Prognostic significance of estrogen receptor status in breast cancer in relation to tumor stage, axillary node metastasis, and histopathologic grading

Abstract

The value of estrogen receptor (ER) measurements for predicting recurrence and survival rates in primary breast cancer was examined in 121 women who were followed from 5 to 12 years after mastectomy with a median follow‐up of 64 months. The prognostic significance of the ER status was evaluated independently and in association with tumor stage, axillary node metastasis, and histopathologic grade. The independent evaluation demonstrated no statistically significant difference in prognosis between women with ER‐negative and ER‐positive cancers, although the latter group tended to have a longer time to recurrence and longer survival. Multivariate analysis of the data by Cox's proportional hazard regression techniques revealed a synergistic effect of ER status on the risk associated with axillary node metastasis. Patients with nodal metastasis were at 2.8 times the risk of recurrence compared to patients without metastasis. For women with nodal metastasis whose primary cancer was ER‐negative, this risk increased to 4.6 times compared to women without metastasis and ER‐positive tumors (P = 0.0003). The risk of cancer‐related death was 5.6 times more likely for poorly differentiated tumors than for highly differentiated tumors. Patients with poorly differentiated ER‐negative tumors were at an even higher risk (7.0) of dying than women with highly differentiated ER‐positive carcinomas (P = 0.009). In conjunction with tumor stage, axillary node metastasis and histopathologic grade ER determination is useful for identifying subpopulations at increased risk of tumor recurrence or mortality.

Estrogen receptor-negative breast carcinomas: a review of morphology and immunophenotypical analysis

“…1 Conversely, ER-negative tumors are more likely to be of higher histological grade, and the patients to have a decreased overall survival depending on age and lymph node status. 2 ER receptor status of breast cancers in postmenopausal women is also associated with survival; a higher recurrence rate is observed in ER-negative group. 3 Although most of the ER-negative tumors are presumed to be poorly differentiated, 4 a significant proportion of a small subset of invasive cancers (adenoid cystic carcinoma, secretory carcinoma) are ER-negative.…”

Immunoradiometric detection of pS2 and total cathepsin D in primary breast cancer biopsies: their correlation with steroid receptors

“…Values between 3 and 20 fmol mg-' protein have commonly been used as a cut-off point for classifying a receptor as positive or negative. A value of 10 fmol mg-' protein is used in the majority of studies (Parl et al, 1984;Alanko et al, 1985) and in the present one.…”

Oestrogen receptor status of primary breast carcinomas and their metastases. Relation to pattern of spread and survival after recurrence

“…The The presence of oestrogen receptors (ERs) is associated with a prolonged survival in patients with both primary and recurrent breast cancer. This probability applies both to an increased effect of endocrine therapy in receptor positive patients (Alanko et al, 1985;Howell et al, 1984;Rose et al, 1985) and to qualitative differences between ER positive and negative tumours (Clark et al, 1987;Parl et al, 1984;Shek et al, 1987).The ER status of a given tumour should be regarded as a reflection of the average receptor content from cell clones with varying receptor contents. It is unknown whether clones with different receptor content metastasise to different organs or whether it is the 'average' ER content per se which reflects specific biological subtypes.…”

“…This probability applies both to an increased effect of endocrine therapy in receptor positive patients (Alanko et al, 1985;Howell et al, 1984;Rose et al, 1985) and to qualitative differences between ER positive and negative tumours (Clark et al, 1987;Parl et al, 1984;Shek et al, 1987).…”