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. 2023 Apr 11;23(1):330.
doi: 10.1186/s12885-023-10796-4.

Association of progesterone receptor status with 21-gene recurrence score and survival among patients with estrogen receptor-positive breast cancer

Sung Jun Ma  1 , Jasmin Gill  2 , Keerti Yendamuri  2 , Udit Chatterjee  1 , Olivia Waldman  3 , Cynthia Dunne-Jaffe  3 , Fatemeh Fekrmandi  1 , Rohil Shekher  1 , Austin Iovoli  1 , Song Yao  4 , Oluwadamilola T Oladeru  5 , Anurag K Singh  6
Affiliations

Association of progesterone receptor status with 21-gene recurrence score and survival among patients with estrogen receptor-positive breast cancer

Sung Jun Ma et al. BMC Cancer. .

Abstract

Background: Progesterone receptor (PR)-negative tumors have been shown to have worse prognosis and were underrepresented in recent trials on patients with estrogen receptor (ER)-positive breast cancer. The role of PR-negative status in the context of 21-gene recurrence score (RS) and nodal staging remains unclear.

Methods: The National Cancer Database (NCDB) was queried for women diagnosed between 2010 and 2017 with ER-positive, human epidermal growth factor receptor 2 (HER2)-negative, pT1-3N0-1a breast cancer. Logistic and Cox multivariable analyses (MVA) were performed to identify association of PR status with high RS (> 25) and overall survival (OS), respectively.

Results: Among 143,828 women, 130,349 (90.6%) and 13,479 (9.4%) patients had PR-positive and PR-negative tumors, respectively. Logistic MVA showed that PR-negative status was associated with higher RS (> 25: aOR 16.15, 95% CI 15.23-17.13). Cox MVA showed that PR-negative status was associated with worse OS (adjusted hazards ratio [aHR] 1.20, 95% CI 1.10-1.31). There was an interaction with nodal staging and chemotherapy (p = 0.049). Subgroup analyses using Cox MVA showed the magnitude of the chemotherapy benefit was greater among those with pN1a, PR-negative tumors than pN1a, PR-positive tumors (PR-positive: aHR 0.57, 95% CI 0.47-0.67; PR-negative: aHR 0.31, 95% CI 0.20-0.47). It was comparable among those with pN0 tumors regardless of PR status (PR-positive: aHR 0.74, 95% CI 0.66-0.82; PR-negative: aHR 0.63, 95% CI 0.51-0.77).

Conclusion: PR-negative tumors were independently correlated with higher RS and were associated with greater OS benefits from chemotherapy for pN1a tumors, but not pN0 tumors.

Keywords: Chemo; Chemotherapy; Oncotype score; PR status.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Forest plot of overall survival associated with chemotherapy stratified by progesterone receptor status and nodal staging using multivariable Cox regression. Dotted vertical line represents a hazards ratio of 0.66 associated with chemotherapy use for the entire cohort. No.: number of patients; aHR: adjusted hazards ratio; CI: confidence interval; PR: progesterone receptor; chemo: chemotherapy
Fig. 2
Fig. 2
Kaplan Meier plots for overall survival associated with chemotherapy stratified by progesterone receptor status and nodal staging after propensity score matching, Red: no chemotherapy; blue: chemotherapy; PR: progesterone receptor; OS: overall survival; HR: hazards ratio; 95% CI: 95% confidence interval; chemo: chemotherapy
See this image and copyright information in PMC

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