Thorpe S M, Rose C
Cancer Surv. 1986;5(3):505-25.
Our present state of knowledge regarding oestrogen and progesterone receptors (ER and PgR, respectively) has led to changes in treatment strategies: patients without receptors in their tumour tissues cannot be expected to respond to endocrine therapy; furthermore, groups of patients with specifically good or poor prognoses can be selected. Treatment of the disease is now starting to be rational rather than empirical. However, it is imperative that we achieve a greater level of understanding before we can predict with high probabilities which patients will benefit from endocrine therapy. Only through a coordinated effort by many centres can we hope to attain this goal. In such collaboration several factors must be considered if reproducible conclusions with respect to results from receptor assays are to be reached: sampling of the tumour biopsy for analysis, potential differences in assay procedures which may affect results and the composition of the population studied. Differences between centres in any of these aspects may affect the study conclusions. The causes of and direction of possible biases due to these factors will be discussed here. Approximately 90% of all patients with primary breast cancer have been registered in the national Danish Breast Cancer Cooperative Group (DBCG) project. ER and PgR determinations have been performed on tumour tissue from approximately 30% of these patients in a single laboratory. The results of these analyses are presented here for 3735 patients in relation to age, menopausal status, tumour size, grade of anaplasia, lymph node involvement and parity. Approximately 30% of these patients have been in DBCG protocols in which no adjuvant systemic therapy has been administered. Because of this large number of cases, the recurrence-free survival of the untreated disease in relation to receptor status can be reliably analysed. Both ER status and PgR status were found to be significant prognostic variables for premenopausal women under 50 years of age. In contrast, in the postmenopausal women neither ER nor PgR status was a significant prognostic factor in the low risk group (tumour less than 5 cm, no lymph node involvement). In high risk, postmenopausal women, however, ER status is a significant prognostic factor for recurrence-free survival and it appears to be independent of lymph node status.
我们目前对雌激素受体和孕激素受体（分别为ER和PgR）的了解，已使治疗策略发生了改变：肿瘤组织中无受体的患者预计不会对内分泌治疗产生反应；此外，还可以筛选出预后特别好或特别差的患者群体。现在，该疾病的治疗开始趋于合理而非经验性。然而，在我们能够高概率地预测哪些患者将从内分泌治疗中获益之前，必须加深理解。只有通过许多中心的共同努力，我们才有希望实现这一目标。在这样的合作中，如果要就受体检测结果得出可重复的结论，必须考虑几个因素：用于分析的肿瘤活检样本、可能影响结果的检测程序的潜在差异以及所研究人群的构成。这些方面中任何一个方面的中心间差异都可能影响研究结论。本文将讨论由于这些因素导致的可能偏差的原因及方向。丹麦所有原发性乳腺癌患者中约90%已登记参加丹麦国家乳腺癌协作组（DBCG）项目。约30%的这些患者的肿瘤组织在单个实验室进行了ER和PgR测定。本文给出了3735例患者的这些分析结果，涉及年龄、绝经状态、肿瘤大小、间变程度、淋巴结受累情况和产次。这些患者中约30%参加了DBCG方案，其中未给予辅助全身治疗。由于病例数量众多，可以可靠地分析未治疗疾病与受体状态相关的无复发生存率。对于50岁以下的绝经前女性，ER状态和PgR状态均被发现是显著的预后变量。相比之下，在绝经后女性中，低风险组（肿瘤小于5 cm，无淋巴结受累）中ER和PgR状态均不是显著的预后因素。然而，在高风险的绝经后女性中，ER状态是无复发生存率的显著预后因素，并且似乎与淋巴结状态无关。
