Abstract
1078 Background: AJCC stage and St Gallen risk classifications are used by clinicians worldwide to help guide the course of treatment. The ER/PR/HER2 subtypes highlight differences among the St. Gallen Risk Classification of 2007. The purpose of this investigation is to determine how survival differs among the ER/PR/HER2 subtypes within the AJCC pathologic stages. Methods: Using the California Cancer Registry 2001-2008, we examined 92,231 cases of Stages 1-3 first primary female invasive breast cancers. Anti HER-2 treatment status was not available. Five-year relative survival was computed among the subtypes within each stage. The Log-Rank test was used to compare survival between the ER+/PR+/HER2- subtype and all other subtypes within each stage. Results: For Stage I, all ER-negative cases had worse survival than ER-positive cases. At 5-years, the ER-/PR-/HER2- (triple negative) and ER-/PR+/HER+ subtypes had nearly identical survival (94%) and were statistically significantly worse than the ER+/PR+/HER2- subtype (P<0.0001). The ER-/PR-/HER2+ subtype had the best survival of all of the ER-negative subtypes but still had worse survival at 5-years compared with the ER+/PR+/HER2- (P<0.0001). For Stage II, the four ER-positive subtypes were more distinctly separated from the four ER-negative subtypes and the latter all had worse survival than the ER+/PR+/HER2- subtype (P<0.0001). The triple negative subtype had the worst survival of all. A HER2-positive subtype (ER+/PR-/HER2+) had the best 5-year survival (97%) and the ER+/PR+/HER2+ subtype had 92% survival. Survival of Stage III cancers revealed a more heterogeneous pattern. Although the four ER-positive subtypes had distinctly better survival than the ER-negative subtypes, there was some overlap. The triple negative subtype had a sharp drop off in survival at 10-15 months follow-up. The ER+/PR+/HER2- subtype had a 5-year survival of 84% whereas the triple negative subtype had a survival of 55% (P < 0.0001). Conclusions: The triple negative subtype has the worst survival regardless of stage. HER2-positive cancers are heterogeneous and not all have poor survival. ER and PR must be considered. ER status appears to influence 5-year survival more than HER2 status.
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