Prognostic Value of the Progesterone Receptor by Subtype in Patients with Estrogen Receptor-Positive, HER-2 Negative Breast Cancer.
- Van Asten K Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Slembrouck L Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Olbrecht S Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Jongen L Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Brouckaert O Department of Gynecology and Obstetrics, Senology, Jan Yperman Hospital, Ypres, Belgium.
- Wildiers H Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Floris G Laboratory of Translational Cell & Tissue Research, Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium.
- Van Limbergen E Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Weltens C Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Smeets A Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Paridaens R Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Giobbie-Hurder A Department of Biostatistics and Computational Biology, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
- Regan MM Department of Biostatistics and Computational Biology, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
- Viale G Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy.
- Thürlimann B Breast Center St. Gallen, Cantonal Hospital, St. Gallen, Switzerland.
- Vergote I Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
- Christodoulou E Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.
- Van Calster B Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.
- Neven P Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium patrick.neven@uzleuven.be.
- 2018-09-02
Published in:
- The oncologist. - 2019
Age
Breast cancer
Luminal
Progesterone receptor
Prognostic value
Subtype
Breast Neoplasms
Female
Humans
Prognosis
Receptors, Progesterone
Survival Analysis
English
BACKGROUND
In estrogen receptor-positive (ER+), human epidermal growth factor receptor 2 (HER-2) negative breast cancers, the progesterone receptor (PR) is an independent prognostic marker. Little is known about the prognostic value of PR by tumor grade. We assessed this in two independent datasets.
PATIENTS AND METHODS
Women with primary operable, invasive ER+ HER-2 negative breast cancer diagnosed between 2000 and 2012, treated at University Hospitals Leuven, were included. We assessed the association of PR status and subtype (grade 1-2 vs. grade 3) with distant recurrence-free interval (DRFI) and breast cancer-specific survival. The interaction between PR status and subtype was investigated, and associations of PR status by subtype were calculated. The BIG 1-98 data set was used for validation.
RESULTS
In total, 4,228 patients from Leuven and 5,419 from BIG 1-98 were analyzed. In the Leuven cohort, the adjusted hazard ratio (HR) of PR-positive versus PR-negative tumors for DRFI was 0.66 (95% confidence interval [CI], 0.50-0.89). For the interaction with subtype (p = .34), the HR of PR status was 0.79 (95% CI, 0.61-1.01) in luminal A-like and 0.59 (95% CI, 0.46-0.76) in luminal B-like tumors. In luminal A-like tumors, observed 5-year cumulative incidences of distant recurrence were 4.1% for PR-negative and 2.8% for PR-positive tumors, and in luminal B-like 18.7% and 9.2%, respectively. In the BIG 1-98 cohort, similar results were observed; for the interaction with subtype (p = .12), the adjusted HR of PR status for DRFI was 0.88 (95% CI, 0.57-1.35) in luminal A-like and 0.58 (95% CI, 0.43-0.77) in luminal B-like tumors. Observed 5-year cumulative incidences were similar.
CONCLUSION
PR positivity may be more protective against metastatic relapse in luminal B-like versus luminal A-like breast cancer, but no strong conclusions can be made. In absolute risk, results suggest an absent PR is clinically more important in high compared with low proliferative ER+ HER-2 negative tumors.
IMPLICATIONS FOR PRACTICE
An absent progesterone receptor (PR) predicts a worse outcome in women treated for an estrogen receptor-positive, human epidermal growth factor receptor 2 negative breast cancer. As low proliferative tumors lacking PR are now also classified high risk, the prognostic value of PR across risk groups was studied. Despite a negative test for interaction of the prognostic value of PR by tumor grade, the magnitude of an absent PR on breast cancer relapse is much larger in high than in low proliferative breast cancers.
In estrogen receptor-positive (ER+), human epidermal growth factor receptor 2 (HER-2) negative breast cancers, the progesterone receptor (PR) is an independent prognostic marker. Little is known about the prognostic value of PR by tumor grade. We assessed this in two independent datasets.
PATIENTS AND METHODS
Women with primary operable, invasive ER+ HER-2 negative breast cancer diagnosed between 2000 and 2012, treated at University Hospitals Leuven, were included. We assessed the association of PR status and subtype (grade 1-2 vs. grade 3) with distant recurrence-free interval (DRFI) and breast cancer-specific survival. The interaction between PR status and subtype was investigated, and associations of PR status by subtype were calculated. The BIG 1-98 data set was used for validation.
RESULTS
In total, 4,228 patients from Leuven and 5,419 from BIG 1-98 were analyzed. In the Leuven cohort, the adjusted hazard ratio (HR) of PR-positive versus PR-negative tumors for DRFI was 0.66 (95% confidence interval [CI], 0.50-0.89). For the interaction with subtype (p = .34), the HR of PR status was 0.79 (95% CI, 0.61-1.01) in luminal A-like and 0.59 (95% CI, 0.46-0.76) in luminal B-like tumors. In luminal A-like tumors, observed 5-year cumulative incidences of distant recurrence were 4.1% for PR-negative and 2.8% for PR-positive tumors, and in luminal B-like 18.7% and 9.2%, respectively. In the BIG 1-98 cohort, similar results were observed; for the interaction with subtype (p = .12), the adjusted HR of PR status for DRFI was 0.88 (95% CI, 0.57-1.35) in luminal A-like and 0.58 (95% CI, 0.43-0.77) in luminal B-like tumors. Observed 5-year cumulative incidences were similar.
CONCLUSION
PR positivity may be more protective against metastatic relapse in luminal B-like versus luminal A-like breast cancer, but no strong conclusions can be made. In absolute risk, results suggest an absent PR is clinically more important in high compared with low proliferative ER+ HER-2 negative tumors.
IMPLICATIONS FOR PRACTICE
An absent progesterone receptor (PR) predicts a worse outcome in women treated for an estrogen receptor-positive, human epidermal growth factor receptor 2 negative breast cancer. As low proliferative tumors lacking PR are now also classified high risk, the prognostic value of PR across risk groups was studied. Despite a negative test for interaction of the prognostic value of PR by tumor grade, the magnitude of an absent PR on breast cancer relapse is much larger in high than in low proliferative breast cancers.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1634/theoncologist.2018-0176
- PMID 30171067
- Persistent URL
- https://sonar.ch/global/documents/93206
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