Abstract
BACKGROUND: Features in preoperative ultrasound could predict the prognosis of triple-negative breast cancer (TNBC), while its prognostic value in other molecular subtypes of breast cancer (BC) was unknown. The study aimed to assess the prognostic value of preoperative sonographic features, including orientations, on long-term outcomes in BC and its association with different molecular subtypes. METHODS: Women diagnosed with invasive BC > 5 mm who underwent surgery were retrospectively reviewed. Clinical, pathological, and sonographic profiles were collected and recurrence-free survival (RFS) and breast cancer-specific survival (BCSS) were reported. Interactions between clinicopathological features and tumor orientations in predicting RFS and BCSS were analyzed. Competing risk model was performed to estimate prognostic values of sonographic features for RFS and BCSS. RESULTS: A total of 2812 patients were included. With a median follow-up of 60.0 months, 268 (9.5%) patients suffered from recurrences and 104 (3.7%) died of BC. The prognostic values of vertical orientation in predicting RFS (P = .001) and BCSS (P = .001) were strongly associated with molecular subtypes. Non-TNBC tumors with vertical orientation had less recurrence events compared with parallel orientation (6.3% vs 8.7%, P = .035), whereas failed to predict disease outcomes in multivariate analysis (P > .05). Oppositely, in TNBC, vertical orientation was associated with worse RFS (HR = 3.50; 95% confidence interval [CI] 1.69-7.24; P < .001) and BCSS (HR = 6.36; 95% CI 2.86-14.14; P < .001) in multivariate analysis with a 5-year RFS and BCSS of 73.4% and 74.6%. Meanwhile, vertical orientation was related with smaller tumor size (P < .001), human epidermal growth factor receptor 2 nonamplification (P < .001), and lower Ki-67 expression (P = .001) among non-TNBC population, whereas TNBC tumors with vertical orientation had a higher burden of axillary lymph node metastases (2.8 ± 1.0 vs 1.4 ± 0.2, P = .001). CONCLUSIONS: Prognostic values of sonographic orientation in predicting BC disease outcomes were associated with molecular subtypes. Vertical orientation in preoperative sonogram may serve as a prognostic biomarker for TNBC patients.