Progesterone receptor status significantly improves outcome prediction over estrogen receptor status alone for adjuvant endocrine therapy in two large breast cancer databases
Progesterone receptor status significantly improves outcome prediction over estrogen receptor status alone for adjuvant endocrine therapy in two large breast cancer databases
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DOI：
10.1200/jco.2003.09.099
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发表时间：
2003-05-15
影响因子：
45.3
通讯作者：
Clark, GM
中科院分区：
文献类型：
--
作者：
Bardou, VJ;Arpino, G;Clark, GM
目的：确定孕激素受体(PGR)状态是否为雌激素受体(ER)状态提供附加价值，并改善对乳腺癌患者内分泌治疗益处的预测。患者和方法：在两个大型数据库中分析患者的临床结果作为类固醇受体状态的函数。第一个数据库(PP)包含3,739名未接受任何系统辅助治疗的患者和1,688名接受辅助内分泌治疗但未接受化疗的患者。第二个数据库(孢子)包含10,444名接受辅助内分泌治疗但未接受化疗的患者。在两个不同的中心实验室进行了相同的生化ER和PGR检测。结果：在单变量和多变量分析中，未接受系统治疗的患者的PGR状态对预后的意义不大。然而，在接受内分泌治疗的患者中，包括淋巴转移、肿瘤大小和年龄在内的多变量分析表明，PGR状态与无病和总存活率独立相关。在复发方面，ER阳性/PGR阴性患者的相对风险(RR)比ER阴性/PGR阴性患者降低25%，ER阳性/PGR阳性患者减少53%(P<；.0001，PP患者)。与ER阴性/PGR阴性肿瘤患者相比，ER阳性/PGR阴性肿瘤患者的死亡率降低了30%(孢子期患者)和38%(PP患者)(P<；.0001)。对于ER阳性/PGR阳性肿瘤，芽胞患者死亡风险降低46%，PP患者死亡风险降低58%，表明ER阳性/PGR阳性患者从内分泌治疗中获益更多(P<；.0001)。结论：当准确测量时，PGR状态是受益于辅助内分泌治疗的独立预测因素。因此，在与个别患者讨论内分泌治疗预期的RR降低时，应考虑PGR状态。(C)2003年，由美国临床肿瘤学会提供。
Purpose : To determine whether progesterone, receptor (PgR) status provides additional value to estrogen receptor (ER) status and improves prediction of benefit from endocrine treatment among patients with primary breast cancer.Patients and Methods: Clinical outcomes of patients in two large databases were analyzed as a function of steroid receptor status. The first database (PP), contained 3,739 patients who did not receive any systemic adjuvant therapy and 1,688 patients who received adjuvant endocrine therapy but no chemotherapy. The second database (SPORE), contained 10,444 patients who received adjuvant endocrine therapy but no chemotherapy. Biochemical ER and PgR assays were identically performed in two different central laboratories.Results: In univariate and multivariate, analyses, the prognostic significance of PgR status among systemically untreated patients is modest. Among endocrine-treated patients, however, multivariate, analyses, including lymphnode involvement, tumor size, and age, demonstrate that PgR status is independently associated with disease-free and overall survival. For recurrence, the reduction in relative risk (RR) was 25% for ER-positive/PgR-negative patients and 53% for ER-positive/PgR-positive patients, compared with ER-negative/PgR-negative patients (P < .0001, PP patients). Patients with ER-positive/PgR-negative tumors have a reduction in RR of death of 30% (SPORE patients) and 38% (PP patients), compared with patients with ER-negative/PgR-negative tumors (P < .0001). For ER-positive/PgR-positive tumors, the reduction of the risk of death was greater than 46% in SPORE patients and 58% in PP patients, indicating that ER-positive/PgR-positive patients derive more benefit from endocrine therapy (P < .0001).Conclusion: When accurately measured, PgR status is an independent predictive factor for benefit from adjuvant endocrine therapy. Therefore, PgR status should be taken into account when discussing RR reductions expected from endocrine treatment with individual patients. (C) 2003 by American Society of Clinical Oncology.