J Breast Cancer.  2017 Jun;20(2):160-169. 10.4048/jbc.2017.20.2.160.

Prognostic Impact of Progesterone Receptor Status in Chinese Estrogen Receptor Positive Invasive Breast Cancer Patients

• Yao N
• Song Z
• Wang X
• Yang S
• Song H

• KMID: 2389753
• DOI: http://doi.org/10.4048/jbc.2017.20.2.160

Abstract

PURPOSE
Estrogen receptor (ER) and progesterone receptor (PR) have been used as indicators of endocrine system status since the mid-1970s in the clinical management of breast cancer. The predictive role of ER in endocrine therapy is undisputed, but the prognostic value of PR is still debated. The aim of this study was to investigate the clinical characteristics and prognosis of ER positive breast cancer with different PR expression levels.
METHODS
A population cohort of 3,030 primary invasive ER positive breast cancer patients from a single cancer center underwent surgery and received adjuvant endocrine therapy from 2004 to 2010. The clinical and biological features of these patients with high PR-expressing tumors were compared with those of patients with low PR-expressing tumors. The follow-up data for disease-free survival (DFS), overall survival (OS), and breast cancer specific survival (BCSS) was obtained from 2,778 patients. Cox regression analysis was used to correlate biomarkers and tumor characteristics with DFS, OS, and BCSS.
RESULTS
Tumors with low PR expression had more invasive pathological features and biological indexes than those with high PR expression. Low PR expression was an independent poor prognostic factor for DFS (p=0.014; hazard ratio [HR], 0.781; 95% confidence interval [CI], 0.641-0.950), OS (p=0.002; HR, 0.699; 95% CI, 0.560-0.873), and BCSS (p=0.005; HR, 0.714; 95% CI, 0.566-0.902). Furthermore, in low PR expressing tumors, patients who received chemotherapy had better DFS (p=0.002; HR, 0.449; 95% CI, 0.268-0.751), OS (p<0.001; HR, 0.341; 95% CI, 0.192-0.606), and BCSS (p<0.001; HR, 0.292; 95% CI, 0.156-0.549) than patients who did not received chemotherapy.
CONCLUSION
Patients with ER positive invasive breast cancer with low PR expressing tumors have a worse prognosis than those with high PR expressing tumors, and these patients can benefit from chemotherapy.

Keyword

Breast neoplasms; Progesterone receptor; Prognosis; Tamoxifen

MeSH Terms

Asian Continental Ancestry Group*
Biomarkers
Breast Neoplasms*
Breast*
Cohort Studies
Disease-Free Survival
Drug Therapy
Endocrine System
Estrogens*
Follow-Up Studies
Humans
Progesterone*
Prognosis
Receptors, Progesterone*
Tamoxifen
Biomarkers
Estrogens
Progesterone
Receptors, Progesterone
Tamoxifen

Figure

• 

  Figure 1 Flow chart of patients selection for final analysis. ER=estrogen receptor.

• 

  Figure 2 Univariate survival analysis of the estrogen receptor-positive (ER+)/progesterone receptor (PR) low expression patients and the ER+/PR high expression patients with disease-free survival (DFS), overall survival (OS) and breast cancer specific survival (BCSS). (A) DFS, (B) OS, and (C) BCSS. The figure show that low expression of PR expression was associated with significantly poorer DFS, OS, and BCSS in ER+ patients treated with any endocrine therapy.

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