S_inary The prognostic value of oestrogen receptor (ER) and progesterone receptor (PR) was estimated through a multicentric study of 2257 operable breast cancer patients followed up for a median of 8.5 years. None of the patients had received adjuvant therapy.

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Summary We recently defined a new early prognostic factor, the ER+(R) status, which permits the discrimination of a group presenting a high risk of early relapse among the ER' patients. This group was referred to as ER+(R2) in contrast to ER+(R1) which corresponded to the group of ER' patients having a lower risk of early relapse. Taking into account the whole population including the ER-and inflammatory tumours, we have extended this view and showed that ER+(R) status is a significant predictor of disease-free survival. Determination of c-erbB-2 mRNA levels in the same series of tumours showed that high expression of c-erbB-2 mRNA is significantly correlated with ER-, inflammatory tumours and with lymph nodes involvement. Moreover, a multivariate analysis showed that c-erbB-2 mRNA overexpression was a significant predictor of early relapse (P=0.02), as significant as ER negativity and ER+(R2). For ER' patients a high level of c-erbB-2 mRNA constitutes a higher risk of relapse for both ER+(RI) and ER+(R2) patients. However, in the case of ER-patients, early relapses were strongly correlated with c-erbB-2 overexpression. The counterpart of this observation is that ER-patients with no overexpression of c-erbB-2 constitute a group with a relatively good prognosis.Management of breast cancer treatment depends on a good knowledge of the prognostic factors enabling the identification of patients with either a low or high risk of recurrence. A knowledge of the steroid receptor status, specifically the oestrogen receptor (ER), should allow the prediction of the response to hormonal therapy and to some extent disease-free survival, site of relapse and overall survival (Knight et al., 1977;Pichon et al., 1980;Clark et al., 1983;Allegra et al., 1979;Blanco et al., 1984;Fisher et al., 1983;Hahnel et al., 1979;Saez et al., 1983). Although there is a general agreement on the higher risk of relapse for receptornegative (ER-) patients, the prognostic value of ER status is not accepted by all authors (Aamdal et al., 1984;Howell et al., 1984; Felman et al., 1986;Parl et al., 1984). Among ER-positive (ER') patients regarded as having a more favourable prognosis, we have recently defined a group presenting a high risk of relapse (May et al., 1989). This group of patients, called ER+(R2), has been characterised by a ratio of (ER-protein in fmol per mg total proteins) to (ERmRNA in pg per 4pg total RNA) higher than 1.5. According to these results, ER+(R) status has been assigned as an early prognostic factor.On the other hand, amplification of the c-erbB-2 gene is an alteration frequently associated with breast cancer. This gene encodes a transmembrane protein that shows extensive homology with the receptor for epidermal growth factor (Coussens et al., 1985;Bargmann et al., 1986;Yamamoto et al., 1986), indicating that c-erbB-2 is a membrane-bound receptor. A ligand for c-erbB-2, however, has not yet been identified. A number of studies regarding amplification of this gene in primary human breast cancer has been published (see Table I...

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