC. LVI was associated with worse OS in N0 patients with RS 11–25 [HR 1.31 (95% CI 1.09, 1.57)] and ≥26 [HR 1.58 (95% CI 1.30, 1.93)], but not RS 0–10. No interaction between LVI and chemotherapy benefit was seen. Black race was associated with worse OS in N0 (HR 1.21, p = 0.009) and N+ (HR 1.37, p = 0.015) disease. LVI adds prognostic information in ER+, HER2−, N0 BCA with RS 11–100, but does not predict chemotherapy benefit. Black race is associated with worse OS, but not LVI.
Highlights
Lymphovascular invasion (LVI), the presence of tumor cells within the lumen of lymphatic or vascular system in the tumor primary site, is associated with a higher risk of regional lymph node metastasis at diagnosis and subsequent distant recurrence in early breast cancer (EBC)[1,2,3,4,5,6,7]
We evaluated the association between LVI, race, and the 21-gene recurrence score (RS) in 77,425 women with ER-positive, HER2-positive EBC with 0–3 positive axillary nodes
We confirmed prior reports that LVI is associated with a worse prognosis in N0 disease[1,3,5,6], and that Black race is associated with a worse prognosis[20,23,24], but report for the first time no association between Black race and the presence of LVI
Summary
Lymphovascular invasion (LVI), the presence of tumor cells within the lumen of lymphatic or vascular system in the tumor primary site, is associated with a higher risk of regional lymph node metastasis at diagnosis and subsequent distant recurrence in early breast cancer (EBC)[1,2,3,4,5,6,7]. The extent to which LVI adds prognostic information or predictive information for chemotherapy benefit to the 21-gene RS or other assays has not been adequately evaluated[16]. In the TAILORx trial, Black race was associated with a 1.4-fold higher risk of recurrence after adjustment for clinicopathologic characteristics, despite similar chemotherapy and endocrine therapy use and similar RS distribution[23]. Biological factors that are not captured by the 21-gene RS, including racial differences in the tumor microenvironment[24,25], may contribute to the worse outcomes for Black women with EBC. Sought to assess whether LVI adds prognostic or predictive information to the 21gene RS, and whether there is an association between LVI and race that may contribute to racial disparities in EBC
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