E-ISSN 2146-8362
 

Original Research 


Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.

Saba El-Gendi, Iman Talaat, Ghada Abu-Sheasha.

Abstract
Objectives
Surrogate immunohistochemical (IHC) classification of breast carcinoma into the molecular subtypes was reported to provide additional prognostic information. We aimed to investigate the prognostic value of this surrogate classification and to develop an algorithmic approach for the prediction of tumor recurrence.
Material and Methods
A retrospective cohort of 176 breast carcinomas was reclassified into the molecular subtypes using ER, PR, HER2-neu and Ki-67. The significant predictors of survival as determined by bivariate analysis were entered into a classification and regression tree (CART) model to identify the independent predictors.
Results
CART classified the study sample according to the ki-67 index at a cut off of 21% into two categories with significant differences in the hazard rate (HR). Patients whose ki-67 was <21%, exhibited the best prognosis irrespective of the molecular subtype. Patients whose ki-67 was ≥21% were categorized into two groups. The luminal B HER2-negative patients revealed a better prognosis -that worsened if the nodes were positive or the PR was negative or low- while luminal B HER2-positive, HER2 enriched and triple negative types displayed the worst outcome, with lymphovascular invasion predicting the worst prognosis irrespective of the molecular subtype.
Conclusions
Ki-67 at a cutoff value of 21% represents a reliable prognostic marker in the management of breast carcinoma patients. Low ki-67 index (<21%) predicts the best outcome irrespective of the molecular subtype. A high Ki-67 index, combined with nodal metastasis and low PR status recognize hormone receptor positive patients with expected adverse outcome who might benefit from chemotherapy in addition to the hormonal therapy.

Key words: Molecular types, Ki-67 index, CART, recurrence, Breast carcinoma


 
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How to Cite this Article
Pubmed Style

El-Gendi S, Talaat I, Abu-Sheasha G. Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.. J Interdiscip Histopathol. 2017; 5(3): 60-68. doi:10.5455/jihp.20170608045131


Web Style

El-Gendi S, Talaat I, Abu-Sheasha G. Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.. http://www.ejmjih.com/?mno=259588 [Access: August 14, 2018]. doi:10.5455/jihp.20170608045131


AMA (American Medical Association) Style

El-Gendi S, Talaat I, Abu-Sheasha G. Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.. J Interdiscip Histopathol. 2017; 5(3): 60-68. doi:10.5455/jihp.20170608045131



Vancouver/ICMJE Style

El-Gendi S, Talaat I, Abu-Sheasha G. Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.. J Interdiscip Histopathol. (2017), [cited August 14, 2018]; 5(3): 60-68. doi:10.5455/jihp.20170608045131



Harvard Style

El-Gendi, S., Talaat, I. & Abu-Sheasha, G. (2017) Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.. J Interdiscip Histopathol, 5 (3), 60-68. doi:10.5455/jihp.20170608045131



Turabian Style

El-Gendi, Saba, Iman Talaat, and Ghada Abu-Sheasha. 2017. Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.. Journal of Interdisciplinary Histopathology, 5 (3), 60-68. doi:10.5455/jihp.20170608045131



Chicago Style

El-Gendi, Saba, Iman Talaat, and Ghada Abu-Sheasha. "Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.." Journal of Interdisciplinary Histopathology 5 (2017), 60-68. doi:10.5455/jihp.20170608045131



MLA (The Modern Language Association) Style

El-Gendi, Saba, Iman Talaat, and Ghada Abu-Sheasha. "Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.." Journal of Interdisciplinary Histopathology 5.3 (2017), 60-68. Print. doi:10.5455/jihp.20170608045131



APA (American Psychological Association) Style

El-Gendi, S., Talaat, I. & Abu-Sheasha, G. (2017) Molecular Subtypes and Conventional Prognosticators for Prediction of Recurrence in a Cohort of Primary Breast Carcinoma. A Classification and Regression Trees-guided (CART-guided) Algorithm.. Journal of Interdisciplinary Histopathology, 5 (3), 60-68. doi:10.5455/jihp.20170608045131





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