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Single Hormone Receptor-Positive Breast Cancers Have Distinct Characteristics and Survival

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Estrogen receptor (ER) and progesterone receptor (PR) status is pivotal to determining the prognosis and treatment of human epidermal growth factor 2 (HER2) receptor-negative invasive breast cancer. Frequently ER-positive (ER+) and/or PR-positive (PR+) cancers are labeled nonspecifically as “hormone receptor-positive” although only one is positive. This study aimed to evaluate and characterize the ER+PR− and ER−PR+ breast cancer phenotypes in reference to ER+PR+ cancers.

Methods

A retrospective cohort study of female patients with HER2-negative (HER2−) invasive breast cancer diagnosed in 2010−2015 was performed using the National Cancer Database. Cases were grouped into ER+PR+, ER−PR+, ER+PR−, and ER−PR− phenotypes to determine differences in patient demographics, tumor characteristics, and overall survival.

Results

Of 823,969 cases, 619,050 (75.1%) were ER+PR+, 79,777 (9.7%) were ER+PR−, 7006 (0.9%) were ER−PR+, and 118,136 (14.3%) were ER−PR−. Compared with the ER+PR+ group, the ER+PR− and ER−PR+ groups were more likely to be high-grade cancer (16.0% vs. 34.2% and 80.0%, respectively; p < 0.001), to have lymphovascular invasion (17.9% vs. 19.6% and 23.0%; p < 0.001), to be node-positive (13.5% vs. 19.7% and 26.3%; p < 0.001), to be stage 4 cancer (3.6% vs. 5.9% and 6.7%; p < 0.001), to have a higher multigene assay score (mean, 16.0 vs. 27.8 and 38.1; p < 0.001), and to have a worse survival (90.6% vs. 83.8% and 78.1%; p < 0.001).

Conclusion

Single hormone receptor-positive breast cancer subtypes (ER+PR− and ER−PR+) are more likely to have unfavorable characteristics and worse survival than the ER+PR+ subtype, with the ER−PR+ subtype having outcomes similar to those for ER−PR− cancers. The single hormone receptor-positive subtypes, representing 10% of HER2− cancers, should be considered clinically distinct from ER+PR+ disease.

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Correspondence to Christine Dauphine MD.

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Disclosure

Rowan T. Chlebowski is a consultant for Novartis, AstraZeneca, Genentech, Merck, Immunomedics, and Puma and received honorarium from Novartis and AstraZeneca.

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The authors have no conflicts of interest to declare.

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The NCDB and the hospitals participating in the NCDB are the source of the de-identified data used in this study. They have not verified the statistical validity of the data analysis or the conclusions derived by the authors and are not responsible for them.

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Dauphine, C., Moazzez, A., Neal, J.C. et al. Single Hormone Receptor-Positive Breast Cancers Have Distinct Characteristics and Survival. Ann Surg Oncol 27, 4687–4694 (2020). https://doi.org/10.1245/s10434-020-08898-5

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  • DOI: https://doi.org/10.1245/s10434-020-08898-5

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