Molecular Subtypes and Prognostic Factors among Premenopausal and Postmenopausal Thai Women with Invasive Breast Cancer: 15 Years Follow-up Data

Document Type: Research Articles

Authors

1 Doctor of Public Health Program, Faculty of Public Health, Khon Kaen University, Thailand.

2 Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Thailand.

3 ASEAN Cancer Epidemiology and Prevention Research Group, Khon Kaen University, Thailand.

4 Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

5 Ubon Ratchathani Cancer Hospital, Ubon Ratchathani Province, Thailand.

Abstract

Background and Purpose: This study focused on molecular subtypes and prognostic factors for survival of preand
post-menopausal breast cancer patients. Methods: A retrospective cohort study was performed on 523 patients
with invasive carcinoma of the breast treated at Ubon Ratchathani Cancer Hospital,Thailand from 2002 to 2016.
Patient characteristics were collected based on a systematic chart audit from medical records. Prognostic factors were
performed by observe survival analysis. A Cox regression model was used to calculate hazard ratios of death, taking
into account the age and menopause status, molecular subtype, stage of disease, histological grade, lymphatic and
vascular invasion, resection margin, hormone receptor expression, and treatment modality. Results: The median time
from the diagnosis of invasive breast cancer to the last follow-up or death was 10.2 [95% CI = 9.28-11.95] years in
premenopausal women, and 7.4 [95% CI = 6.48-8.44] years in postmenopausal cases. The overall survival estimates
at 5 and 10 years for younger woman of 71.2% and 51.8% respectively, appeared slightly better than the 68.3% and
40.9% for postmenopausal women [HRadj = 1.27, 95% CI =0.99-1.63]. In the multivariate analysis, 3 prognostic
indicators significantly predicted a worse overall survival in premenopausal patients, triple negative subtype [HRadj =
6.03, 95% CI = 1.94-18.74], HER2-enriched status [HRadj = 4.11, 95% CI = 1.59-10.65] and stage III [HRadj = 2.73,
95% CI = 1.10-6.79]. Statistically significant increased risk of death in postmenopausal patients was noted for only
chemotherapy after mastectomy [HRadj = 8.76, 95% CI = 2.88-26.61], and for a Luminal B status [HRadj = 3.55, 95%
CI = 1.47-8.53]. Conclusion: Postmenopausal women with invasive breast cancer experience a significantly shorter
survival than do their premenopausal counterparts. The predictors of worse overall survival were molecular subtype,
stage of disease and type of treatment administered.

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