Caldarella Adele, Barchielli Alessandro
Clinical Epidemiology, Institute for Study and Cancer Prevention, via Cosimo il Vecchio 2, 50141, Florence, Italy.
J Cancer Res Clin Oncol. 2017 Dec;143(12):2505-2509. doi: 10.1007/s00432-017-2514-3. Epub 2017 Sep 9.
The role of progesterone (PR) expression in the management of breast cancer is controversial. The aim of this study is to evaluate the characteristics and prognosis of progesterone status among breast cancers patients in a population-based analysis.
Through the Tuscan Cancer Registry data on all the invasive breast cancer cases diagnosed during the period 2004-2005 in the provinces of Florence and Prato, central Italy, were retrieved. Histological reports were re-examined to obtain information on the percentage of positive tumor cells for estrogen (ER), progesterone (PR) receptors, Ki67 marker and human epidermal growth factor 2 (HER2). Information on age, stage, differentiation grade were also obtained.
Out of 1487 patients, 28% had PR- breast cancer. These patients were older (p 0.006) than PR+ cancer patients, with more frequently high Ki67 (p < 0.0001), HER2 + (p < 0.0001), ER- (p < 0.0001) tumoral expression. The ER+/PR+ subtype was the most represented (n.1053), while ER-/PR+ was the most rare (n.23); 210 cases (14.1%) ER+ PR- and 201 (13.5%) ER-/PR- cases were found. Analysis of survival by the Cox proportional hazards model showed an independent prognostic value of PR expression (p < 0.0001), also when estrogen, Ki67, HER2 status and age were included. The 5-year cancer-specific survival was 82.1, 86.5, 100, 92% for ER-/PR-, ER+/PR-, ER-/PR+, ER+/PR+ subtype, respectively.
Our study revealed significant differences in clinicopathological characteristics among breast cancer according to PR expression and confirmed its prognostic independent role, suggesting a role of PR in the improvement of breast cancer prognostic characterization.
孕酮（PR）表达在乳腺癌治疗中的作用存在争议。本研究旨在通过基于人群的分析评估乳腺癌患者中孕酮状态的特征及预后。
通过托斯卡纳癌症登记处，检索了意大利中部佛罗伦萨省和普拉托省2004 - 2005年期间诊断的所有浸润性乳腺癌病例的数据。重新审查组织学报告以获取雌激素（ER）、孕酮（PR）受体、Ki67标记物和人表皮生长因子2（HER2）的肿瘤细胞阳性百分比信息。还获取了年龄、分期、分化程度的信息。
在1487例患者中，28%患有PR - 乳腺癌。这些患者比PR + 乳腺癌患者年龄更大（p = 0.006），肿瘤表达Ki67高（p < 0.0001）、HER2 +（p < 0.0001）、ER -（p < 0.0001）更为频繁。ER + /PR + 亚型最为常见（n = 1053），而ER - /PR + 最为罕见（n = 23）；发现210例（14.1%）ER + PR - 和201例（13.5%）ER - /PR - 病例。通过Cox比例风险模型进行生存分析显示，PR表达具有独立的预后价值（p < 0.0001），即使纳入雌激素、Ki67、HER2状态和年龄时也是如此。ER - /PR - 、ER + /PR - 、ER - /PR + 、ER + /PR + 亚型的5年癌症特异性生存率分别为82.1%、86.5%、100%、92%。
我们的研究揭示了根据PR表达乳腺癌在临床病理特征上存在显著差异，并证实了其独立的预后作用，提示PR在改善乳腺癌预后特征方面发挥作用。
