Clinical significance of estrogen receptor/progesterone receptor expression changes in breast cancer patients after neoadjuvant chemotherapy

doi:10.3877/cma.j.issn.1674-0807.2021.06.003

Abstract

Abstract:

Objective

To explore the relationship between the expression changes of estrogen receptor (ER)/progesterone receptor (PR) before and after neoadjuvant chemotherapy (NAC) and the efficacy of NAC in breast cancer patients.

Methods

The clinical data of 127 patients with HER-2-negative invasive breast cancer who had not achieved pCR after NAC (anthracycline and docetaxel-based regimen) in the Department of Pathology, Fifth Medical Center, General Hospital of PLA from January 2015 to June 2017 were retrospectively analyzed. ER and PR expressions in tumor tissues before and after NAC were determined by immunohistochemistry. ER/PR was regarded as positive if nuclear staining percentage ≥1%, > 10% or > 20%, respectively. The patients with different ER/PR expression status before and after NAC were in Group A, and others were in Group B. The χ² test or rank sum test was used to compare the clinicopathological characteristics between two groups. The t test or rank sum test was used to compare the tumor remission rates between two groups. According to the different change of ER and PR after NAC, Group A was divided into 4 subgroups: ER negative to positive subgroup, ER positive to negative subgroup, PR negative to positive subgroup and PR positive to negative subgroup. Analysis of variance was used to compare the tumor remission rates among 4 subgroups under the three positive expression standards.

Results

With nuclear staining percentage ≥1% as the positive standard, there was no statistically significant difference in clinicopathological characteristics between two groups (all P>0.050). With nuclear staining percentage >10% as the positive standard, PR expression showed a significant difference between two groups (χ²=4.757, P=0.029). With nuclear staining percentage >20% as the positive standard, Group A had higher rates of axillary lymph node metastasis, ER positive, PR positive and triple negative breast cancer compared with Group B (χ²=5.572, 8.683, 11.724, 4.686; P=0.018, 0.003, 0.001, 0.030). With nuclear staining percentage ≥1% as the positive standard, the tumor remission rate was (46.8±23.8)% in Group A, (35.9±26.8)% in Group B, indicating a significant difference (t=2.190, P=0.032). With nuclear staining percentage >10% or >20% as the positive standard, the tumor remission rate showed no significant difference between Group A and Group B[M(P₂₅, P₇₅): 38.5(26.8, 54.7)% vs 37.3(21.4, 53.6)%, Z=0.446, P=0.656; 39.5(27.3, 56.9)% vs 39.1(22.7, 55.1)%, Z=0.548, P=0.584]. Under the three positive expression standards (≥1%, >10% and >20%), there was no significant difference in tumor remission rate among four subgroups (F=1.380, 1.890, 1.970; P=0.266, 0.146, 0.131).

Conclusions

With nuclear staining percentage≥10% as the positive standard, the change of ER/PR status after NAC may indicate a higher tumor remission rate. The different changes of ER/PR status after NAC have no impact on the efficacy of NAC.

Key words: Breast neoplasms, Neoadjuvant therapy, Receptors, estrogen, Receptors, progesterone

Sheng Chen, Minghua Zhu, Yan Huang, Huaitao Wang, Qi He. Clinical significance of estrogen receptor/progesterone receptor expression changes in breast cancer patients after neoadjuvant chemotherapy[J]. Chinese Journal of Breast Disease(Electronic Edition), 2021, 15(06): 346-351.

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References 15

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临床病理特征		≥1%				>10%				>20%
临床病理特征		一致组(n＝91)	差异组(n＝36)	检验值	P值	一致组(n＝86)	差异组(n＝41)	检验值	P值	一致组(n＝80)	差异组(n＝47)	检验值	P值
年龄
	≤50岁	56	26	χ²＝1.287	0.257	54	28	χ²＝0.367	0.544	53	29	χ²＝0.268	0.605
	>50岁	35	10	χ²＝1.287	0.257	32	13	χ²＝0.367	0.544	27	18	χ²＝0.268	0.605
绝经
	是	31	12	χ²＝0.006	0.937	28	15	χ²＝0.201	0.654	24	19	χ²＝1.437	0.231
	否	60	24	χ²＝0.006	0.937	58	26	χ²＝0.201	0.654	56	28	χ²＝1.437	0.231
肿瘤大小
	T₁	18	6	Z＝0.670	0.503	15	9	Z＝-0.571	0.568	16	8	Z＝0.590	0.556
	T₂	62	24			59	27			54	32
	T₃	7	4			8	3			8	3
	T₄	4	2			4	2			2	4
腋窝淋巴结转移
	阴性	16	5	χ²＝0.255	0.614	18	3	χ²＝3.728	0.054	18	3	χ²＝5.572	0.018
	阳性	75	31	χ²＝0.255	0.614	68	38	χ²＝3.728	0.054	62	44	χ²＝5.572	0.018
ER
	阴性	21	12	χ²＝1.411	0.235	31	9	χ²＝2.557	0.110	34	8	χ²＝8.683	0.003
	阳性	70	24	χ²＝1.411	0.235	55	32	χ²＝2.557	0.110	46	39	χ²＝8.683	0.003
PR
	阴性	29	18	χ²＝3.638	0.057	45	13	χ²＝4.757	0.029	49	14	χ²＝11.724	0.001
	阳性	62	18	χ²＝3.638	0.057	41	28	χ²＝4.757	0.029	31	33	χ²＝11.724	0.001
Ki-67
	<14%	22	9	χ²＝0.010	0.922	24	7	χ²＝1.766	0.184	19	12	χ²＝0.051	0.821
	≥14%	69	27	χ²＝0.010	0.922	62	34	χ²＝1.766	0.184	61	35	χ²＝0.051	0.821
分子分型
	非三阴性	71	27	χ²＝0.134	0.715	59	32	χ²＝1.219	0.270	50	38	χ²＝4.686	0.030
	三阴性	20	9	χ²＝0.134	0.715	27	9	χ²＝1.219	0.270	30	9	χ²＝4.686	0.030

