Dunnwald Lisa K, Rossing Mary Anne, Li Christopher I
Department of Epidemiology, University of Washington, Box 356113, 1959 NE Pacific St, Seattle, WA 98195, USA.
Breast Cancer Res. 2007;9(1):R6. doi: 10.1186/bcr1639.
Breast cancer patients with tumors that are estrogen receptor (ER)-positive and/or progesterone receptor (PR)-positive have lower risks of mortality after their diagnosis compared to women with ER- and/or PR-negative disease. However, few studies have evaluated variations in the risks of breast cancer-specific mortality across ER/PR status by either demographic or clinical characteristics.
Using data from 11 population-based cancer registries that participate in the SEER (Surveillance, Epidemiology, and End Results) program, 155,175 women at least 30 years old with a primary diagnosis of invasive breast carcinoma from 1990 to 2001 were included in the study. Associations between joint hormone receptor status and breast cancer mortality risk within categories of diagnosis age, diagnosis year, race/ethnicity, histologic tumor type, stage, grade, size, and axillary lymph node status were evaluated using the Cox proportional hazards model.
Compared to ER+/PR+ cases, elevations in risk of mortality were observed across all subcategories of age at diagnosis, ranging from 1.2- to 1.5-fold differences for ER+/PR- cases, 1.5- to 2.1-fold differences for ER-/PR+ cases, and 2.1- to 2.6-fold differences for ER-/PR- cases. Greater differences were observed in analyses stratified by grade; among women with low-grade lesions, ER-/PR- patients had a 2.6-fold (95% confidence interval [CI] 1.7 to 3.9) to 3.1-fold (95% CI 2.8 to 3.4) increased risk of mortality compared to ER+/PR+ patients, but among women with high-grade lesions, they had a 2.1-fold (95% CI 1.9 to 2.2) to 2.3-fold (95% CI 1.8 to 2.8) increased risk.
Compared to women with ER+/PR+ tumors, women with ER+/PR-, ER-/PR+, or ER-/PR- tumors experienced higher risks of mortality, which were largely independent of the various demographic and clinical tumor characteristics assessed in this study. The higher relative mortality risks identified among ER-/PR- patients with small or low-grade tumors raise the question of whether there may be a beneficial role for adjuvant chemotherapy in this population.
与雌激素受体（ER）和/或孕激素受体（PR）阴性的乳腺癌患者相比，ER阳性和/或PR阳性肿瘤的乳腺癌患者在诊断后的死亡风险较低。然而，很少有研究根据人口统计学或临床特征评估ER/PR状态下乳腺癌特异性死亡风险的差异。
利用来自参与监测、流行病学和最终结果（SEER）计划的11个基于人群的癌症登记处的数据，本研究纳入了1990年至2001年期间至少30岁、初诊为浸润性乳腺癌的155175名女性。使用Cox比例风险模型评估诊断年龄、诊断年份、种族/民族、组织学肿瘤类型、分期、分级、大小和腋窝淋巴结状态类别内联合激素受体状态与乳腺癌死亡风险之间的关联。
与ER+/PR+病例相比，在诊断时的所有年龄亚组中均观察到死亡风险升高，ER+/PR-病例的差异为1.2至1.5倍，ER-/PR+病例为1.5至2.1倍，ER-/PR-病例为2.1至2.6倍。按分级分层分析时观察到更大差异；在低级别病变的女性中，与ER+/PR+患者相比，ER-/PR-患者的死亡风险增加2.6倍（95%置信区间[CI]1.7至3.9）至3.1倍（95%CI2.8至3.4），但在高级别病变的女性中，死亡风险增加2.1倍（95%CI1.9至2.2）至2.3倍（95%CI1.8至2.8）。
与ER+/PR+肿瘤的女性相比，ER+/PR-、ER-/PR+或ER-/PR-肿瘤的女性死亡风险更高，这在很大程度上与本研究评估的各种人口统计学和临床肿瘤特征无关。在ER-/PR-的小肿瘤或低级别肿瘤患者中确定的较高相对死亡风险，引发了辅助化疗在该人群中是否可能发挥有益作用的问题。
