Hormone Receptor Status, Tumor Characteristics, and Prognosis: A Prospective Cohort of Breast Cancer Patients

Lisa K Dunnwald; Mary Anne Rossing; Christopher I Li

Disclosures

Breast Cancer Res. 2007;9(1) 

In This Article

Abstract and Introduction

Background: Breast cancer patients with tumors that are estrogen receptor (ER)-positive and/or progesterone receptor (PR)-positive have lower risks of mortality after their diagnosis compared to women with ER- and/or PR-negative disease. However, few studies have evaluated variations in the risks of breast cancer-specific mortality across ER/PR status by either demographic or clinical characteristics.
Methods: Using data from 11 population-based cancer registries that participate in the SEER (Surveillance, Epidemiology, and End Results) program, 155,175 women at least 30 years old with a primary diagnosis of invasive breast carcinoma from 1990 to 2001 were included in the study. Associations between joint hormone receptor status and breast cancer mortality risk within categories of diagnosis age, diagnosis year, race/ethnicity, histologic tumor type, stage, grade, size, and axillary lymph node status were evaluated using the Cox proportional hazards model.
Results: Compared to ER+/PR+ cases, elevations in risk of mortality were observed across all subcategories of age at diagnosis, ranging from 1.2- to 1.5-fold differences for ER+/PR- cases, 1.5- to 2.1-fold differences for ER-/PR+ cases, and 2.1- to 2.6-fold differences for ER-/PR- cases. Greater differences were observed in analyses stratified by grade; among women with low-grade lesions, ER-/PR- patients had a 2.6-fold (95% confidence interval [CI] 1.7 to 3.9) to 3.1-fold (95% CI 2.8 to 3.4) increased risk of mortality compared to ER+/PR+ patients, but among women with high-grade lesions, they had a 2.1-fold (95% CI 1.9 to 2.2) to 2.3-fold (95% CI 1.8 to 2.8) increased risk.
Conclusion: Compared to women with ER+/PR+ tumors, women with ER+/PR-, ER-/PR+, or ER-/PR- tumors experienced higher risks of mortality, which were largely independent of the various demographic and clinical tumor characteristics assessed in this study. The higher relative mortality risks identified among ER-/PR- patients with small or low-grade tumors raise the question of whether there may be a beneficial role for adjuvant chemotherapy in this population.

Breast cancer patients with tumors that are estrogen receptor (ER)-positive and/or progesterone receptor (PR)-positive have lower risks of mortality after their diagnosis compared to women with ER- and/or PR-negative disease.[1,2,3,4,5,6] Clinical trials have also shown that the survival advantage for women with hormone receptor-positive tumors is enhanced by treatment with adjuvant hormonal and/or chemotherapeutic regimens.[7,8,9] However, few studies have evaluated variations in the risks of breast cancer-specific mortality across ER/PR status by either demographic or clinical characteristics. The goal of this study was to determine whether the greater relative risk of breast cancer mortality observed among women with hormone receptor-negative tumors was similar for those with different demographic characteristics, such as race/ethnicity, age of cancer diagnosis, and year of cancer diagnosis, and for those with different tumor characteristics, such as stage, grade, tumor size, and histology, using data from Surveillance, Epidemiology, and End Results (SEER), the population-based tumor registry program of the National Cancer Institute (NCI). Such an assessment may further elucidate the relationships between various prognostic indicators in breast cancer and provide knowledge regarding the prognostic utility of ER/PR status by demographic and clinical tumor characteristics.

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