Department of Breast Surgery, Harbin Medical University Cancer Hospital, No.150, Haping Road, Nangang District, Harbin, 150081, Heilongjiang, People's Republic of China.
Diagn Pathol. 2024 Jan 4;19(1):5. doi: 10.1186/s13000-023-01433-6.
The status of hormone receptors (HR) is an independent factor affecting survival and chemotherapy sensitivity in breast cancer (BC) patients, with estrogen receptor (ER) and progesterone receptor (PR) having the most significant effects. The ER-/PR + phenotype has been controversial in BC, and experts will face many challenges in determining treatment strategies. Herein, we systematically analyzed the clinicopathological characteristics of the ER-/PR + phenotype in BC patients and the response to chemotherapy.
We included two cohorts. The first cohort counted the relationship between clinicopathologic data and survival outcomes for 72,666 female patients in the Surveillance, Epidemiology, and End Results (SEER) database. The second cohort analyzed the relationship between clinicopathological data and pathologic complete response (pCR) rate in 879 patients at the Harbin Medical University Cancer Hospital. The classification data were compared by the chi-square test and Fister's exact test of the Logistic regression model, and predictor variables with P < 0.05 in the univariate analysis were included in the multivariate regression analysis. The Kaplan-Meier method evaluated breast cancer-specific survival (BCSS) and overall survival (OS) to investigate the relationship between different HR typing and survival and pCR.
In the two cohorts, 704 (0.9%) and 11 (1.3%) patients had the ER-/PR + phenotype, respectively. The clinicopathologic features of patients with the ER-/PR + phenotype are more similar to those of the ER-/PR- phenotype. The ER-/PR + phenotype is more common in younger and premenopausal women, and most ER-/PR + phenotypes exhibit higher histological grades. Survival analysis showed that there were significant differences in OS and BCSS among patients with different HR states (P < 0.001). The survival results of patients with the ER + /PR + phenotype were the best. The prognosis of the ER-/PR + phenotype was similar to that of the ER-/PR- phenotype. On the other hand, we found that HR status was also an independent predictor of post-NAC pCR rate in BC patients. The ER + /PR- and ER-/PR- phenotypes were more sensitive to chemotherapy than the ER + /PR + phenotypes.
HR status is the main factor affecting BC's survival outcome and pCR rate. Patients with the ER-/PR + phenotype possess more aggressive biological factors and can benefit significantly from chemotherapy. We need to pay more attention to this group and achieve individualized treatment, which will help us treat BC better and provide new targets and blueprints for our clinical treatment.
激素受体（HR）状态是影响乳腺癌（BC）患者生存和化疗敏感性的独立因素，其中雌激素受体（ER）和孕激素受体（PR）的影响最大。在 BC 中，ER-/PR+表型一直存在争议，专家在确定治疗策略时将面临许多挑战。在此，我们系统分析了 ER-/PR+表型在 BC 患者中的临床病理特征以及对化疗的反应。
我们纳入了两个队列。第一队列通过 SEER 数据库中 72666 名女性患者的临床病理数据和生存结局，计算了两者之间的关系。第二队列通过分析哈尔滨医科大学附属肿瘤医院 879 名患者的临床病理数据与病理完全缓解（pCR）率之间的关系。采用卡方检验和逻辑回归模型的 Fister 精确检验比较分类数据，单因素分析中 P<0.05 的预测变量纳入多因素回归分析。Kaplan-Meier 法评估乳腺癌特异性生存（BCSS）和总生存（OS），以探讨不同 HR 分型与生存和 pCR 的关系。
在两个队列中，分别有 704（0.9%）和 11（1.3%）例患者为 ER-/PR+表型。ER-/PR+表型患者的临床病理特征与 ER-/PR-表型更为相似。ER-/PR+表型更常见于年轻和绝经前女性，且大多数 ER-/PR+表型的组织学分级更高。生存分析显示，不同 HR 状态的患者 OS 和 BCSS 存在显著差异（P<0.001）。ER+/PR+表型患者的生存结果最佳，ER-/PR+表型的预后与 ER-/PR-表型相似。另一方面，我们发现 HR 状态也是影响 BC 患者新辅助化疗后 pCR 率的独立预测因素。与 ER+/PR+表型相比，ER+/PR-和 ER-/PR-表型对化疗更敏感。
HR 状态是影响 BC 生存结局和 pCR 率的主要因素。ER-/PR+表型患者具有更具侵袭性的生物学因素，可从化疗中显著获益。我们需要更加关注这一群体，并实现个体化治疗，这将有助于我们更好地治疗 BC，并为我们的临床治疗提供新的靶点和蓝图。
