ER(-)PR(+)乳腺癌辅助内分泌治疗的疗效

The efficacy of adjuvant endocrine therapy for ER(-)PR(+) primary breast cancer

背景与目的：孕激素受体（PR）状态是雌激素受体（ER）状态预测乳腺癌辅助内分泌治疗的补充，临床上推荐ER阳性（＋）或PR（＋）患者均可接受内分泌治疗。ER阴性（-）PR（＋）肿瘤应用辅助内分泌治疗的疗效如何还存在争议。本研究将探讨辅助内分泌治疗对ER（＋）PR（＋）与ER（-）PR（＋）乳腺癌的疗效，并研究ER（-）PR（＋）患者的临床病理特性及预后。方法：回顾了1991年1月-2001年12月间的1863位ER／PR资料可用的可手术乳腺癌患者资料，ER、PR均采用免疫组化法检测。中位随访48个月，比较ER（-）PR（＋）组（205例）和ER（＋）PR（＋）组（798例）接受或不接受辅助内分泌治疗（3～5年的他莫昔芬）的无病生存（DFS）和总生存（0s）的差异。结果：ER（-）PR（＋）患者占全部乳腺癌患者的11．0％，中位年龄49岁，肿块中值大小3．0cm，其中未绝经者比例高达63．9％。ER（-）PR（＋）组较ER（＋）PR（＋）组而言，腋淋巴结转移数高、肿块大、分期晚。ER（＋）PR（＋）组和ER（-）PR（＋）组未行内分泌治疗时，组间生存差异无显著性；内分泌治疗后，两组的生存率均有所提高，但ER（＋）PR（＋）组的预后比ER（-）PR（＋）组更好（DFS：P=0．016，OS：P=0．007）。多因素分析显示对ER（-）PR（＋）患者，仅有腋淋巴结状态是独立的预后指标。结论：辅助内分泌治疗对ER（＋）PR（＋）乳腺癌的疗效优于对ER（-）PR（＋）乳腺癌的疗效，ER（-）PR（＋）患者能从内分泌治疗中得到一定收益，但较有限。

Background and purpose： Progesterone receptor （PR） status provides predictive value for adjuvant endocrine therapy in estrogen receptor （ER） -positive breast cancer patients. It is recommended for the patients with both ER and PR positive to receive adjuvant hormone therapy. However, it still is a controversial issue how much efficacy of adjuvant endocrine therapy is for ER（ - ） PR（ ＋ ） tumors. This study was to investigate the options of adjuvant endocrine therapy for ER（ ＋ ） PR（ ＋ ） primary breast cancer （205 cases） and ER（ - ） PR（ ＋ ） primary breast cancer （798 eases）. Methods： The expressions of ER and PR status in 1836 consecutive operable patients of primary breast cancer were treated into Shanghai Cancer Hospital between Jan 1991 and Dee 2001 and reviewed. The differences of DFS and OS for ER（ - ） PR （ ＋ ） group and ER（ ＋ ） PR（ ＋ ） group with or without endocrine therapy were analyzed with median following period up to 48 months（6-14l months）. The survival time were calculated by Kaplan-Meier and 5-year survival rates were evaluated by Life Table estimates. Results： ER（ - ） PR（ ＋ ） patients accounted for 11.0% of the whole population, and median age was 49 years. The proportion of premenopausal patients was higher in ER（ - ） PR（ ＋ ） group （63.9%） compared to ER（ ＋ ） PR （＋） group, the ER（-） PR（ ＋ ） group had also more auxiliary lymph node metastases, larger mass and higher clinical staging than that in ER（＋） PR（ ＋ ） group . The DFS and OS were similar between both groups in the absence of endocrine therapy, however, the ER（ ＋ ） PR（ ＋ ） group had a significant better survival than ER（ - ） PR（ ＋ ） group if hormonal treatment was added into the treatment（ DFS： P =0. 016, OS： P =0. 007）, and both groups had better 5-year survival after the treatment of hormonal therapy. The 5-year DFS rate increased from 68.7% to 79.0% in ER（ ＋ ） PR（ ＋ ） group, and from 56.6% to 70.9% in ER（-） PR（＋） group; similar results were found in OS. The multivariate analysis showed that the status of auxiliary lymph node metastases was only important independent prognostic factor for ER（ - ） PR（ ＋ ） patients. Conclusions： The adjuvant endocrine therapy is more effective for ER（ ＋ ） PR（ ＋ ） primary breast cancer than for ER（ - ） PR（ ＋ ） primary breast cancer. Further study is needed determined the best option of hormone therapy for the patients with ER（-） PR（＋） status.