Journal of Clinical Oncology, Vol 21, Issue 10
(May), 2003: 1973-1979
© 2003 American Society for Clinical Oncology
Progesterone Receptor Status Significantly Improves Outcome Prediction Over Estrogen Receptor Status Alone for Adjuvant Endocrine Therapy in Two Large Breast Cancer Databases
Valerie-Jeanne Bardou,
Grazia Arpino,
Richard M. Elledge,
C. Kent Osborne,
Gary M. Clark
From the Breast Center, Baylor College of Medicine, and the Methodist Hospital, Houston, TX.
Address reprint requests to Richard M. Elledge, MD, Breast Center at Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030; email: relledge{at}breastcenter.tmc.edu.
Purpose: To determine whether progesterone receptor (PgR) status provides additional value to estrogen receptor (ER) status and improves prediction of benefit from endocrine treatment among patients with primary breast cancer.
Patients and Methods: Clinical outcomes of patients in two large databases were analyzed as a function of steroid receptor status. The first database (PP), contained 3,739 patients who did not receive any systemic adjuvant therapy and 1,688 patients who received adjuvant endocrine therapy but no chemotherapy. The second database (SPORE), contained 10,444 patients who received adjuvant endocrine therapy but no chemotherapy. Biochemical ER and PgR assays were identically performed in two different central laboratories.
Results: In univariate and multivariate analyses, the prognostic significance of PgR status among systemically untreated patients is modest. Among endocrine-treated patients, however, multivariate analyses, including lymph-node involvement, tumor size, and age, demonstrate that PgR status is independently associated with disease-free and overall survival. For recurrence, the reduction in relative risk (RR) was 25% for ER-positive/PgR-negative patients and 53% for ER-positive/PgR-positive patients, compared with ER-negative/PgR-negative patients (P < .0001, PP patients). Patients with ER-positive/PgR-negative tumors have a reduction in RR of death of 30% (SPORE patients) and 38% (PP patients), compared with patients with ER-negative/PgR-negative tumors (P < .0001). For ER-positive/PgR-positive tumors, the reduction of the risk of death was greater than 46% in SPORE patients and 58% in PP patients, indicating that ER-positive/PgR-positive patients derive more benefit from endocrine therapy (P < .0001).
Conclusion: When accurately measured, PgR status is an independent predictive factor for benefit from adjuvant endocrine therapy. Therefore, PgR status should be taken into account when discussing RR reductions expected from endocrine treatment with individual patients.
Supported in part by grants P01 CA30195 and P50 CA58183 (Specialized Program of Research Excellence) from the National Institutes of Health, Bethesda, MD, and Aventis, and a Fondazione Itaiana per la Ricerca sul Cancro grant.
Both V-J.B. and G.A. contributed equally to this article.
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