ER+/PR- breast cancer twice as likely to relapse as ER+/PR+ disease

Posted: March 5, 2017

Study:	Negative progesterone receptor is associate early breast cancer relapse, even among good prognosis tumors Cite Winner M, Rosman M, Mylander C, Jackson R, Pozo M, Wolff A, et al. Abstract P2-05-13: Negative progesterone receptor is associate early breast cancer relapse, even among good prognosis tumors. Poster Session Abstracts. American Association for Cancer Research; 2017; 10.1158/1538-7445.sabcs16-p2-05-13
Conference:	Proceedings of 39th CTRC-AACR San Antonio Breast Cancer Symposium, December 2016

Study:

Negative progesterone receptor is associate early breast cancer relapse, even among good prognosis tumors Cite

Winner M, Rosman M, Mylander C, Jackson R, Pozo M, Wolff A, et al. Abstract P2-05-13: Negative progesterone receptor is associate early breast cancer relapse, even among good prognosis tumors. Poster Session Abstracts. American Association for Cancer Research; 2017; 10.1158/1538-7445.sabcs16-p2-05-13

Conference:

Proceedings of 39th CTRC-AACR San Antonio Breast Cancer Symposium, December 2016

ER+/PR- twice as likely to relapse as ER+/PR+

Breast tumors that are estrogen receptor positive and progesterone receptor negative (ER+/PR-) are a distinct subset of breast cancer known to have aggressive behavior and tamoxifen resistance despite being ER+. Such tumors are typically grade 2 or grade 3, have relatively high proliferation (often with Ki-67 > 30%) and greater DNA instability than ER+/PR+ tumors.

These factors contribute to lower survival among women with ER+/PR- disease than those with ER+/ER+ disease. Now a new study presented at the Thirty-Ninth Annual CTRC-AACR San Antonio Breast Cancer Symposium has reported that women with ER+/PR- disease have more than double the rate of relapse (including both locoregional and distant recurrence) as those with ER+/PR+ disease during the first five years after diagnosis.

Latest research finds PR- status worsens prognosis

The study referenced above was designed to investigate the association between negative progesterone receptor status and outcomes of ER+/HER2- breast cancer using data from Johns Hopkins University School of Medicine in Baltimore, MD. To conduct the study, the authors analyzed consecutive, early stage, unilateral (one breast only), HER2-, invasive breast cancers diagnosed during the period 2000 to 2011. Medical records were used to collect data concerning age at diagnosis, stage, tumor characteristics, and breast cancer recurrence. Tumors were classified as having ER+ or PR+ status as long as immunoreactive cells ≥1%. Early recurrence was defined as breast cancer relapse (locoregional or distant recurrence) taking place six months to five years after diagnosis; late recurrence was defined as taking place after five years. Study participants were followed for a median of 84 months.

The study included 1,933 patients, of whom 1,489 had ER+/PR+, 337 had triple negative, and 107 had ER+/PR- disease. Those with ER+/PR- tumors did not differ significantly from those with ER+/PR+ disease with respect to age or stage at diagnosis.

However, ER+/PR- tumors were more likely to be high grade (37.9% compared to 17.8% of ER+/PR+ cases) and had higher median Ki-67 (20.0% compared to 10.0%). ER expression also tended to be lower in cases of ER+/PR- disease (median of 80.0% compared 90.0%). A total of 119 early and 54 late relapses took place during follow up.

Negative PR was found to be strongly associated with early recurrence: ER+/PR- tumors were 2.1 times more likely to relapse during the first five years as ER+/PR+ tumors.

