PAM50 subtyping and ROR score add long-term prognostic information in premenopausal breast cancer patients

Christine Lundgren; Pär-Ola Bendahl; Sarah E Church; Maria Ekholm; Mårten Fernö; Carina Forsare; Ute Krüger; Bo Nordenskjöld; Olle Stål; Lisa Rydén

doi:10.1038/s41523-022-00423-z

PAM50 subtyping and ROR score add long-term prognostic information in premenopausal breast cancer patients

NPJ Breast Cancer. 2022 May 9;8(1):61. doi: 10.1038/s41523-022-00423-z.

Authors

Christine Lundgren^{1

2}, Pär-Ola Bendahl³, Sarah E Church⁴, Maria Ekholm^{5

6}, Mårten Fernö³, Carina Forsare³, Ute Krüger³, Bo Nordenskjöld⁷, Olle Stål⁷, Lisa Rydén^{8

9}

Affiliations

¹ Department of Oncology, Region Jönköping County, Jönköping, Sweden. [email protected].
² Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden. [email protected].
³ Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden.
⁴ NanoString Technologies, Inc., Seattle, United States.
⁵ Department of Oncology, Region Jönköping County, Jönköping, Sweden.
⁶ Sahlgrenska Center for Cancer Research, Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
⁸ Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.
⁹ Department of Surgery, Skåne University Hospital, Malmö, Sweden.

Abstract

PAM50 intrinsic subtyping and risk of recurrence (ROR) score are approved for risk profiling in postmenopausal women. We aimed to examine their long-term prognostic value in terms of breast cancer-free interval (BCFi) and overall survival (OS) (n = 437) in premenopausal women randomised to 2 years of tamoxifen versus no systemic treatment irrespective of hormone-receptor status. Intrinsic subtyping added independent prognostic information in patients with oestrogen receptor-positive/human epidermal growth factor 2-negative tumours for BCFi and OS after maximum follow-up (overall P-value 0.02 and 0.006, respectively) and those with high versus low ROR had worse prognosis (maximum follow-up: hazard ratio (HR)_BCFi: 1.70, P = 0.04). The prognostic information by ROR was similar regarding OS and in multivariable analysis. These results support that PAM50 subtyping and ROR score provide long-term prognostic information in premenopausal women. Moreover, tamoxifen reduced the incidence of breast cancer events only in patients with Luminal A_PAM50 tumours (0-10 years: HR_{BCFi(Luminal A)}: 0.41, HR_{BCFi(Luminal B)}: 1.19, P_interaction = 0.02).Trial registration: This trial is registered in the ISRCTN database, trial ID: ISRCTN12474687.