Ponzone R, Montemurro F, Maggiorotto F, Robba C, Gregori D, Jacomuzzi M E, Kubatzki F, Marenco D, Dominguez A, Biglia N, Sismondi P
Academic Units of Gynaecological Oncology, University of Turin, Institute for Cancer Research and Treatment (IRCC) of Candiolo, A.S.O. Ordine Mauriziano, Turin, Italy.
Ann Oncol. 2006 Nov;17(11):1631-6. doi: 10.1093/annonc/mdl296. Epub 2006 Sep 15.
Patients with estrogen receptor (ER)+/progesterone receptor (PR)- and/or HER-2 overexpressing breast carcinomas may derive lower benefit from endocrine treatment. We examined retrospectively data from 972 breast cancer patients who received tamoxifen (725), tamoxifen + Gn-RH analogs (127) and aromatase inhibitors (120) as adjuvant treatments. ER+/PR- versus ER+/PR+ tumours were characterised by larger size (P = 0.001), higher tumour grade (P = 0.001), higher Ki-67 expression (P = 0.001) and lower mean ER (P = 0.000) and HER-2 expression (P = 0.000). At univariate analysis, tumour grading [hazard ratio (HR) = 4.0; 95% confidence interval (CI) = 1.4-11.1; P = 0.007], nodal status (HR = 3.4; 95% CI 1.2-5.7; P = 0.000), tumour diameter (HR = 2.9; 95% CI 1.7-4.7; P = 0.000) lack of PR expression (HR = 2.1; 95% CI 1.3-3.4; P = 0.002) and HER-2 overexpression (HR = 1.9; 95% CI 1.0-3.5; P = 0.03), as well as Ki 67 expression (HR = 1.7; 95% CI 1.0-2.7; P = 0.04) were associated with shorter disease-free survival (DFS). At the multivariate analysis, nodal status (HR = 3.6; 95% CI 1.9-6.8; P = 0.0001), lack of PR expression (HR = 2.3; 95% CI 1.3-4.0; P = 0.003) and tumour diameter (HR = 2.1; 95% CI 1.1-3.8; P = 0.018) retained their prognostic significance, whereas HER-2 overexpression was associated with a trend towards shorter DFS that was of borderline statistical significance (HR = 2.0; 95 % CI 1.0-3.9; P = 0.05). Our data suggest that lack of PR expression and HER-2 overexpression are both associated with aggressive tumour features, but the prognostic information of PR status on the risk of recurrence in endocrine-treated breast cancer patients is stronger.
雌激素受体（ER）阳性/孕激素受体（PR）阴性和/或HER-2过表达的乳腺癌患者可能从内分泌治疗中获益较少。我们回顾性分析了972例接受他莫昔芬（725例）、他莫昔芬+Gn-RH类似物（127例）和芳香化酶抑制剂（120例）作为辅助治疗的乳腺癌患者的数据。ER+/PR-肿瘤与ER+/PR+肿瘤相比，具有更大的肿瘤尺寸（P = 0.001）、更高的肿瘤分级（P = 0.001）、更高的Ki-67表达（P = 0.001）以及更低的平均ER（P = 0.000）和HER-2表达（P = 0.000）。单因素分析显示，肿瘤分级[风险比（HR）= 4.0；95%置信区间（CI）= 1.4 - 11.1；P = 0.007]、淋巴结状态（HR = 3.4；95% CI 1.2 - 5.7；P = 0.000）、肿瘤直径（HR = 2.9；95% CI 1.7 - 4.7；P = 0.000）、PR表达缺失（HR = 2.1；95% CI 1.3 - 3.4；P = 0.002）、HER-2过表达（HR = 1.9；95% CI 1.0 - 3.5；P = 0.03）以及Ki 67表达（HR = 1.7；95% CI 1.0 - 2.7；P = 0.04）均与无病生存期（DFS）缩短相关。多因素分析显示，淋巴结状态（HR = 3.6；95% CI 1.9 - 6.8；P = 0.0001）、PR表达缺失（HR = 2.3；95% CI 1.3 - 4.0；P = 0.003）和肿瘤直径（HR = 2.1；95% CI 1.1 - 3.8；P = 0.018）仍具有预后意义，而HER-2过表达与DFS缩短趋势相关，具有临界统计学意义（HR = 2.0；95% CI 1.0 - 3.
