BIRC5 expression by race, age and clinical factors in breast cancer patients

• Published in: Breast cancer research : BCR Vol. 26; no. 1; pp. 50 - 11
• Main Authors: Hamilton, Alina M, Walens, Andrea, Van Alsten, Sarah C, Olsson, Linnea T, Nsonwu-Farley, Joseph, Gao, Xiaohua, Kirk, Erin L, Perou, Charles M, Carey, Lisa A, Troester, Melissa A, Abdou, Yara
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.03.2024; BioMed Central; BMC
• Subjects: Age; Apoptosis; Binomial distribution; Black or African American; Black people; Breast cancer; Breast Neoplasms - pathology; Cancer; Cancer patients; Cancer therapies; Care and treatment; Cell cycle; Estrogen; Estrogen receptors; Estrogens; Female; Gene expression; Generalized linear models; Genetic aspects; Genomes; Genomics; Health aspects; Humans; Medical colleges; Medical prognosis; Medical records; Middle Aged; Mortality; Oncology, Experimental; Patients; Population studies; Prognosis; Self report; Survivin; Survivin - genetics; Therapeutic targets; Tumors; Variables; White people; Womens health; North Carolina
• ISSN: 1465-542X; 1465-5411; 1465-542X
• DOI: 10.1186/s13058-024-01792-y

Survivin/BIRC5 is a proliferation marker that is associated with poor prognosis in breast cancer and an attractive therapeutic target. However, BIRC5 has not been well studied among racially diverse populations where aggressive breast cancers are prevalent. We studied BIRC5 expression in association with clinical and demographic variables and as a predictor of recurrence in 2174 participants in the Carolina Breast Cancer Study (CBCS), a population-based study that oversampled Black (n = 1113) and younger (< 50 years; n = 1137) participants with breast cancer. For comparison, similar analyses were conducted in The Cancer Genome Atlas [TCGA N = 1094, Black (n = 183), younger (n = 295)]. BIRC5 was evaluated as a continuous and categorical variable (highest quartile vs. lower three quartiles). Univariate, continuous BIRC5 expression was higher in breast tumors from Black women relative to non-Black women in both estrogen receptor (ER)-positive and ER-negative tumors and in analyses stratified by stage (i.e., within Stage I, Stage II, and Stage III/IV tumors). Within CBCS and TCGA, BIRC5-high was associated with young age (< 50 years) and Black race, as well as hormone receptor-negative tumors, non-Luminal A PAM50 subtypes, advanced stage, and larger tumors (> 2 cm). Relative to BIRC5-low, BIRC5-high tumors were associated with poor 5-year recurrence-free survival (RFS) among ER-positive tumors, both in unadjusted models [HR (95% CI): 2.7 (1.6, 4.6)] and after adjustment for age and stage [Adjusted HR (95% CI): 1.87 (1.07, 3.25)]. However, this relationship was not observed among ER-negative tumors [Crude HR (95% CI): 0.7 (0.39, 1.2); Adjusted HR (95% CI): 0.67 (0.37, 1.2)]. Black and younger women with breast cancer have a higher burden of BIRC5-high tumors than older and non-Black women. Emerging anti-survivin treatment strategies may be an important future direction for equitable breast cancer outcomes.