A five-gene molecular grade index and HOXB13.IL17BR are complementary prognostic factors in early stage breast cancer

Ma Xiao-Jun, Ranelle Salunga, Sonika Dahiya, Wilson Wang, Erin Carney, Virginie Durbecq, Adrian Harris, Paul Goss, Christos Sotiriou, Mark Erlander, Dennis Sgroi

Research output: Contribution to journalArticlepeer-review

265 Scopus citations


Purpose: Histologic tumor grade is a well-established prognostic factor for breast cancer, and tumor grade-associated genes are the common denominator of many prognostic gene signatures. The objectives of this study are as follows: (a) to develop a simple gene expression index for tumor grade (molecular grade index or MGI), and (b) to determine whether MGI and our previously described HOXB13:IL17BR index together provide improved prognostic information. Experimental Design: From our previously published list of genes whose expression correlates with both tumor grade and tumor stage progression, we selected five cell cycle - related genes to build MGI and evaluated MGI in two publicly available microarray data sets totaling 410 patients. Using two additional cohorts (n = 323), we developed a real-time reverse transcription PCR assay for MGI, validated its prognostic utility, and examined its interaction with HOXB13:IL17BR. Results: MGI performed consistently as a strong prognostic factor and was comparable with a more complex 97-gene genomic grade index in multiple data sets. In patients treated with endocrine therapy, MGI and HOXB13:IL17BR modified each other's prognostic performance. High MGI was associated with significantly worse outcome only in combination with high H0XB13:IL17BR, and likewise, high HOXB13:IL17BR was significantly associated with poor outcome only in combination with high MGI. Conclusions: We developed and validated a five-gene reverse transcription PCR assay for MGI suitable for analyzing routine formalin-fixed paraffin-embedded clinical samples. The combination of MGI and HOXB13.IL17BR outperforms either alone and identifies a subgroup ∼ 30%) of early stage estrogen receptor - positive breast cancer patients with very poor outcome despite endocrine therapy.

Original languageEnglish
Pages (from-to)2601-2608
Number of pages8
JournalClinical Cancer Research
Issue number9
StatePublished - May 1 2008


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