Clinical outcome of adjuvant endocrine treatment according to PR and HER-2 status in early breast cancer

Abstract

Patients with estrogen receptor (ER)+/progesterone receptor (PR)- and/or HER-2 overexpressing breast carcinomas may derive lower benefit from endocrine treatment. We examined retrospectively data from 972 breast cancer patients who received tamoxifen (725), tamoxifen + Gn-RH analogs (127) and aromatase inhibitors (120) as adjuvant treatments. ER+/PR- versus ER+/PR+ tumours were characterised by larger size (P = 0.001), higher tumour grade (P = 0.001), higher Ki-67 expression (P = 0.001) and lower mean ER (P = 0.000) and HER-2 expression (P = 0.000). At univariate analysis, tumour grading [hazard ratio (HR) = 4.0; 95% confidence interval (CI) = 1.4-11.1; P = 0.007], nodal status (HR = 3.4; 95% CI 1.2-5.7; P = 0.000), tumour diameter (HR = 2.9; 95% CI 1.7-4.7; P = 0.000) lack of PR expression (HR = 2.1; 95% CI 1.3-3.4; P = 0.002) and HER-2 overexpression (HR = 1.9; 95% CI 1.0-3.5; P = 0.03), as well as Ki 67 expression (HR = 1.7; 95% CI 1.0-2.7; P = 0.04) were associated with shorter disease-free survival (DFS). At the multivariate analysis, nodal status (HR = 3.6; 95% CI 1.9-6.8; P = 0.0001), lack of PR expression (HR = 2.3; 95% CI 1.3-4.0; P = 0.003) and tumour diameter (HR = 2.1; 95% CI 1.1-3.8; P = 0.018) retained their prognostic significance, whereas HER-2 overexpression was associated with a trend towards shorter DFS that was of borderline statistical significance (HR = 2.0; 95 % CI 1.0-3.9; P = 0.05). Our data suggest that lack of PR expression and HER-2 overexpression are both associated with aggressive tumour features, but the prognostic information of PR status on the risk of recurrence in endocrine-treated breast cancer patients is stronger.

The role of surgery in breast cancer patients with isolated bone metastases at the time of diagnosis

“…If there is elevated CA 15-3 levels in the patients with isolated bone metastasis, then patients had poor metastatic free survival and overall survival in this study. In addition to the CA 15-3 levels, the Her2/neu overexpression is associated with aggressive clinical and pathological features [27]. Clinically, a patient whose Her2/new strongly positive tends to have a poor prognosis and a decreased survival time [28].…”

“…Clinically, a patient whose Her2/new strongly positive tends to have a poor prognosis and a decreased survival time [28]. PR status defines a subset of tumor with distinctive pathological characteristic and may help selecting those patients who derive the greatest benefit from endocrine adjuvant treatment [27]. When the survival in the patients with isolated bone metastasis is evaluated, it is demonstrated that the positiveness in PR status had positive and Her2/neu overexpression had negative effect.…”

Short-term outcome of primary operated early breast cancer by hormone and HER-2 receptors

“…A weakness in our study is the median FU period which consisted of 3.5 years only and which allows us only short-term DFI interpretations. Others have referred to ER and PR as only being short-term prognostic factors whereas little data are available on HER-2 as a prognostic factor beyond five years of FU [6,54,55].…”

Clinical significance of progesterone receptor and HER2 status in estrogen receptor-positive, operable breast cancer with adjuvant tamoxifen

“…Clinical studies have shown that the benefit of tamoxifen is less for ER-positive/PR-negative tumors than for ER-positive/PR-positive tumors in both adjuvant and palliative settings (Bardou et al 2003;Liu et al 2010;Ponzone et al 2006;Ravdin et al 1992;Stendahl et al 2006). However, there are conflicting reports on the value of PR status, with some studies suggesting that it may not provide additional prognostic information for ER-positive breast cancers (Early Breast Cancer Trialists' Collaborative Group 2005;Olivotto et al 2004;Paik et al 2005).…”