Internal Medicine Department and Comprehensive Cancer Center, 1 University of New Mexico, MSC 10 5550, Albuquerque, NM, 87131-0001, USA.
Department of Pathology, University of New Mexico, Albuquerque, NM, USA.
Breast Cancer Res Treat. 2017 Dec;166(3):855-864. doi: 10.1007/s10549-017-4439-6. Epub 2017 Aug 19.
While the estrogen receptor (ER) is the single most widely used biomarker to evaluate breast cancer outcomes, aspects of ER marker biology remain poorly understood. We sought to determine whether quantitative measures of ER, such as protein expression and intensity, were associated with survival, or with survival disparities experienced by Hispanic women.
A case-cohort study included a 15% random sample of invasive breast cancer cases diagnosed from 1997 to 2009 in six New Mexico counties and all deaths due to breast cancer-related causes. Pathology reports and tissue microarrays served as sources of ER information. Analyses were restricted to women with ≥1% ER immunohistochemical staining. Hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer death were estimated using Cox proportional hazards models.
Included women represented 4336 ER+ breast cancer cases and 448 deaths. Median follow-up was 93 months. ER percent expression was not associated with breast cancer survival after adjustment for standard prognostic factors (p trend = 0.76). ER intensity remained a strong and independent risk factor for breast cancer survival in multivariate analyses: Women whose tumors expressed ER at intensity = 2 (HR 0.6; 95% CI 0.4-1.0) or 3 (HR 0.5; 95% CI 0.2-0.9) had a reduced risk of breast cancer mortality, compared to ER intensity = 1 (p trend = 0.02). Neither ER protein expression nor intensity influenced Hispanic survival disparities.
Estrogen receptor percent positive staining is not independently related to breast cancer survival after adjustment for other survival-related factors. ER intensity, in contrast, demonstrates promise for prognostic utility.
尽管雌激素受体（ER）是评估乳腺癌预后的最广泛使用的单一生物标志物，但 ER 标志物生物学的某些方面仍未得到充分理解。我们试图确定 ER 的定量测量，如蛋白表达和强度，是否与生存相关，或者与西班牙裔女性所经历的生存差异相关。
一项病例-队列研究包括了 1997 年至 2009 年在新墨西哥州六个县诊断出的 15%的浸润性乳腺癌病例的随机样本，以及所有因乳腺癌相关原因导致的死亡。病理学报告和组织微阵列是 ER 信息的来源。分析仅限于至少有 1%的 ER 免疫组织化学染色的女性。使用 Cox 比例风险模型估计乳腺癌死亡的风险比（HR）和 95%置信区间（CI）。
纳入的女性代表了 4336 例 ER+乳腺癌病例和 448 例死亡。中位随访时间为 93 个月。在调整标准预后因素后，ER 百分比表达与乳腺癌生存无关（p 趋势=0.76）。在多变量分析中，ER 强度仍然是乳腺癌生存的一个强有力的独立危险因素：与 ER 强度=1 的女性相比，肿瘤表达 ER 强度=2（HR 0.6；95% CI 0.4-1.0）或 3（HR 0.5；95% CI 0.2-0.9）的女性乳腺癌死亡风险降低，p 趋势=0.02。ER 蛋白表达或强度均不影响西班牙裔生存差异。
在调整其他生存相关因素后，雌激素受体阳性染色百分比与乳腺癌生存无关。相比之下，ER 强度在预后方面具有一定的应用前景。
