Wittliff J L
Cancer. 1984 Feb 1;53(3 Suppl):630-43. doi: 10.1002/1097-0142(19840201)53:3+<630::aid-cncr2820531308>3.0.co;2-3.
An obvious problem for the surgeon or oncologist treating breast cancer has been to identify the patients likely to respond to endocrine manipulation. Until recently, clinical factors such as previous response to hormone therapy, disease-free interval, age and menopausal status, and location of the dominant metastatic lesion were the principal criteria for selecting therapeutic regimens for these women. Recently, the measurement of steroid hormone receptors has become an important laboratory test. Progress during the last decade has shown that: the most reliable methods of determining estrogen receptors (ER) and progestin receptors (PR) are multipoint titration analysis using dextran-coated charcoal, and sucrose density gradient centrifugation; 55% to 65% of primary breast tumors contain more than 10 femtomole/mg cytosol protein of ER; 45% to 55% of metastatic breast tumors contain more than 10 fmol/mg cytosol protein of ER; ER are present more often in tumors of postmenopausal women compared with those of premenopausal women; benign breast lesions such as fibrocystic disease and fibroadenomas usually contain less than 10 fmol/mg cytosol protein of ER; 90% of male breast carcinomas contain ER; approximately 55% of women with breast tumors containing ER respond objectively to endocrine therapy, either additive or ablative; less than 3% of women with breast tumors lacking ER respond objectively to hormone therapy. In addition, it has been suggested that the absence of ER in a breast tumor correlates well with an increased response to cytotoxic chemotherapy; 45% to 60% of primary or metastatic breast tumors contain PR. Also, the presence of both ER and PR in a breast tumor indicates a 75% to 80% likelihood that the patient will respond to endocrine manipulation, either additive or ablative; it has been suggested that the presence of the 8 Svedberg form of ER in a breast tumor (as detected by sucrose gradient centrifugation) improves the accuracy of selecting the patient likely to respond to endocrine therapy; and there appears to be a relationship between the quantity of ER in a breast tumor and a patient's response to endocrine therapy. The incidence of response to hormone therapy increases with increasing ER levels.
对于治疗乳腺癌的外科医生或肿瘤学家而言，一个明显的问题是如何识别可能对内分泌治疗有反应的患者。直到最近，诸如既往对激素治疗的反应、无病间期、年龄和绝经状态以及主要转移病灶的位置等临床因素，一直是为这些女性选择治疗方案的主要标准。最近，类固醇激素受体的检测已成为一项重要的实验室检查。过去十年的研究进展表明：测定雌激素受体（ER）和孕激素受体（PR）最可靠的方法是使用葡聚糖包被活性炭的多点滴定分析和蔗糖密度梯度离心法；55%至65%的原发性乳腺肿瘤含有超过10飞摩尔/毫克胞浆蛋白的ER；45%至55%的转移性乳腺肿瘤含有超过10飞摩尔/毫克胞浆蛋白的ER；与绝经前女性的肿瘤相比，绝经后女性的肿瘤中ER更常见；良性乳腺病变如纤维囊性疾病和纤维腺瘤通常含有少于10飞摩尔/毫克胞浆蛋白的ER；90%的男性乳腺癌含有ER；大约55%的含有ER的乳腺肿瘤女性对内分泌治疗（无论是添加性还是去除性）有客观反应；少于3%的缺乏ER的乳腺肿瘤女性对激素治疗有客观反应。此外，有人提出乳腺肿瘤中ER的缺失与对细胞毒性化疗的反应增加密切相关；45%至60%的原发性或转移性乳腺肿瘤含有PR。而且，乳腺肿瘤中同时存在ER和PR表明患者对内分泌治疗（无论是添加性还是去除性）有反应的可能性为75%至80%；有人提出乳腺肿瘤中8 Svedberg形式的ER（通过蔗糖梯度离心检测）可提高选择可能对内分泌治疗有反应的患者的准确性；并且乳腺肿瘤中ER的数量与患者对内分泌治疗的反应之间似乎存在关联。激素治疗反应的发生率随ER水平的升高而增加。
