Bouchard-Fortier A, Provencher L, Blanchette C, Diorio C
Division of Surgical Oncology, University of Calgary, Calgary, AB.
Centre des maladies du sein Deschênes-Fabia, Hôpital du Saint-Sacrement.
Curr Oncol. 2017 Apr;24(2):e106-e114. doi: 10.3747/co.24.3238. Epub 2017 Apr 27.
Anti-hormonal therapy (tamoxifen) is recommended for estrogen receptor (er)-positive breast cancer (bca); however, its effect on low-receptor cancers is unclear. We retrospectively evaluated the effect of adjuvant tamoxifen in patients with weakly er-positive bca.
We identified 2221 bca patients who had been er-tested by ligand-based assay (lba) during 1976-1995 and who had been treated and followed until 2008. Cox proportional hazards models adjusted for age, body mass index, tumour size, nodal status, surgery, and chemotherapy were used to assess the effect of er level on bca survival in patients who received tamoxifen.
Overall, 17% (383) of patients were within 0-3 fmol/mg cytosol protein, and 12% (266) were within 4-9 fmol/mg cytosol protein. Patients with er levels of 0-3, 4-9, 10-19, 20-49, and 50 fmol/mg or more cytosol protein had 20-year bca survival rates of 56%, 56%, 63%, 71%, and 60% respectively. Of the 2221 patients studied, 661 (29.8%) received anti-hormonal therapy. Within the latter group, er levels of 0-3, 4-9, 10-19, 20-49, and 50 fmol/mg or more cytosol protein were associated with a hazard ratio for lower bca mortality: respectively, 1.00 (reference), 0.59 ( = 0.09), 0.19 ( < 0.0001), 0.26 ( < 0.0001), and 0.31 ( < 0.0001)-the risk reduction being significant only for er levels of 10 fmol/mg or more cytosol protein.
Tamoxifen use in bca patients with a weakly positive er status (4-9 fmol/mg cytosol protein), compared with those having higher er levels (≥10 fmol/mg cytosol protein), is not associated with a significantly lower bca-specific mortality. Our results do not support treatment with anti-hormonal therapy for bca patients with a weakly positive er status as identified by lba.
抗激素治疗（他莫昔芬）被推荐用于雌激素受体（ER）阳性乳腺癌（BCA）；然而，其对低受体癌症的影响尚不清楚。我们回顾性评估了辅助性他莫昔芬对ER弱阳性BCA患者的疗效。
我们确定了2221例在1976年至1995年间接受基于配体检测（LBA）的ER检测、并接受治疗及随访至2008年的BCA患者。使用经年龄、体重指数、肿瘤大小、淋巴结状态、手术和化疗校正的Cox比例风险模型，评估ER水平对接受他莫昔芬治疗的BCA患者生存率的影响。
总体而言，17%（383例）患者的细胞溶质蛋白水平在0 - 3 fmol/mg之间，12%（266例）患者的细胞溶质蛋白水平在4 - 9 fmol/mg之间。细胞溶质蛋白水平为0 - 3、4 - 9、10 - 19、20 - 49以及50 fmol/mg及以上的患者，其20年BCA生存率分别为56%、56%、63%、71%和60%。在研究的2221例患者中，661例（29.8%）接受了抗激素治疗。在这组患者中，细胞溶质蛋白水平为0 - 3、4 - 9、10 - 19、20 - 49以及50 fmol/mg及以上与较低的BCA死亡率风险比相关：分别为1.00（参照）、0.59（P = 0.09）、0.19（P < 0.0001）、0.26（P < 0.0001）和0.31（P < 0.0001）——仅细胞溶质蛋白水平为10 fmol/mg及以上时风险降低显著。
与ER水平较高（≥10 fmol/mg细胞溶质蛋白）的BCA患者相比，他莫昔芬用于ER弱阳性（4 - 9 fmol/mg细胞溶质蛋白）的BCA患者，并未使BCA特异性死亡率显著降低。我们的结果不支持对LBA检测为ER弱阳性的BCA患者采用抗激素治疗。
