Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: The Danish Breast Cancer Cooperative Group
Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: The Danish Breast Cancer Cooperative Group
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DOI：
10.1200/jco.2007.14.5565
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发表时间：
2008-03-20
影响因子：
45.3
通讯作者：
Overgaard, Jens
中科院分区：
文献类型：
--
作者：
Kyndi, Marianne;Sorensen, Flemming B.;Overgaard, Jens
在一项随机分配患者接受或不接受乳房切除术后放疗（PMRT）的大型研究中，检测雌激素受体（ER）、孕激素受体（PgR）、人表皮生长因子受体2（HER-2）及其构建亚型的重要性。083例高危乳腺癌患者在丹麦乳腺癌合作组（DBCG）方案82试验B和c中随机分配至PMRT组。对组织微阵列切片进行ER、PgR和HER-2染色。存活患者的中位随访时间为17年。终点为孤立的首次事件局部复发、远处转移和总生存率。为了进行统计分析，从激素受体（Rec）构建了四个亚组。Rec+定义为ER+和/或PgR+。Rec-作为ER-和PgR-。四个亚组分别为Rec+/HER-2-，Rec+/HER-2+，Rec-/HER-2-（三阴性），和Rec-/HER-2+.ResultsA显着改善PMRT后的总生存期仅见于具有良好预后标志物的患者，如激素受体阳性和HER-2-患者（包括两个Rec+亚型）。在先验预后不良的患者、激素受体阴性和HER-2+患者，特别是Rec-/HER-2+亚型患者中，PMRT后总体生存期没有显着改善。此外，比较风险比和95%CI，发现ER-和PgR-肿瘤与ER+和PgR+肿瘤相比，PMRT后局部复发控制的改善显著较小。（分别为P = 0.003和0.04），对于三阴性（P = .02），Rec-/HER-2+亚型（P = .003）与Rec-/HER-2- subtype.ConclusionHormonal receptor status，HER-2，和构建的亚型可以预测乳腺切除术后放疗后局部复发和生存。
PurposeTo examine the importance of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), and constructed subtypes in a large study randomly assigning patients to receive or not receive postmastectomy radiotherapy (PMRT).Patients and MethodsThe present analysis included 1,000 of the 3,083 high-risk breast cancer patients randomly assigned to PMRT in the Danish Breast Cancer Cooperative Group (DBCG) protocol 82 trials b and c. Tissue microarray sections were stained for ER, PgR, and HER-2. Median follow-up time for patients alive was 17 years. End points were locoregional recurrence as isolated first event, distant metastases, and overall survival. For statistical analyses four subgroups were constructed from hormonal receptors (Rec). Rec+ was defined as ER+ and/or PgR+. Rec- as both ER- and PgR-. The four subgroups were Rec+/HER-2-, Rec+/HER-2+, Rec-/HER-2- (triple negative), and Rec-/HER-2+.ResultsA significantly improved overall survival after PMRT was seen only among patients characterized by good prognostic markers such as hormonal receptor-positive and HER-2- patients (including the two Rec+ subtypes). No significant overall survival improvement after PMRT was found among patients with an a priori poor prognosis, the hormonal receptor-negative and HER-2+ patients, and in particular the Rec-/HER-2+ subtype. Furthermore, comparing hazard ratios and 95% CIs, significantly smaller improvements in locoregional recurrence control after PMRT were found for ER- and PgR- tumors compared with the ER+ and PgR+ tumors (P = .003 and 04, respectively), and for the triple-negative (P = .02), and the Rec-/HER-2+ subtypes (P = .003) compared with the Rec-/HER-2- subtype.ConclusionHormonal receptor status, HER-2, and the constructed subtypes may be predictive of locoregional recurrence and survival after postmastectomy radiotherapy.