Genomic grade adds prognostic value in invasive lobular carcinoma

Abstract

Background: The prognostic value of histologic grade (HG) in invasive lobular carcinoma (ILC) remains uncertain, and most ILC tumors are graded as HG2. Genomic grade (GG) is a 97-gene signature that improves the prognostic value of HG. This study evaluates whether GG may overcome the limitations of HG in ILC. Methods: Gene expression data were generated from frozen tumor samples, and GG calculated according to the expression of 97 genes. The prognostic value of GG was assessed in a stratified Cox regression model for invasive disease-free survival (IDFS) and overall survival (OS). Results: A total of 166 patients were classified by GG. HG classified 33 (20%) tumors as HG1, 120 (73%) as HG2 and 12 (7%) as HG3. GG classified 106 (64%) tumors as GG low (GG1), 29 (17%) as GG high (GG3) and 31 (19%) as equivocal (cases not classified as GG1 or GG3). The median follow-up time was 6.5 years. In multivariate analyses, GG was associated with IDFS [HRGG3 vs GG1 5.6 (2.1-15.3); P < 0.001] and OS [HRGG3 vs GG1 7.2, 95% CI (1.6-32.2); P = 0.01]. Conclusions: GG outperformed HG in ILC and added prognostic value to classic clinicopathologic variables, including nodal status. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.