ORIGINAL ARTICLE

Basal-like breast carcinomas: clinical outcome and response to chemotherapy

S Banerjee¹, J S Reis-Filho^2,3, S Ashley⁴, D Steele², A Ashworth², S R Lakhani⁵ and I E Smith¹

¹ Breast Unit, Royal Marsden Hospital, London, UK
² The Breakthough Breast Cancer Research Centre, Institute of Cancer Research, London
³ Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
⁴ Department of Computing, Royal Marsden Hospital, Sutton, UK
⁵ Molecular and Cellular Pathology, School of Medicine, The University of Queensland, Mayne Medical School, Herston, Australia

Correspondence to:
Correspondence to:
Professor I E Smith
Breast Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK; ian.smith{at}rmh.nhs.uk

Background: Grade-III invasive ductal carcinomas of no special type (IDCs-NST) constitute a heterogeneous group of tumours with different clinical behaviour and response to chemotherapy. As many as 25% of all grade-III IDCs-NST are known to harbour a basal-like phenotype, as defined by gene expression profiling or immunohistochemistry for basal cytokeratins. Patients with basal-like breast carcinomas (BLBC) are reported to have a shorter disease-free and overall survival.

Material and methods: A retrospective analysis of 49 patients with BLBC (as defined by basal cytokeratin expression) and 49 controls matched for age, nodal status and grade was carried out. Histological features, immunohistochemical findings for oestrogen receptor (ER), progesterone receptor (PgR) and HER2, and clinical outcome and survival after adjuvant chemotherapy were compared between the two groups.

Results: It was more likely for patients with BLBCs to be found negative for ER (p<0.0001), PgR (p<0.0001) and HER2 (p<0.01) than controls. Patients with BLBCs were found to have a significantly higher recurrence rate (p<0.05) and were associated with significantly shorter disease-free and overall survival (both p<0.05). In the group of patients who received anthracycline-based adjuvant chemotherapy (BLBC group, n = 47; controls, n = 49), both disease-free and overall survival were found to be significantly shorter in the BLBC group (p<0.05).

Conclusions: BLBCs are a distinct clinical and pathological entity, characterised by high nuclear grade, lack of hormone receptors and HER2 expression and a more aggressive clinical course. Standard adjuvant chemotherapy seems to be less effective in these tumours and new therapeutic approaches are indicated.

Abbreviations: BLBC, basal-like breast carcinoma; Ck, cytokeratin; EGFR, epidermal growth factor receptor; ER, oestrogen receptor; IDCs-NST, invasive ductal carcinomas of no special type; PgR, progesterone receptor

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