Characterizing Clinicopathologic Features of Estrogen Receptor-Positive/Progesterone Receptor-Negative Breast Cancers
Characterizing Clinicopathologic Features of Estrogen Receptor-Positive/Progesterone Receptor-Negative Breast Cancers
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DOI：
10.1016/j.clbc.2022.07.001
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发表时间：
2022-10-01
影响因子：
3.1
通讯作者：
Wei, Shi
中科院分区：
文献类型：
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作者：
Fei, Fei;Siegal, Gene P.;Wei, Shi
大约12%的乳腺癌具有雌激素受体阳性/孕激素受体阴性（ER+/PR-）表型。ER+/PR-肿瘤的预后介于ER+/PR+和ER/PR-肿瘤之间。在ER/原肿瘤中，需要一个接近最大的ER表达来补偿ER信号的改变。背景：虽然大多数雌激素受体阳性（ER+）乳腺癌表达孕激素受体（PR），但一小部分肿瘤表现为ER+/PR-表型，尽管PR是ER依赖基因产物。先前的研究表明，与ER+/PR+乳腺癌相比，这些肿瘤通常与更差的临床结果相关，这表明它们在临床上和可能在基因上是不同的实体。方法：我们从监测、流行病学和最终结果（SEER）数据库和作者的机构队列中描述ER+/PR-肿瘤的临床病理特征。结果：ER+/PR-肿瘤占两组乳腺癌的12%，在白种人中较少发生，与ER+/PR+肿瘤相比，ER+/PR+肿瘤更有可能具有更高的组织学分级和更高的分期。相反，与ER-/PR-肿瘤相比，ER+/PR-肿瘤更常见于高加索人，组织学分级较高的可能性较小，临床分期较低。此外，ER+/PR-肿瘤与ER+/PR +和ER-/PR-肿瘤之间的疾病特异性生存相关。在ER+/PR-肿瘤中，ER h评分>= 270与显著优越的无复发生存相关，这表明需要接近最大的ER表达来补偿这些肿瘤中ER信号的改变。病理分期和HER2水平是影响ER+/PR-肿瘤预后的独立因素。这些发现可能为在追求精准医学的过程中指导个体化全身治疗的临床决策提供额外的见解。
Approximately 12% of breast cancers have an estrogen receptor-positive/progesterone receptor-negative (ER+/PR-) phenotype. The prognosis of ER+/PR- tumors is intermediate to that between ER+/PR+ and ER/PR- tumors. A near-maximal ER expression is needed to compensate for the altered ER signaling in ER/PRtumors.Background: While most estrogen receptor-positive (ER+) breast cancers express progesterone receptor (PR), a small subset of tumors exhibits an ER+/PR- phenotype despite the fact that PR is an ER-dependent gene product. Previous studies have shown that these tumors are generally associated with a worse clinical outcome when compared to the ER+/PR+ breast cancers, indicating that they are clinically and probably genetically different entities. Methods: We characterized the clinicopathologic features of ER+/PR- tumors from the Surveillance, Epidemiology and End Results (SEER) database and the authors' institutional cohort. Results: ER+/PR- tumors, constituting 12% of all breast cancers in both cohorts, less frequently occurred in Caucasians, were more likely to be of a higher histologic grade and presented with a higher stage when compared to ER+/PR+ tumors. Conversely, ER+/PR- neoplasms were more frequently seen in Caucasians, less likely to be of a higher histologic grade and less frequently presented with an advanced clinical stage when compared to ER-/PR- tumors. Further, the ER+/PR- tumors were associated with a disease-specific survival intermediate to that between ER +/PR + and ER-/PR- tumors. An ER H-score of >= 270 was associated with a significantly superior relapse-free survival in the ER+/PR- tumors, suggesting that a near-maximal ER expression is needed to compensate for the altered ER signaling in these tumors. Pathologic stage and HER2 status were independent prognostic factors in the ER+/PR- tumors. These findings may provide additional insights in directing clinical decision making for individualized systemic therapy in the pursuit of precision medicine.