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Clinical Cancer Research Vol. 10, 5367-5374, August 15, 2004
© 2004 American Association for Cancer Research


Molecular Oncology, Markers, Clinical Correlates

Immunohistochemical and Clinical Characterization of the Basal-Like Subtype of Invasive Breast Carcinoma

Torsten O. Nielsen1, Forrest D. Hsu1, Kristin Jensen2, Maggie Cheang1, Gamze Karaca4,5, Zhiyuan Hu4,5, Tina Hernandez-Boussard3, Chad Livasy4,6, Dave Cowan4,7, Lynn Dressler4,7, Lars A. Akslen8, Joseph Ragaz9, Allen M. Gown10, C. Blake Gilks1, Matt van de Rijn2 and Charles M. Perou4,5,6

1 Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver Hospital & British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Departments of 2 Pathology and 3 Genetics, Stanford University Medical Center, Stanford, California; 4 Lineberger Comprehensive Cancer Center and Departments of 5 Genetics, 6 Pathology and Laboratory Medicine, and 7 Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 8 Department of Pathology, The Gade Institute, Haukeland University Hospital, Bergen, Norway; 9 McGill University Health Center, Royal Victoria Hospital, Montreal, Quebec, Canada; and 10 PhenoPath Laboratories, Seattle, Washington

ABSTRACT

Purpose: Expression profiling studies classified breast carcinomas into estrogen receptor (ER)+/luminal, normal breast-like, HER2 overexpressing, and basal-like groups, with the latter two associated with poor outcomes. Currently, there exist clinical assays that identify ER+/luminal and HER2-overexpressing tumors, and we sought to develop a clinical assay for breast basal-like tumors.

Experimental Design: To identify an immunohistochemical profile for breast basal-like tumors, we collected a series of known basal-like tumors and tested them for protein patterns that are characteristic of this subtype. Next, we examined the significance of these protein patterns using tissue microarrays and evaluated the prognostic significance of these findings.

Results: Using a panel of 21 basal-like tumors, which was determined using gene expression profiles, we saw that this subtype was typically immunohistochemically negative for estrogen receptor and HER2 but positive for basal cytokeratins, HER1, and/or c-KIT. Using breast carcinoma tissue microarrays representing 930 patients with 17.4-year mean follow-up, basal cytokeratin expression was associated with low disease-specific survival. HER1 expression was observed in 54% of cases positive for basal cytokeratins (versus 11% of negative cases) and was associated with poor survival independent of nodal status and size. c-KIT expression was more common in basal-like tumors than in other breast cancers but did not influence prognosis.

Conclusions: A panel of four antibodies (ER, HER1, HER2, and cytokeratin 5/6) can accurately identify basal-like tumors using standard available clinical tools and shows high specificity. These studies show that many basal-like tumors express HER1, which suggests candidate drugs for evaluation in these patients.




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