Breast Oncology

Annals of Surgical Oncology

, Volume 20, Issue 5, pp 1505-1513

First online:

Lack of Either Estrogen or Progesterone Receptor Expression Is Associated with Poor Survival Outcome among Luminal A Breast Cancer Subtype

  • Seho ParkAffiliated withDepartment of Surgery, Yonsei University College of Medicine, Seoul and Target Molecule Study Group, The Korean Breast Cancer Society
  • , Byeong-Woo ParkAffiliated withDepartment of Surgery, Yonsei University College of Medicine, Seoul and Target Molecule Study Group, The Korean Breast Cancer SocietyBrain Korea 21 Project for Medical Science, Yonsei University College of Medicine Email author 
  • , Tae Hyun KimAffiliated withDepartment of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan and Target Molecule Study Group, The Korean Breast Cancer Society
  • , Chang Wan JeonAffiliated withDepartment of Surgery, Cancer Center, Dongnam Institute of Radiological & Medical Sciences, Busan and Target Molecule Study Group, The Korean Breast Cancer Society
  • , Han-Sung KangAffiliated withCenter for Breast Cancer, National Cancer Center
  • , Jung-Eun ChoiAffiliated withDepartment of Surgery, Yeungnam University College of Medicine
  • , Ki-Tae HwangAffiliated withDepartment of Surgery, Seoul National University Boramae Medical Center
  • , In Cheol KimAffiliated withDepartment of Surgery, Breast Cancer Center, Saegyaero Hospital

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Abstract

Background

This study was designed to evaluate the impact of lack of either estrogen receptor (ER) or progesterone receptor (PR) on characteristics and outcomes among luminal A breast cancer subtype treated with endocrine with or without chemotherapeutic agents.

Methods

The luminal A subtype was categorized into three subgroups: ER+/PR+, ER+/PR−, and ER−/PR+. All tumors were human epidermal growth factor receptor 2 (HER2) negative. Clinicopathological features and survival were analyzed using the Severance Hospital dataset (n = 1,180) and were validated by the nationwide Korean Breast Cancer Society (KBCS) registry (n = 9,916).

Results

Despite the different distribution of ER/PR status, tumor stage, grade, and local therapies between the two datasets, similarly ER+/PR+ showed smaller size and good differentiation, ER+/PR− patients had the oldest age at diagnosis, and ER−/PR+ was associated with the youngest age at onset and grade III tumor. Single hormone receptor-positive subgroups demonstrated worse disease-related outcomes than the ER+/PR+ subgroup. These associations were confirmed by the KBCS dataset. This trend was also demonstrated in the subpopulation of 1,944 patients with Ki-67 < 14 %. Inferior survival of single receptor-positive tumors was more definite among node-positive patients even when receiving both chemo-endocrine therapies.

Conclusions

Current results suggest that the luminal A subtype is also heterogeneous and each subgroup has unique clinicopathologic characteristics. Lack of either ER or PR expression is associated with worse survival, especially among node-positive luminal A subtype.