Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249; Present address: Department of Pathology and Laboratory Medicine, Stanford University School of Medicine, Stanford, CA 94305.
Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249.
Clin Breast Cancer. 2022 Oct;22(7):e788-e797. doi: 10.1016/j.clbc.2022.07.001. Epub 2022 Jul 9.
While most estrogen receptor-positive (ER+) breast cancers express progesterone receptor (PR), a small subset of tumors exhibits an ER+/PR- phenotype despite the fact that PR is an ER-dependent gene product. Previous studies have shown that these tumors are generally associated with a worse clinical outcome when compared to the ER+/PR+ breast cancers, indicating that they are clinically and probably genetically different entities.
We characterized the clinicopathologic features of ER+/PR- tumors from the Surveillance, Epidemiology and End Results (SEER) database and the authors' institutional cohort.
ER+/PR- tumors, constituting 12% of all breast cancers in both cohorts, less frequently occurred in Caucasians, were more likely to be of a higher histologic grade and presented with a higher stage when compared to ER+/PR+ tumors. Conversely, ER+/PR- neoplasms were more frequently seen in Caucasians, less likely to be of a higher histologic grade and less frequently presented with an advanced clinical stage when compared to ER-/PR- tumors. Further, the ER+/PR- tumors were associated with a disease-specific survival intermediate to that between ER+/PR+ and ER-/PR- tumors. An ER H-score of ≥270 was associated with a significantly superior relapse-free survival in the ER+/PR- tumors, suggesting that a near-maximal ER expression is needed to compensate for the altered ER signaling in these tumors. Pathologic stage and HER2 status were independent prognostic factors in the ER+/PR- tumors. These findings may provide additional insights in directing clinical decision making for individualized systemic therapy in the pursuit of precision medicine.
虽然大多数雌激素受体阳性（ER+）乳腺癌表达孕激素受体（PR），但一小部分肿瘤表现出 ER+/PR-表型，尽管 PR 是 ER 依赖性基因产物。先前的研究表明，与 ER+/PR+乳腺癌相比，这些肿瘤通常与更差的临床结局相关，这表明它们在临床上可能具有不同的遗传特征。
我们从监测、流行病学和最终结果（SEER）数据库以及作者的机构队列中描述了 ER+/PR-肿瘤的临床病理特征。
ER+/PR-肿瘤构成了两个队列中所有乳腺癌的 12%，在白种人中的发生率较低，与 ER+/PR+肿瘤相比，组织学分级更高，分期更高。相反，与 ER-/PR-肿瘤相比，ER+/PR-肿瘤在白种人中更常见，组织学分级较低，临床分期较晚的情况较少。此外，与 ER+/PR+和 ER-/PR-肿瘤相比，ER+/PR-肿瘤的疾病特异性生存率处于中间水平。ER 免疫组化评分（H-score）≥270 与 ER+/PR-肿瘤无复发生存率显著提高相关，提示这些肿瘤需要接近最大的 ER 表达来补偿改变的 ER 信号。病理分期和 HER2 状态是 ER+/PR-肿瘤的独立预后因素。这些发现可能为指导个体化系统治疗的临床决策提供更多见解，以追求精准医学。
