We investigate the association between rate of breast cancer lymph node spread and grade, estrogen receptor status, progesteron receptor status, decision tree derived PAM50 molecular subtype, and a polygenic risk score, using data on 10950 women included from two different data sources. Lymph node spread was analyzed using a novel continuous tumor progression model that adjusts for tumor volume in a biologically motivated way and that incorporates covariates of interest. Grade 2 and 3 tumors, respectively, were associated with 1.63 and 2.17 times faster rates of lymph node spread than grade 1 tumors (p<10-16). ER/PR negative breast cancer was associated with a 1.25/1.19 times faster spread than ER/PR positive breast cancer, respectively (p=0.0011 and p=0.0012). Among the molecular subtypes luminal A, luminal B, Her2-enriched, and basal-like, Her2-enriched breast cancer was associated with 1.53 times faster spread than luminal A cancer (p=0.00072). Polygenic risk score was not associated with the rate of lymph node spread. Continuous growth models are useful for quantifying associations between lymph node spread and tumor characteristics. These may be useful for building realistic progression models for microsimulation studies used to design individualized screening programs. This article is protected by copyright. All rights reserved.
Bibliographical noteDATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author on request, after ethical approvals have been obtained from the Swedish ethical review board.
Cancerfonden, Grant/Award Number: 2020/0716;
Vetenskapsrådet, Grant/Award Number: 2020-01302
- Breast cancer
- lymph node metastases
- molecular subtype
- polygenic risk score
- continuous growth model