Clinicopathological Characteristics and Breast Cancer-Specific Survival of Patients With Single Hormone Receptor-Positive Breast Cancer
Clinicopathological Characteristics and Breast Cancer-Specific Survival of Patients With Single Hormone Receptor-Positive Breast Cancer
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DOI：
10.1001/jamanetworkopen.2019.18160
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发表时间：
2020-01-03
影响因子：
13.8
通讯作者：
Ren, Guosheng
中科院分区：
文献类型：
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作者：
Li, Yunhai;Yang, Dejuan;Ren, Guosheng
类固醇激素受体，包括雌激素受体（ER）和孕激素受体（PR），是乳腺癌（BC）的重要生物标志物。然而，关于单一激素受体阳性（ER阳性/PR阴性和ER阴性/PR阳性）亚型的数据有限，使得这些BC亚型患者的治疗决策和生存预测困难。目的探讨单一激素受体阳性乳腺癌的临床病理特征及乳腺癌特异性生存期（BCSS）。在这项队列研究中，从监测，流行病学和最终结果数据库（N = 1158032）中检索了1990年至2015年期间诊断为BC的患者数据。排除了缺乏ER状态、PR状态或BCSS信息的患者（n = 334633）。对单激素受体阳性BC和双激素受体阳性/双激素受体阴性BC进行比较。分析日期为2018年9月1日至2019年6月31日。主要结果和指标单一激素受体阳性乳腺癌患者的BCSS。结果该队列研究包括823399例BC患者，其中女性818002例，男性5397例。诊断时的中位（范围）年龄为60（8-108）岁，中位（范围）随访时间为71（0-311）个月。ER阳性/PR阳性、ER阳性/PR阴性、ER阴性/PR阳性和ER阴性/PR阴性的比例分别为67.2%、12.2%、1.6%和19.0%。单激素受体阳性亚型与双激素受体阳性/双激素受体阴性亚型相比，具有明显的临床特征。多变量考克斯比例风险回归分析显示，ER阳性/PR阴性（风险比[HR]，1.36; 95% CI，1.34-1.38）和ER阴性/PR阳性（HR，1.61; 95% CI，1.55-1.67）肿瘤患者的BCSS比ER阳性/PR阳性亚型患者更差。相反，ER阳性/PR阴性（HR，1.27; 95% CI，1.24-1.29）和ER阴性/PR阳性（HR，1.07; 95% CI，1.03-1.11）肿瘤患者的BCSS优于ER阴性/PR阴性亚型患者。ER阴性/PR阳性肿瘤患者的BCSS在统计学上显著差于ER阳性/PR阴性肿瘤患者（HR，1.18; 95% CI，1.14-1.23）。结论和相关性在这项队列研究中，观察到单激素受体阳性BC与双激素受体阳性/双激素受体阴性BC患者的生存率之间存在统计学显著差异。不同的策略可能需要为患者与单一的激素受体阳性肿瘤，以确保最佳的治疗和最大的好处therapy.This队列研究调查的临床病理特征和乳腺癌特异性生存的患者与单一的激素受体阳性breast cancer.Question是单一的激素受体阳性肿瘤乳腺癌的不同群体？结果：这项队列研究分析了823399例乳腺癌患者，结果显示，单激素受体阳性亚型患者的乳腺癌特异性生存率（BCSS）低于双激素受体阳性亚型患者，但BCSS优于双激素受体阴性亚型患者，差异有统计学意义。单雌激素受体阳性亚型患者的BCSS在统计学上显著优于单孕激素受体阳性亚型患者。未来的研究旨在为单一激素受体阳性肿瘤患者制定优化的治疗策略可能是必要的。
Importance Steroid hormone receptors, including estrogen receptor (ER) and progesterone receptor (PR), are crucial biomarkers in breast cancer (BC). However, limited data are available regarding single hormone receptor-positive (ER-positive/PR-negative and ER-negative/PR-positive) subtypes, rendering treatment decision and survival forecast difficult in patients with these BC subtypes. Objective To investigate the clinicopathological characteristics and BC-specific survival (BCSS) of patients with single hormone receptor-positive BC. Design, Setting, and Participants In this cohort study, data on patients diagnosed with BC between 1990 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results database (N = 1158032). Patients lacking information on ER status, PR status, or BCSS were excluded (n = 334633). Comparisons were performed between single hormone receptor-positive BC and double hormone receptor-positive/double hormone receptor-negative BC. The dates of analysis were September 1, 2018, to June 31, 2019. Main Outcomes and Measures The BCSS of patients with single hormone receptor-positive BC. Results This cohort study included 823399 patients with BC (818002 women and 5397 men). The median (range) age at diagnosis was 60 (8-108) years, and the median (range) follow-up duration was 71 (0-311) months. The percentages of ER-positive/PR-positive, ER-positive/PR-negative, ER-negative/PR-positive, and ER-negative/PR-negative cases were 67.2%, 12.2%, 1.6%, and 19.0%, respectively. Single hormone receptor-positive subtypes showed distinct clinical characteristics compared with double hormone receptor-positive/double hormone receptor-negative subtypes. Multivariable Cox proportional hazards regression analysis showed that patients with ER-positive/PR-negative (hazard ratio [HR], 1.36; 95% CI, 1.34-1.38) and ER-negative/PR-positive (HR, 1.61; 95% CI, 1.55-1.67) tumors had worse BCSS than patients with the ER-positive/PR-positive subtype. In contrast, patients with ER-positive/PR-negative (HR, 1.27; 95% CI, 1.24-1.29) and ER-negative/PR-positive (HR, 1.07; 95% CI, 1.03-1.11) tumors had better BCSS than patients with the ER-negative/PR-negative subtype. The BCSS was statistically significantly worse in patients with ER-negative/PR-positive tumors than in patients with ER-positive/PR-negative tumors (HR, 1.18; 95% CI, 1.14-1.23). Conclusions and Relevance In this cohort study, statistically significant distinctions between survival rates of patients with single hormone receptor-positive BC vs double hormone receptor-positive/double hormone receptor-negative BC were observed. Different strategies may be required for patients with single hormone receptor-positive tumors to ensure optimal treatment and maximum benefits from therapies.This cohort study investigates the clinicopathological characteristics and breast cancer-specific survival of patients with single hormone receptor-positive breast cancer.Question Are single hormone receptor-positive tumors distinct groups of breast cancer? Findings This cohort study analyzed 823399 patients with breast cancer and showed that patients with single hormone receptor-positive subtypes had worse breast cancer-specific survival (BCSS) than patients with double hormone receptor-positive subtypes but better BCSS than patients with double hormone receptor-negative subtypes, and the differences were statistically significant. Patients with single estrogen receptor-positive subtypes had statistically significantly better BCSS than those with single progesterone receptor-positive subtypes. Meaning Future studies aimed at developing optimized treatment strategies for patients with single hormone receptor-positive tumors may be warranted.