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Clinical relevance of the reappraisal of negative hormone receptor expression in breast cancer.

Pinto AE, Areia F, Pereira T, Cardoso P, Aparício M, Silva GL, Ferreira MC, André S - Springerplus (2013)

Bottom Line: Accurate assessment of estrogen (ER) and progesterone (PR) receptors is critical in predicting the response to endocrine therapies in breast cancer.From 101 ER- and 158 PR- cases, 38 (37.6%) and 58 (36.7%) became positive, increasing ER and PR expression from 71.9% and 56.1% to 82.5% and 72.2%, respectively (P<0.001).Kaplan-Meier survival curves showed significant differences related to RFS and OS for PR, either in the whole series or in the subset (n = 151) submitted to hormonal treatment.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Matemática do Instituto Superior Técnico da Universidade Técnica de Lisboa, Lisboa, Portugal.

ABSTRACT

Background: Accurate assessment of estrogen (ER) and progesterone (PR) receptors is critical in predicting the response to endocrine therapies in breast cancer.

Material and methods: From a series of 360 patients with breast invasive carcinoma assessed for hormone receptors by immunohistochemistry (IHC) in the 90's, we re-analysed, on the same tumour material, the cases considered negative (n = 164), i.e., ER-/PR- (n = 95), ER+/PR- (n = 63) and ER-/PR+ (n=6), and 16 of 196 ER+/PR+ tumours with unfavourable outcome. Concordance between the previous IHC (Streptavidin-Biotin-Peroxidase) method and the current one (Peroxidase-Indirect-Polymer) was determined by the McNemar's test. Relapse-free (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method.

Results: From 101 ER- and 158 PR- cases, 38 (37.6%) and 58 (36.7%) became positive, increasing ER and PR expression from 71.9% and 56.1% to 82.5% and 72.2%, respectively (P<0.001). All 16 ER+/PR+ cases maintained their co-positivity, while all ER-/PR+ tumours changed to ER positive. Kaplan-Meier survival curves showed significant differences related to RFS and OS for PR, either in the whole series or in the subset (n = 151) submitted to hormonal treatment. The patients' subgroup with ER+/PR- tumours exhibited the worst prognosis.

Conclusion: The current IHC method improves the clinical usefulness of ER/PR assessment by decreasing the rate of false negative results.

No MeSH data available.


Related in: MedlinePlus

Immunohistochemical analysis (x10) of hormonal receptors in a breast cancer case A) Previously considered double-negative and B) Its change to ER/PR double-positivity by the current IHC method.
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Fig1: Immunohistochemical analysis (x10) of hormonal receptors in a breast cancer case A) Previously considered double-negative and B) Its change to ER/PR double-positivity by the current IHC method.

Mentions: All cases negative for ER (n = 101) and PR (n = 158), as well as 16 ER+/PR+ cases that showed unfavourable clinical outcome, were re-evaluated using the current IHC method. The specific changes in the hormone receptor status, as compared to the previous IHC technique, were as follows: 20 (21.1%) and 12 (12.6%) of 95 ER-/PR- cases were classified as ER+/PR+ (Figure 1) and ER+/PR-, respectively; also, 38 (60.3%) of 63 previous ER+/PR- cases became PR positive. Of noting, all 6 ER-/PR+ cases changed to ER positive. All 16 ER+/PR+ cases, used as control for positive expression, maintained their co-positivity, and therefore, the observation was extended to the remaining ER and PR positive cases. Overall, using the currently recommended ≥1% cut-off (Hammond et al. 2010), 297 (82.5%) cases were considered ER positive, while PR positivity was found in 260 (72.2%). Specifically, the hormone receptor status assessed by the current IHC method was as follows: ER+/PR+ (n = 260), ER-/PR- (n = 63), and ER+/PR- (n=37).Figure 1


Clinical relevance of the reappraisal of negative hormone receptor expression in breast cancer.

Pinto AE, Areia F, Pereira T, Cardoso P, Aparício M, Silva GL, Ferreira MC, André S - Springerplus (2013)

Immunohistochemical analysis (x10) of hormonal receptors in a breast cancer case A) Previously considered double-negative and B) Its change to ER/PR double-positivity by the current IHC method.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3755814&req=5

Fig1: Immunohistochemical analysis (x10) of hormonal receptors in a breast cancer case A) Previously considered double-negative and B) Its change to ER/PR double-positivity by the current IHC method.
Mentions: All cases negative for ER (n = 101) and PR (n = 158), as well as 16 ER+/PR+ cases that showed unfavourable clinical outcome, were re-evaluated using the current IHC method. The specific changes in the hormone receptor status, as compared to the previous IHC technique, were as follows: 20 (21.1%) and 12 (12.6%) of 95 ER-/PR- cases were classified as ER+/PR+ (Figure 1) and ER+/PR-, respectively; also, 38 (60.3%) of 63 previous ER+/PR- cases became PR positive. Of noting, all 6 ER-/PR+ cases changed to ER positive. All 16 ER+/PR+ cases, used as control for positive expression, maintained their co-positivity, and therefore, the observation was extended to the remaining ER and PR positive cases. Overall, using the currently recommended ≥1% cut-off (Hammond et al. 2010), 297 (82.5%) cases were considered ER positive, while PR positivity was found in 260 (72.2%). Specifically, the hormone receptor status assessed by the current IHC method was as follows: ER+/PR+ (n = 260), ER-/PR- (n = 63), and ER+/PR- (n=37).Figure 1

Bottom Line: Accurate assessment of estrogen (ER) and progesterone (PR) receptors is critical in predicting the response to endocrine therapies in breast cancer.From 101 ER- and 158 PR- cases, 38 (37.6%) and 58 (36.7%) became positive, increasing ER and PR expression from 71.9% and 56.1% to 82.5% and 72.2%, respectively (P<0.001).Kaplan-Meier survival curves showed significant differences related to RFS and OS for PR, either in the whole series or in the subset (n = 151) submitted to hormonal treatment.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Matemática do Instituto Superior Técnico da Universidade Técnica de Lisboa, Lisboa, Portugal.

ABSTRACT

Background: Accurate assessment of estrogen (ER) and progesterone (PR) receptors is critical in predicting the response to endocrine therapies in breast cancer.

Material and methods: From a series of 360 patients with breast invasive carcinoma assessed for hormone receptors by immunohistochemistry (IHC) in the 90's, we re-analysed, on the same tumour material, the cases considered negative (n = 164), i.e., ER-/PR- (n = 95), ER+/PR- (n = 63) and ER-/PR+ (n=6), and 16 of 196 ER+/PR+ tumours with unfavourable outcome. Concordance between the previous IHC (Streptavidin-Biotin-Peroxidase) method and the current one (Peroxidase-Indirect-Polymer) was determined by the McNemar's test. Relapse-free (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method.

Results: From 101 ER- and 158 PR- cases, 38 (37.6%) and 58 (36.7%) became positive, increasing ER and PR expression from 71.9% and 56.1% to 82.5% and 72.2%, respectively (P<0.001). All 16 ER+/PR+ cases maintained their co-positivity, while all ER-/PR+ tumours changed to ER positive. Kaplan-Meier survival curves showed significant differences related to RFS and OS for PR, either in the whole series or in the subset (n = 151) submitted to hormonal treatment. The patients' subgroup with ER+/PR- tumours exhibited the worst prognosis.

Conclusion: The current IHC method improves the clinical usefulness of ER/PR assessment by decreasing the rate of false negative results.

No MeSH data available.


Related in: MedlinePlus