Yao Nan, Song Zhenchuan, Wang Xinle, Yang Shan, Song Heng
Department of General Surgery, Aerospace Central Hospital, Beijing, China.
Breast Diseases Treatment Center, Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
J Breast Cancer. 2017 Jun;20(2):160-169. doi: 10.4048/jbc.2017.20.2.160. Epub 2017 Jun 26.
Estrogen receptor (ER) and progesterone receptor (PR) have been used as indicators of endocrine system status since the mid-1970s in the clinical management of breast cancer. The predictive role of ER in endocrine therapy is undisputed, but the prognostic value of PR is still debated. The aim of this study was to investigate the clinical characteristics and prognosis of ER positive breast cancer with different PR expression levels.
A population cohort of 3,030 primary invasive ER positive breast cancer patients from a single cancer center underwent surgery and received adjuvant endocrine therapy from 2004 to 2010. The clinical and biological features of these patients with high PR-expressing tumors were compared with those of patients with low PR-expressing tumors. The follow-up data for disease-free survival (DFS), overall survival (OS), and breast cancer specific survival (BCSS) was obtained from 2,778 patients. Cox regression analysis was used to correlate biomarkers and tumor characteristics with DFS, OS, and BCSS.
Tumors with low PR expression had more invasive pathological features and biological indexes than those with high PR expression. Low PR expression was an independent poor prognostic factor for DFS (=0.014; hazard ratio [HR], 0.781; 95% confidence interval [CI], 0.641-0.950), OS (=0.002; HR, 0.699; 95% CI, 0.560-0.873), and BCSS (=0.005; HR, 0.714; 95% CI, 0.566-0.902). Furthermore, in low PR expressing tumors, patients who received chemotherapy had better DFS (=0.002; HR, 0.449; 95% CI, 0.268-0.751), OS (<0.001; HR, 0.341; 95% CI, 0.192-0.606), and BCSS (<0.001; HR, 0.292; 95% CI, 0.156-0.549) than patients who did not received chemotherapy.
Patients with ER positive invasive breast cancer with low PR expressing tumors have a worse prognosis than those with high PR expressing tumors, and these patients can benefit from chemotherapy.
自20世纪70年代中期以来，雌激素受体（ER）和孕激素受体（PR）一直被用作乳腺癌临床管理中内分泌系统状态的指标。ER在内分泌治疗中的预测作用无可争议，但PR的预后价值仍存在争议。本研究的目的是调查不同PR表达水平的ER阳性乳腺癌的临床特征和预后。
对来自单个癌症中心的3030例原发性浸润性ER阳性乳腺癌患者进行队列研究，这些患者在2004年至2010年间接受了手术并接受辅助内分泌治疗。将这些PR高表达肿瘤患者的临床和生物学特征与PR低表达肿瘤患者进行比较。从2778例患者中获得无病生存期（DFS）、总生存期（OS）和乳腺癌特异性生存期（BCSS）的随访数据。采用Cox回归分析将生物标志物和肿瘤特征与DFS、OS和BCSS进行关联。
PR低表达的肿瘤比PR高表达的肿瘤具有更多的浸润性病理特征和生物学指标。PR低表达是DFS（P = 0.014；风险比[HR]，0.781；95%置信区间[CI]，0.641 - 0.950）、OS（P = 0.002；HR，0.699；95% CI，0.560 - 0.873）和BCSS（P = 0.005；HR，0.714；95% CI，0.566 - 0.902）的独立不良预后因素。此外，在PR低表达的肿瘤中，接受化疗的患者的DFS（P = 0.002；HR，0.449；95% CI，0.268 - 0.751）、OS（P < 0.001；HR，0.341；95% CI，0.192 - 0.606）和BCSS（P < 0.001；HR，0.292；95% CI，0.156 - 0.549）均优于未接受化疗的患者。
PR低表达的ER阳性浸润性乳腺癌患者的预后比PR高表达的患者差，这些患者可从化疗中获益。
