Estrogen receptor determination and long term survival of patients with carcinoma of the breast.
Estrogen receptor determination and long term survival of patients with carcinoma of the breast.
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发表时间：
1991-10
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通讯作者：
Joseph P. Crowe;Nahida H. Gordon;Charles A. Hubay;Robert R. Shenk;Robert M. Zollinger;D. J. Brumberg;W. McGuire;Jerry M. Shuck
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作者：
Joseph P. Crowe;Nahida H. Gordon;Charles A. Hubay;Robert R. Shenk;Robert M. Zollinger;D. J. Brumberg;W. McGuire;Jerry M. Shuck
为了研究激素受体检测是否能为乳腺癌患者的长期生存提供独立的预后信息，我们研究了1392例早期乳腺癌患者。患者参与了两项前瞻性、多机构试验，第一项于1974年开始，第二项于1980年开始。雌激素受体测定对所有原发性乳腺癌标本进行。所有患者的初始治疗均为改良的乳房根治术。917例患者腋窝淋巴结阴性，未接受额外治疗。475例淋巴结阳性，随机接受化疗-内分泌联合辅助治疗。163例（76.4%）患者被发现有雌激素受体阳性（ER+）肿瘤（大于或等于每毫克细胞质蛋白3飞摩尔）。10年总生存率为65.9%，明显优于329例雌激素受体阴性（ER-）肿瘤（小于3毫摩尔/毫克细胞质蛋白）患者（23.6%），后者10年总生存率为56.0% （p = 0.0001）。较高的雌激素受体值与白种人（p = 0.0001）和绝经后患者（p = 0.0001）相关。在比例风险回归模型中，ER+肿瘤患者的总体生存期明显长于ER-肿瘤患者（p = 0.0001），但与ER-肿瘤患者相比，无病生存时间仅略有改善（p = 0.07）。这些结果表明，雌激素受体测定确实对乳腺癌患者的长期总体生存具有预后价值。与无病生存相比，ER分析对总体生存的重要性更大，这可能与ER+组更容易控制复发性疾病有关。
To investigate whether or not hormone receptor determination gives independent prognostic information for long term survival of patients with carcinoma of the breast, we studied 1,392 patients with early carcinoma of the breast. Patients were part of two prospective, multi-institutional trials, the first begun in 1974 and the second in 1980. Estrogen receptor assays were performed on all primary specimens taken of the carcinoma of the breast. Initial treatment for all patients was a modified radical mastectomy. Nine hundred and seventeen patients had negative axillary nodes and were observed without additional therapy. Four hundred and seventy-five had positive nodes and were randomized to receive combination chemoendocrine adjuvant therapy. One thousand and sixty-three (76.4 per cent) of the patients were found to have estrogen receptor positive (ER+) tumors (greater than or equal to 3 femtomoles per milligram cytosol of protein). The ten year over-all survival rate of 65.9 per cent was significantly better than that of 329 (23.6 per cent) patients with estrogen receptor negative (ER-) tumors (less than 3 femtomoles per milligram cytosol protein), who had a ten year over-all survival rate of 56.0 per cent (p = 0.0001). Higher estrogen receptor values were associated with Caucasian (p = 0.0001) and postmenopausal patients (p = 0.0001). In a proportional hazards regression model, patients with ER+ tumors had a significantly longer over-all survival period (p = 0.0001), but only a marginally improved disease-free survival time (p = 0.07) when compared with patients who had ER- tumors. These results indicate that ER determination does have prognostic value for long term over-all survival of patients with carcinoma of the breast. The greater importance of ER analysis to over-all compared with disease-free survival may be related to more easily managed recurrent disease among the ER+ group.