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. 2020 Jan 3;3(1):e1918160.
doi: 10.1001/jamanetworkopen.2019.18160.

Clinicopathological Characteristics and Breast Cancer-Specific Survival of Patients With Single Hormone Receptor-Positive Breast Cancer

Yunhai Li  1 , Dejuan Yang  1 , Xuedong Yin  1 , Xiang Zhang  1 , Jiefeng Huang  2 , Yusheng Wu  2 , Mengxue Wang  2 , Zhiying Yi  2 , Hongyuan Li  1 , Hongzhong Li  2 , Guosheng Ren  1   2
Affiliations

Clinicopathological Characteristics and Breast Cancer-Specific Survival of Patients With Single Hormone Receptor-Positive Breast Cancer

Yunhai Li et al. JAMA Netw Open. .

Abstract

Importance: Steroid hormone receptors, including estrogen receptor (ER) and progesterone receptor (PR), are crucial biomarkers in breast cancer (BC). However, limited data are available regarding single hormone receptor-positive (ER-positive/PR-negative and ER-negative/PR-positive) subtypes, rendering treatment decision and survival forecast difficult in patients with these BC subtypes.

Objective: To investigate the clinicopathological characteristics and BC-specific survival (BCSS) of patients with single hormone receptor-positive BC.

Design, setting, and participants: In this cohort study, data on patients diagnosed with BC between 1990 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results database (N = 1 158 032). Patients lacking information on ER status, PR status, or BCSS were excluded (n = 334 633). Comparisons were performed between single hormone receptor-positive BC and double hormone receptor-positive/double hormone receptor-negative BC. The dates of analysis were September 1, 2018, to June 31, 2019.

Main outcomes and measures: The BCSS of patients with single hormone receptor-positive BC.

Results: This cohort study included 823 399 patients with BC (818 002 women and 5397 men). The median (range) age at diagnosis was 60 (8-108) years, and the median (range) follow-up duration was 71 (0-311) months. The percentages of ER-positive/PR-positive, ER-positive/PR-negative, ER-negative/PR-positive, and ER-negative/PR-negative cases were 67.2%, 12.2%, 1.6%, and 19.0%, respectively. Single hormone receptor-positive subtypes showed distinct clinical characteristics compared with double hormone receptor-positive/double hormone receptor-negative subtypes. Multivariable Cox proportional hazards regression analysis showed that patients with ER-positive/PR-negative (hazard ratio [HR], 1.36; 95% CI, 1.34-1.38) and ER-negative/PR-positive (HR, 1.61; 95% CI, 1.55-1.67) tumors had worse BCSS than patients with the ER-positive/PR-positive subtype. In contrast, patients with ER-positive/PR-negative (HR, 1.27; 95% CI, 1.24-1.29) and ER-negative/PR-positive (HR, 1.07; 95% CI, 1.03-1.11) tumors had better BCSS than patients with the ER-negative/PR-negative subtype. The BCSS was statistically significantly worse in patients with ER-negative/PR-positive tumors than in patients with ER-positive/PR-negative tumors (HR, 1.18; 95% CI, 1.14-1.23).

Conclusions and relevance: In this cohort study, statistically significant distinctions between survival rates of patients with single hormone receptor-positive BC vs double hormone receptor-positive/double hormone receptor-negative BC were observed. Different strategies may be required for patients with single hormone receptor-positive tumors to ensure optimal treatment and maximum benefits from therapies.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flowchart of Patient Selection
COD indicates cause of death; ER, estrogen receptor; PR, progesterone receptor; and SEER, Surveillance, Epidemiology, and End Results.
Figure 2.
Figure 2.. Patterns in the Proportion of Each Subtype of Breast Cancer, From the Surveillance, Epidemiology, and End Results Database, 1990-2015
ER indicates estrogen receptor; PR, progesterone receptor.
Figure 3.
Figure 3.. Breast Cancer–Specific Survival of Patients Stratified by Estrogen Receptor (ER) Status and Progesterone Receptor (PR) Status
A, Kaplan-Meier survival curves show breast cancer–specific survival rates. B, Data are presented as hazard ratios (95% CIs). A hazard ratio exceeding 1 favors the column-defining subtype.
See this image and copyright information in PMC

Comment in

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