临床病理特征		≥1%				>10%				>20%
临床病理特征		一致组(n＝91)	差异组(n＝36)	检验值	P值	一致组(n＝86)	差异组(n＝41)	检验值	P值	一致组(n＝80)	差异组(n＝47)	检验值	P值
年龄
	≤50岁	56	26	χ²＝1.287	0.257	54	28	χ²＝0.367	0.544	53	29	χ²＝0.268	0.605
	>50岁	35	10	χ²＝1.287	0.257	32	13	χ²＝0.367	0.544	27	18	χ²＝0.268	0.605
绝经
	是	31	12	χ²＝0.006	0.937	28	15	χ²＝0.201	0.654	24	19	χ²＝1.437	0.231
	否	60	24	χ²＝0.006	0.937	58	26	χ²＝0.201	0.654	56	28	χ²＝1.437	0.231
肿瘤大小
	T₁	18	6	Z＝0.670	0.503	15	9	Z＝-0.571	0.568	16	8	Z＝0.590	0.556
	T₂	62	24			59	27			54	32
	T₃	7	4			8	3			8	3
	T₄	4	2			4	2			2	4
腋窝淋巴结转移
	阴性	16	5	χ²＝0.255	0.614	18	3	χ²＝3.728	0.054	18	3	χ²＝5.572	0.018
	阳性	75	31	χ²＝0.255	0.614	68	38	χ²＝3.728	0.054	62	44	χ²＝5.572	0.018
ER
	阴性	21	12	χ²＝1.411	0.235	31	9	χ²＝2.557	0.110	34	8	χ²＝8.683	0.003
	阳性	70	24	χ²＝1.411	0.235	55	32	χ²＝2.557	0.110	46	39	χ²＝8.683	0.003
PR
	阴性	29	18	χ²＝3.638	0.057	45	13	χ²＝4.757	0.029	49	14	χ²＝11.724	0.001
	阳性	62	18	χ²＝3.638	0.057	41	28	χ²＝4.757	0.029	31	33	χ²＝11.724	0.001
Ki-67
	<14%	22	9	χ²＝0.010	0.922	24	7	χ²＝1.766	0.184	19	12	χ²＝0.051	0.821
	≥14%	69	27	χ²＝0.010	0.922	62	34	χ²＝1.766	0.184	61	35	χ²＝0.051	0.821
分子分型
	非三阴性	71	27	χ²＝0.134	0.715	59	32	χ²＝1.219	0.270	50	38	χ²＝4.686	0.030
	三阴性	20	9	χ²＝0.134	0.715	27	9	χ²＝1.219	0.270	30	9	χ²＝4.686	0.030

标准及组别		例数	肿瘤缓解率(%)	检验值	P值
≥1%
	一致组	91	35.9±26.8^a	t＝2.190	0.032
	差异组	36	46.8±23.8^a
>10%
	一致组	86	37.3(21.4，53.6)^b
	差异组	41	38.5(26.8，54.7)^b	Z＝0.446^a	0.656^a
>20%
	一致组	80	39.1(22.7，55.1)^b
	差异组	47	39.5(27.3，56.9)^b	Z＝0.548^a	0.584^a

标准及组别		例数	肿瘤缓解率(%)	检验值	P值
≥1%
	一致组	91	35.9±26.8^a	t＝2.190	0.032
	差异组	36	46.8±23.8^a
>10%
	一致组	86	37.3(21.4，53.6)^b
	差异组	41	38.5(26.8，54.7)^b	Z＝0.446^a	0.656^a
>20%
	一致组	80	39.1(22.7，55.1)^b
	差异组	47	39.5(27.3，56.9)^b	Z＝0.548^a	0.584^a

变化方式	≥1%		>10%		>20%
变化方式	例数	缓解率(%)	例数	缓解率(%)	例数	缓解率(%)
ER阴转阳	7	36.4±27.7	7	30.9±32.4	6	28.5±34.9
ER阳转阴	6	54.3±10.4	5	30.8±23.2	7	25.0±21.7
PR阴转阳	9	58.1±22.9	11	53.2±23.3	13	48.0±25.7
PR阳转阴	14	45.7±24.0	18	40.2±18.3	21	42.8±20.4
F值		1.380		1.890		1.970
P值		0.266		0.146		0.131

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