Four hundred fifteen patients with metastatic breast cancer with known hormone receptor status received primary treatment with tamoxifen. Measured values for the estrogen receptor (ER, i.e., with estrogen binding) followed a continuous distribution (range, 3 to 1000 fmol/mg of protein). These values correlated positively with age. The response to treatment with tamoxifen correlated with the ER level, with response rates of approximately 80% when the ER level was greater than 30.1 fmol/mg of protein. Two hundred eighteen (218 of 415, 52%) patients had progesterone receptor (PR) values greater than 10 fmol/mg. The PR positivity correlated with the ER level. Patients with PR levels greater than 10 fmol/mg of protein (124 of 226, 55%) had a significantly higher response rate than those with values less than 10 fmol/mg of protein (45 of 189, 24%). However, in a multivariate analysis including both receptor levels, age, site, and number of metastases, only the ER level was significant in predicting the response to treatment with tamoxifen. A quantitative estimation of the ER level thus is the best predictor of response to hormonal treatment with tamoxifen for advanced breast cancer. Cancer 68:867-872,1991. HE UTILITY of estrogen receptor (ER) level estimation T as a predictor for hormone response in patients with advanced breast cancer has been described in several investigations .l-8 Most studies characterized tumors as being either ER positive or ER negative according to an arbitrarily defined value of estrogen binding. Quantitation of estrogen binding, however, shows the receptor values extend over a wide range and show a continuous distribution. It is thus preferable to speak of receptor-poor and receptor-rich tumors' rather than ER-negative and ER-From the Breast Clinic, Departments of *Medicine (Haematology/ Oncology), ?Nuclear Medicine, $Radiation Therapy, and §Surgery,
Background
Several registry‐based analyses suggested a survival advantage for married versus single patients with pancreatic cancer. The mechanisms underlying the association of marital status and survival are likely multiple and complex and, therefore, may be obscured in analyses generated from large population‐based databases. The goal of this research was to characterize this potential association of marital status with outcomes in patients with resected pancreatic cancer who underwent combined modality adjuvant therapy on a prospective clinical trial.
Materials and Methods
This is an ancillary analysis of 367 patients with known marital status treated on NRG Oncology/RTOG 97‐04. Survival analysis was performed using the Kaplan‐Meier method and compared using the log‐rank test. Multivariate analysis was performed using the Cox proportional hazards regression model.
Results
Of 367 patients, 271 (74%) were married or partnered and 96 (26%) were single. Married or partnered patients were more likely to be male. There was no association between marital status and overall survival (OS) or disease‐free survival (DFS) on univariate (hazard ratio [HR], 1.09 and 1.01, respectively) or multivariate analyses (HR, 1.05 and 0.98, respectively). Married or partnered male patients did not have improved survival compared with female or single patients.
Conclusion
Ancillary analysis of data from NRG Oncology/RTOG 97‐04 demonstrated no association between marital and/or partner status and OS or DFS in patients with resected pancreatic cancer who received adjuvant postoperative chemotherapy followed by concurrent external beam radiation therapy and chemotherapy. Clinical trial identification number. NCT00003216.
Implications for Practice
Several population‐based studies have shown an epidemiological link between marital status and survival in patients with pancreatic cancer. A better understanding of this association could offer an opportunity to improve outcomes through psychosocial interventions designed to mitigate the negative effects of not being married. Based on the results of this analysis, patients who have undergone a resection and are receiving adjuvant therapy on a clinical trial are unlikely to benefit from such interventions. Further efforts to study the association between marital status and survival should be focused on less selected subgroups of patients with pancreatic cancer.
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