Prognostic Utility of Breast Cancer Index to Stratify Distant Recurrence Risk in Invasive Lobular Carcinoma

Raquel Nunes, Tal Sella, Kai Treuner, Jennifer M. Atkinson, Jenna Wong, Yi Zhang, Pedro Exman, David Dabbs, Andrea L. Richardson, Catherine A. Schnabel, Dennis C. Sgroi, Steffi Oesterreich, Ashley Cimino-Mathews, Otto Metzger

Research output: Contribution to journalArticlepeer-review


Purpose: The prognostic utility of Breast Cancer Index (BCI) for risk assessment of overall (0–10 years), early (0–5 years), and late (5–10 years) distant recurrence (DR) in hormone receptor–positive (HRþ) invasive lobular carcinoma (ILC) was evaluated. Experimental Design: BCI gene expression analysis was performed blinded to clinical outcome utilizing tumor specimens from patients with HRþ ILC from a multi-institutional cohort. The primary endpoint was time to DR. Kaplan–Meier analyses of overall, early, and late DR risk were performed, and statistical significance was evaluated by log-rank test and Cox proportional hazards regression. The prognostic contribution of BCI in addition to clinicopathologic factors was evaluated by likelihood ratio analysis. Results: Analysis of 307 patients (99% ERþ, 53% T1, 42% Nþ, 70% grade II) showed significant differences in DR over 10 years based on BCI risk categories. BCI low- and intermediate-risk patients demonstrated similar DR rates of 7.6% and 8.0%, respectively, compared with 27.0% for BCI high-risk patients. BCI was a significant independent prognostic factor for overall 10-year DR [HR ¼ 4.09; 95% confidence interval (CI), 2.00–8.34; P ¼ 0.0001] as well as for both early (HR ¼ 8.19; 95% CI, 1.85–36.30; P ¼ 0.0042) and late (HR ¼ 3.04; 95% CI, 1.32–7.00; P ¼ 0.0224) DR. In multivariate analysis, BCI remained the only statistically significant prognostic factor for DR (HR ¼ 3.49; 95% CI, 1.28–9.54; P ¼ 0.0150). Conclusions: BCI is an independent prognostic factor for ILC and significantly stratified patients for cumulative risk of 10-year, early, and late DR. BCI added prognostic value beyond clinicopathologic characteristics in this distinct subtype of breast cancer.

Original languageEnglish (US)
Pages (from-to)5688-5696
Number of pages9
JournalClinical Cancer Research
Issue number20
StatePublished - Oct 15 2021

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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