Niméus Emma, Folkesson Elin, Nodin Björn, Hartman Linda, Klintman Marie
Division of Oncology and Pathology, Department of Clinical Sciences Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden.
Division of Surgery, Department of Clinical Sciences Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden.
Anticancer Res. 2017 Dec;37(12):6845-6853. doi: 10.21873/anticanres.12146.
BACKGROUND/AIM: The value of androgen receptor (AR) in breast cancer has gained renewed interest as a prognostic and treatment predictive biomarker. The aims of this work were to study the associations and the prognostic value of AR in patients from two clinical cohorts.
Cohort 1 included 208 premenopausal, node-negative patients of whom 87% had received no adjuvant medical treatment; cohort 2 consisted of 263 patients with stage II disease who had all received 2 years of adjuvant tamoxifen. A semi-quantitative assessment of nuclear AR expression divided into five groups (0-1%, 2-10%, 11-50%, 51-75%, and 76-100%) was performed. Survival analyses, stratified by cohort, were performed using both a trend-test and a cut-off of >10% for positivity.
A total of 76% of all patients were AR+, and 89%, 48%, and 23% of the estrogen receptor-positive, negative, and triple-negative, respectively. In Cox regression, stratified by cohort, AR divided into five groups was a prognostic factor for 5-year distant disease-free survival with a hazard ratio of 0.86 per step in fraction score (p=0.018). With a predefined cut-off at 10%, moderate evidence of an effect remained (Hazard Ratio=0.67, p=0.077). In multivariable analysis, AR did not retain an independent prognostic value.
AR is a weak, however, not independent prognostic factor for distant metastasis. Although the prognostic value of AR may be questionable, the study identified a subset of AR-positive triple-negative patients as being potential candidates for AR-directed therapy for which further studies are warranted.
背景/目的：雄激素受体（AR）在乳腺癌中的价值作为一种预后和治疗预测生物标志物重新受到关注。本研究的目的是探讨AR在两个临床队列患者中的相关性及预后价值。
队列1包括208例绝经前、淋巴结阴性患者，其中87%未接受辅助药物治疗；队列2由263例II期疾病患者组成，所有患者均接受了2年的辅助他莫昔芬治疗。对核AR表达进行半定量评估，分为五组（0 - 1%、2 - 10%、11 - 50%、51 - 75%和76 - 100%）。采用趋势检验和阳性阈值>10%，按队列分层进行生存分析。
所有患者中共有76%为AR阳性，雌激素受体阳性、阴性和三阴性患者中分别为89%、48%和23%。在按队列分层的Cox回归分析中，AR分为五组是5年无远处疾病生存的预后因素，分数每增加一步风险比为0.86（p = 0.018）。以预定义的10%为阈值时，仍有中等程度的效应证据（风险比 = 0.67，p = 0.077）。在多变量分析中，AR未保留独立的预后价值。
AR是远处转移的一个较弱但并非独立的预后因素。尽管AR的预后价值可能存在疑问，但本研究确定了一部分AR阳性的三阴性患者可能是AR靶向治疗的潜在候选者，对此值得进一步研究。