Selected breast cancer studies

Progesterone receptor positivity is a predictor of long-term benefit from adjuvant tamoxifen treatment of estrogen receptor positive breast cancer Cite
Nordenskjöld A, Fohlin H, Fornander T, Löfdahl B, Skoog L, Stål O. Progesterone receptor positivity is a predictor of long-term benefit from adjuvant tamoxifen treatment of estrogen receptor positive breast cancer. Breast Cancer Research and Treatment. Springer Science and Business Media LLC; 2016; 160:313-322 10.1007/s10549-016-4007-5
Prognostic values of negative estrogen or progesterone receptor expression in patients with luminal B HER2-negative breast cancer Cite
Park C, Park K, Kim J, Sin Y, Park I, Cho H, et al. Prognostic values of negative estrogen or progesterone receptor expression in patients with luminal B HER2-negative breast cancer. World Journal of Surgical Oncology. Springer Science and Business Media LLC; 2016; 14 10.1186/s12957-016-0999-x
Progesterone receptor loss identifies hormone receptor-positive and HER2-negative breast cancer subgroups at higher risk of relapse: a retrospective cohort study Cite
He Z, Sun J, Li F, Lin H, Wu S. Progesterone receptor loss identifies hormone receptor-positive and HER2-negative breast cancer subgroups at higher risk of relapse: a retrospective cohort study. OncoTargets and Therapy. Informa UK Limited; 2016;:1707 10.2147/ott.s98666
High Ki-67 Expression and Low Progesterone Receptor Expression Could Independently Lead to a Worse Prognosis for Postmenopausal Patients With Estrogen Receptor-Positive and HER2-Negative Breast Cancer Cite
Nishimukai A, Yagi T, Yanai A, Miyagawa Y, Enomoto Y, Murase K, et al. High Ki-67 Expression and Low Progesterone Receptor Expression Could Independently Lead to a Worse Prognosis for Postmenopausal Patients With Estrogen Receptor-Positive and HER2-Negative Breast Cancer. Clinical Breast Cancer. Elsevier BV; 2015; 15:204-211 10.1016/j.clbc.2014.12.007
Clinicopathologic Characteristics of Oestrogen Receptor-Positive/Progesterone Receptor-Negative/Her2-Negative Breast Cancer According to a Novel Definition of Negative Progesterone Receptor Status: A Large Population-Based Study from China Cite
Li A, Zhou S, Li M, Xu Y, Shui R, Yu B, et al. Clinicopathologic Characteristics of Oestrogen Receptor-Positive/Progesterone Receptor-Negative/Her2-Negative Breast Cancer According to a Novel Definition of Negative Progesterone Receptor Status: A Large Population-Based Study from China. PLOS ONE. Public Library of Science (PLoS); 2015; 10:e0125067 10.1371/journal.pone.0125067
Abstract P6-01-13: SOX10 and folate receptor alpha are frequently expressed in triple negative and progesterone receptor negative breast cancers Cite
Hoang LL, Qi W, Yu C, Tacha D. Abstract P6-01-13: SOX10 and folate receptor alpha are frequently expressed in triple negative and progesterone receptor negative breast cancers. Poster Session Abstracts. American Association for Cancer Research; 2015; 10.1158/1538-7445.sabcs14-p6-01-13
Progesterone Receptor Status and Ki-67 Index May Predict Early Relapse in Luminal B/HER2 Negative Breast Cancer Patients: A Retrospective Study Cite
Zong Y, Zhu L, Wu J, Chen X, Huang O, Fei X, et al. Progesterone Receptor Status and Ki-67 Index May Predict Early Relapse in Luminal B/HER2 Negative Breast Cancer Patients: A Retrospective Study. PLoS ONE. Public Library of Science (PLoS); 2014; 9:e95629 10.1371/journal.pone.0095629
Intrinsic breast cancer subtypes defined by estrogen receptor signalling—prognostic relevance of progesterone receptor loss Cite
Braun L, Mietzsch F, Seibold P, Schneeweiss A, Schirmacher P, Chang-Claude J, et al. Intrinsic breast cancer subtypes defined by estrogen receptor signalling—prognostic relevance of progesterone receptor loss. Modern Pathology. Springer Science and Business Media LLC; 2013; 26:1161-1171 10.1038/modpathol.2013.60

Latest research finds PR- status worsens prognosis

Selected breast cancer studies

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