Thorpe S M, Rose C, Rasmussen B B, Mouridsen H T, Bayer T, Keiding N
Department of Clinical Physiology and Nuclear Medicine, Finsen Institute, Copenhagen, Denmark.
Cancer Res. 1987 Nov 15;47(22):6126-33.
The value of estrogen and progesterone receptor (ER and PgR, respectively) determinations in predicting the recurrence-free survival (RFS) has been evaluated in a group of 807 node negative breast cancer patients. All of these patients are enrolled in the Danish Breast Cancer Cooperative Group (DBCG) 77-1a and 82-a protocols for low risk patients, and none of them have received systemic adjuvant therapy. At a median observation time of 50 months and in an evaluation of the total patient population as an entity, ER+ patients had only a marginally significant (P = 0.07) longer RFS than ER- patients while PgR+ patients experienced a significant advantage (P = 0.02). Among patients subgrouped according to menopausal status, both ER and PgR statuses were found to be significant prognostic factors for predicting RFS in the premenopausal women (less than 50 years) but not in peri- or postmenopausal women. Using Cox's multivariate analysis, nuclear pleomorphy was found to be the only significant prognostic variable, while the value of PgR status as a prognostic factor approached significance (P = 0.065). Although knowledge of ER status did not significantly improve distinction between patients with good and poor prognoses in the relatively small subgroup of premenopausal patients (n = 120) when PgR status was known, ER+PgR- patients have a lower risk of recurrence or death than ER-PgR- patients. Using a log-likelihood model, significant and distinct cut-off limits for the definition of receptor positivity were found for premenopausal patients: these were 5 fmol/mg cytosol protein for ER and 10 fmol/mg cytosol protein for PgR. These cut-off levels may reflect the ability of the ligand binding assay method used to discriminate between tissues with and without receptor proteins. Qualitative assessment of receptor status was as valuable as quantitative expression of receptor concentrations in predicting the RFS of the natural course of the disease among node negative premenopausal patients.
在一组807例淋巴结阴性乳腺癌患者中，评估了雌激素受体和孕激素受体（分别为ER和PgR）检测在预测无复发生存期（RFS）方面的价值。所有这些患者均纳入丹麦乳腺癌协作组（DBCG）针对低风险患者的77-1a和82-a方案，且均未接受过全身辅助治疗。在中位观察时间为50个月时，将全部患者作为一个整体进行评估，ER阳性患者的无复发生存期仅略长于ER阴性患者（P = 0.07），而PgR阳性患者则具有显著优势（P = 0.02）。在根据绝经状态进行亚组分析的患者中，发现ER和PgR状态均是预测绝经前女性（小于50岁）无复发生存期的重要预后因素，但对围绝经期或绝经后女性则不然。使用Cox多因素分析，发现核多形性是唯一显著的预后变量，而PgR状态作为预后因素的价值接近显著水平（P = 0.065）。尽管在已知PgR状态的绝经前患者相对较小的亚组（n = 120）中，了解ER状态并未显著改善对预后良好和不良患者的区分，但ER+PgR-患者的复发或死亡风险低于ER-PgR-患者。使用对数似然模型，发现绝经前患者受体阳性定义的显著且不同的截断值：ER为5 fmol/mg胞浆蛋白，PgR为10 fmol/mg胞浆蛋白。这些截断水平可能反映了所使用的配体结合测定方法区分有无受体蛋白组织的能力。在预测淋巴结阴性绝经前患者疾病自然病程的无复发生存期方面，受体状态的定性评估与受体浓度的定量表达同样有价值。
