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. 2012 Jan;3(1):66-71.
doi: 10.3892/etm.2011.359. Epub 2011 Oct 3.

Predictive significance of the proportion of ER-positive or PgR-positive tumor cells in response to neoadjuvant chemotherapy for operable HER2-negative breast cancer

Tomofumi Osako  1 , Reiki Nishimura, Yasuhiro Okumura, Yasuo Toyozumi, Nobuyuki Arima
Affiliations

Predictive significance of the proportion of ER-positive or PgR-positive tumor cells in response to neoadjuvant chemotherapy for operable HER2-negative breast cancer

Tomofumi Osako et al. Exp Ther Med. 2012 Jan.

Abstract

Estrogen receptor (ER) and progesterone receptor (PgR) status are predictive factors for the clinical and pathological response to neoadjuvant chemotherapy for operable breast cancer. However, it remains unclear as to how the proportion of ER-positive or PgR-positive tumor cells affects the response to neoadjuvant chemotherapy. We examined the correlation of the proportion of ER-positive or PgR-positive tumor cells with the clinical and pathological response to neoadjuvant chemotherapy for operable human epidermal growth factor receptor 2 (HER2)-negative breast cancer. From April 2002 to October 2010, 103 patients received neoadjuvant chemotherapy containing epirubicin and taxane in our clinic. A clinical response was observed in 86 (83%) patients, and a pathological complete response (pCR) was observed in 16 (16%) patients. Fourteen (30%) of 46 patients with ER-negative tumors achieved pCR and 15 (26%) of 57 patients with PgR-negative tumors achieved pCR. Patients with more than 30% ER-positive tumor cells or more than 1% PgR-positive tumor cells did not achieve pCR. No significant correlation was observed between pCR and the menopausal status, tumor size, grade and Ki-67 expression. In univariate analysis, pCR was associated with the ER status (p=0.001), PgR status (p=0.0001) and chemotherapy regimens (p=0.03). Multivariate analysis revealed that ER and PgR status were significant factors for pCR, and patients with ER-negative tumors were 18.6 times more likely to achieve pCR than those with greater than or equal to 30% ER-positive tumor cells (p=0.006; 95% confidence interval 2.3-149.9). We demonstrated a predictive significance of the proportion of ER-positive or PgR-positive tumor cells in the response to neoadjuvant chemotherapy for operable HER2-negative breast cancer. ER-negativity (<1%) was a significant predictive factor for achieving pCR in multivariate analysis. Conversely, patients with more than 30% ER-positive tumor cells or more than 1% PgR-positive tumor cells may not achieve pCR.

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Figures

Figure 1.
Figure 1.
Frequency distribution according to the proportion of ER-positive-staining tumor cells among 103 primary breast cancers. The bar graph shows the bimodal distribution; most of the ER-negative tumors were ER-absent and most of the ER-positive tumors were >90% ER-positive. The gray bars indicate the number of patients who achieved pCR. Most of the patients who achieved pCR had ER-absent tumors, and patients whose tumor had >30% ER-positive cells did not achieve pCR.
Figure 2.
Figure 2.
Frequency distribution according to the proportion of PgR-positive-staining tumor cells among 103 primary breast cancers. The gray bars indicate the number of patients who achieved pCR. Most of the PgR-negative tumors were PgR-absent. Most of the patients who achieved pCR had PgR-absent tumors, and patients whose tumor had >1% PgR-positive cells did not achieve pCR.
Figure 3.
Figure 3.
Disease-free survival according to pCR in all patients.
Figure 4.
Figure 4.
Overall survival according to pCR in all patients.
Figure 5.
Figure 5.
Disease-free survival according to pCR in patients with ER-negative and ER-positive tumors.
Figure 6.
Figure 6.
Overall survival according to pCR in patients with ER-negative and ER-positive tumors.
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