Cancer Res Treat.  2022 Oct;54(4):1081-1090. 10.4143/crt.2021.890.

Effect of Estrogen Receptor Expression Level and Hormonal Therapy on Prognosis of Early Breast Cancer

• Yoon KH
• Park Y
• Kang E
• Kim EK
• Kim JH
• Kim SH
• Suh KJ
• Kim SM
• Jang M
• Yun BL
• Park SY
• Shin HC

• KMID: 2534187
• DOI: http://doi.org/10.4143/crt.2021.890

Abstract

Purpose
Estrogen receptor (ER) expression in breast cancer plays an essential role in carcinogenesis and disease progression. Recently, tumors with low level (1%-10%) of ER expression have been separately defined as ER low positive (ER^low). It is suggested that ER^low tumors might be morphologically and behaviorally different from tumors with high ER expression (ERhigh).
Materials and Methods
Retrospective analysis of a prospective cohort database was performed. Patients who underwent curative surgery for early breast cancer and had available medical records were included for analysis. Difference in clinicopathological characteristics, endocrine responsiveness and five-year recurrence-free survival was evaluated between different ER subgroups (ERhigh, ER^low, and ER-negative [ER–]).
Results
A total of 2,162 breast cancer patients were included in the analysis, Tis and T1 stage. Among them, 1,654 (76.5%) were ERhigh, 54 (2.5%) were ER^low, and 454 (21.0%) were ER^- patients. ER^low cases were associated with smaller size, higher histologic grade, positive human epidermal growth factor receptor 2, negative progesterone receptor, and higher Ki-67 expression. Recurrence rate was highest in ER– tumors and was inversely proportional to ER expression. Recurrence-free survival was not affected by hormonal therapy in the ER^low group (p=0.418).
Conclusion
ER^low breast cancer showed distinct clinicopathological features. ER^low tumors seemed to have higher recurrence rates compared to ERhigh tumors, and they showed no significant benefit from hormonal therapy. Future large scale prospective studies are necessary to validate the treatment options for ER^low breast cancer.

Keyword

Breast neoplasms; Hormone receptor; Estrogen receptor; Hormonal therapy

Figure

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  Fig. 1 Survival analysis between different estrogen receptor (ER) subgroups in early breast cancer patients. Difference in 5-year recurrence-free survival between ERhigh/ERlow/ER− (A), ERhigh/ER− (B), ERhigh/ERlow (C), and ERlow/ER− (D) patients. ER−, estrogen receptor negative; ERhigh, estrogen receptor high positive; ERlow, estrogen receptor low positive.

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  Fig. 2 Survival analysis between different estrogen receptor (ER) subgroups in early stage invasive ductal carcinoma patients. Difference in 5-year recurrence-free survival between ERhigh/ERlow/ER− (A), ERhigh/ER− (B), ERhigh/ERlow (C), and ERlow/ER− (D) patients. ER−, estrogen receptor negative; ERhigh, estrogen receptor high positive; ERlow, estrogen receptor low positive.

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  Fig. 3 Effect of estrogen receptor (ER) expression level on hormonal therapy (HT) response. (A) Difference in 5-year recurrence-free survival in ERhigh patients. (B) Difference in 5-year recurrence-free survival in ERlow patients. ERhigh, estrogen receptor high positive; ERlow, estrogen receptor low positive.

Reference

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