BACKGROUND: The 70 gene-signature (MammaPrint(®)) is a prognostic profile of 
distant recurrence and survival of primary breast cancer (BC). BC patients with 
4-9 positive nodes (LN 4-9) are considered clinically at high-risk. Herein we 
examined MammaPrint(®) added prognostic value in this group.
PATIENTS AND METHODS: MammaPrint(®) profiles were generated from frozen tumours 
of patients operated from primary BC. Samples were classified as genomic Low 
Risk (GLR) or genomic High Risk (GHR).
RESULTS: Among the 173 samples, 70 (40%) were classified as GLR and 103 (60%) as 
GHR. Tumours in the GHR group were significantly more often ductal carcinomas 
(93%), grade 3 (60%), oestrogen and progesterone-negative, Her2 positive (25%). 
In the GLR category, the 5-year overall survival was 97% vs. 76% for in the GHR 
group (p < 0.01); Distant Metastasis Free Survival (DMFS) at 5 years was 87% for 
GLR patients and 63% for GHR patients (p < 0.01). In the Luminal A subgroup, the 
genomic profile was the only independent risk factor for DM and BC specific 
death.
CONCLUSION: In the Luminal A subgroup, MammaPrint(®) is an independent 
prognostic marker in BC patients with LN 4-9 and may be integrated in a 
selection strategy of patients candidate for more aggressive therapeutic 
approaches.