Basal-like grade III invasive ductal carcinoma of the breast: patterns of metastasis and long-term survival

Laura G Fulford¹^,2 , Jorge S Reis-Filho¹ , Ken Ryder³ , Chris Jones⁴ , Cheryl E Gillett³ , Andrew Hanby⁵ , Douglas Easton⁶ and Sunil R Lakhani¹^,7

¹Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK

²The Ludwig Institute for Cancer Research, 91 Riding House Street, London W1W 7BS, UK

³Hedley Atkins/Imperial Cancer Research Fund Breast Pathology Laboratory, Guy's Hospital, London, SE1 9RT, UK

⁴The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK

⁵Academic Unit of Pathology, Leeds University c/o St James' University Hospital, Beckett Street, Leeds, LS9 7TF, UK

⁶Cancer Research Campaign Genetic Epidemiology Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK

⁷Molecular and Cellular Pathology, School of Medicine, The University of Queensland, and Queensland Institute of Medical Research, 300 Herston Road, Herston, Brisbane, 4006, Australia

author email corresponding author email

Breast Cancer Research 2007, 9:R4doi:10.1186/bcr1636


Published:	11 January 2007

Abstract

Introduction

Cytokeratin (CK) 14, one of several markers expressed in normal myoepithelial/basal cells, is also expressed in a proportion of breast carcinomas. Previous studies have suggested that expression of such 'basal' markers predicts different biological behaviour, with more frequent lung and brain metastases and poorer prognosis than other carcinomas.

Methods

We performed CK14 immunohistochemistry on 443 grade III invasive ductal carcinomas with extended clinical follow-up (mean 116 months), and we correlated CK14 immunopositivity (basal-like phenotype) with clinicopathological criteria.

Results

Eighty-eight of 443 (20%) tumours showed CK14 expression. CK14-positive tumours were more likely to be oestrogen receptor-negative (p < 0.0001) and axillary node-negative (p = 0.001) than were CK14-negative cases. CK14-positive cases developed less bone and liver metastases (hazard ratio [HR] 0.49, p = 0.01, and HR 0.53, p = 0.035, respectively) but more frequent brain metastases (HR 1.92, p = 0.051). In patients without metastatic disease, disease-free survival in CK14-positive cases was significantly better than in CK14-negative cases (HR 0.65, p = 0.005). In patients with metastatic disease, however, CK14 positivity was associated with a poorer prognosis (HR 1.84, p = 0.001). The overall survival in CK14-positive and -negative patients was similar at 5 years (60% and 59%, respectively), but the long-term survival was better in CK14-positive patients (HR 0.69, p = 0.02).

Conclusion

These results demonstrate that basal-like tumours differ in their biological behaviour from other tumours, with a distinct pattern of metastatic spread. Compared to other grade III tumours, basal-like tumours appear to have a relatively good long-term survival but survival after metastases is poor.