Intrinsic Subtypes from the PAM50 Gene Expression Assay in a Population-Based Breast Cancer Survivor Cohort: Prognostication of Short- and Long-term Outcomes
Background: The PAM50, a gene expression assay to categorize breast tumors into intrinsic subtypes, has not been previously used to examine short- and long-term prognostication in a population-based cohort where treatment patterns and time of initial follow-up vary. Methods: In a stratified case-cohort design of 1,691 women from the LACE and Pathways breast cancer survivor cohorts, we used PAM50 to categorize tumors into Luminal A, Luminal B, HER2-enriched (E), Basal-like and Normal-like, and to examine risk of early and late recurrence and mortality by Cox proportional hazards regression. Results: Compared with Luminal A, cumulative risk of recurrence and breast cancer (BC) death was higher for Luminal B, Her2-E and Basal-like tumors at 2, 5 and 10 years. However, hazard ratios (HR) of BC death varied over time (<5 years (early) vs. >5 years (late)) for both Basal-like (HR 6.23 early vs.0.63 late) and HER2-E tumors (HR 2.97 early vs. HR 0.73 late) but not for Luminal B tumors where risk was elevated consistently (HR 2.67 early vs. HR 1.47 late). The contrast between Luminal B, HER2-E and Basal-like compared with Luminal A on early recurrence was stronger when subtype was defined by PAM50 than by immunohistochemistry markers (IHC). Conclusions: The PAM50 categorized intrinsic subtypes in a manner that more accurately predicts recurrence and survival, especially for luminal tumors, compared with commonly used methods that rely on traditional IHC clinical markers. Impact: The PAM50 is robust for use in epidemiological studies and should be considered when archived tumor tissues are available.