Advertisement

Breast Cancer Research and Treatment

, Volume 9, Issue 3, pp 191–199 | Cite as

Progesterone receptor activity and relapse-free survival in patients with primary breast cancer: The role of adjuvant chemotherapy

  • J. M. M. Raemaekers
  • L. V. A. M. Beex
  • G. F. F. M. Pieters
  • A. G. H. Smals
  • Th. J. Benraad
  • P. W. C. Kloppenborg
  • Breast Cancer Study Group
  • T. Wobbes
  • W. van Daal
  • R. Holland
  • J. Hendriks
  • D. Wagener
Report

Abstract

The prognostic significance of progesterone receptor activity (PgR) with regard to the estimated relapse-free survival (RFS) was studied in 350 one-center patients with primary breast cancer. All receptor assays were performed in one laboratory; PgR levels >10 fmol/mg protein were considered positive. Univariate as well as multivariate statistical analyses were used to examine the prognostic significance of several variables. Eighty-nine of the 350 patients received adjuvant CMF chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil). The median observation period was 69 months (range 12–125 months).

In the group of 261 patients who did not receive adjuvant CMF, the PgR-status lacked prognostic significance; only the lymph node status significantly affected the RFS (p<0.00001). In contrast, in the CMF-treated group of patients, the PgR-status was the most powerful predictor of recurrence (p<0.0001). The menopausal and the lymph-node status increased the predictive value of PgR (p<0.001). Premenopausal CMF-treated patients with PgR+ tumors had a significantly longer RFS than those with PgR tumors (p<0.02). The present data urge the need for a reappraisal of the prognostic significance of PgR and of the mechanism of action of adjuvant chemotherapy in primary breast cancer.

Key words

adjuvant chemotherapy breast cancer progesterone receptor prognosis 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Pichon MF, Pallud C, Brunet M, Milgrom E: Relationship of presence of progesterone receptors to prognosis in early breast cancer. Cancer Res 40: 3357–3360, 1980PubMedGoogle Scholar
  2. 2.
    Clark GM, McGuire WL, Hubay CA, Pearson OH, Marshall JS: Progesterone receptor as a prognostic factor in stage II breast cancer. N Engl J Med 309: 1343–1347, 1983PubMedGoogle Scholar
  3. 3.
    Howell A, Harland RNL, Bramwell VHC, Swindell R, Barnes DM, Redford J, Wilkinson MJS, Crowther D, Sellwood RA: Steroid-hormone receptors and survival after first relapse in breast cancer. Lancet i: 558–591, 1984Google Scholar
  4. 4.
    Howat JMT, Harris M, Swindell R, Barnes DM: The effect of oestrogen and progesterone receptors on recurrence and survival in patients with carcinoma of the breast. Br J Cancer 51: 263–270, 1985PubMedGoogle Scholar
  5. 5.
    Raemaekers JMM, Beex LVAM, Koenders AJM, Pieters GFFM, Smals AGH, Benraad ThJ, Kloppenborg PWC, and the Breast Cancer Group: Disease-free interval and estrogen receptor activity in tumor tissue of patients with primary breast cancer: analysis after long-term follow-up. Breast Cancer Res Treat 6: 123–131, 1985PubMedGoogle Scholar
  6. 6.
    Koenders AJ, Geurts-Moespot J, Kho KH, Benraad ThJ: Estradiol and progesterone receptor activities in stored lyophilized target tissue. J Steroid Biochem 9: 947–950, 1978PubMedGoogle Scholar
  7. 7.
    Gehan E: A generalized Wilcoxon test for comparing arbitrarily single censored samples. Biometrika 52: 203–224, 1965PubMedGoogle Scholar
  8. 8.
    Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50: 163–170, 1966PubMedGoogle Scholar
  9. 9.
    Cox DR: Regression models and life-tables. J R Stat Soc 34: 187–200, 1972Google Scholar
  10. 10.
    Dixon WJ (ed): BMDP statistical software. Berkeley California Press, 1983Google Scholar
  11. 11.
    Allegra JC, Lippman ME, Simon R, Thompson EB, Barlock A, Green L, Huff KK, Do HMT, Aitken SL, Warren R: Association between steroid hormone receptor status and disease-free interval in breast cancer. Cancer Treat Rep 63: 1271–1277, 1979PubMedGoogle Scholar
  12. 12.
    Howat JMT, Barnes DM, Harris M, Swindell R: Association of cytosol oestrogen and progesterone receptors with histological features of breast cancer and early recurrence of disease. Br J Cancer 47: 629–640, 1983PubMedGoogle Scholar
  13. 13.
    Mason BH, Holdaway IM, Mullins PR, Yee LH, Kay RG: Progesterone and estrogen receptors as prognostic variables in breast cancer. Cancer Res 43: 2985–2990, 1983PubMedGoogle Scholar
  14. 14.
    Saez S, Cheix F, Asselain B: Prognostic value of estrogen and progesterone receptors in primary breast cancer. Breast Cancer Res Treat 3: 345–354, 1983PubMedGoogle Scholar
  15. 15.
    Alanko A, Heinonen E, Scheinin TM, Tolppanen EM, Vihko RV: Oestrogen and progesterone receptors and disease free interval in primary breast cancer. Cancer 50: 667–672, 1984PubMedGoogle Scholar
  16. 16.
    Di Fronzo G, Cappelletti V, Coradini D, Ronchi E, Scavone G: Prognostic significance of progesterone receptors alone or in association with estrogen receptors in human breast cancer. Tumori 70: 159–164, 1984PubMedGoogle Scholar
  17. 17.
    Coradini D, Scavone GF, Cappelletti V, Miodini P, Granata G, Di Fronzo G: Assessment of the prognostic relevance of PgR in addition to ER in node negative breast cancer patients. Abstract: International Congress on Endocrinology and Malignancy, Rome, 22–27 April 1986. Anticancer Res 6: 373, 1986Google Scholar
  18. 18.
    Kohail HM, Elias EG, El-Nowiem SA, Bashirelahi N, Didolkar MS, Reed WP: A multifactorial analysis of steroid hormone receptors in stage I and II breast cancer. Ann Surg 201: 611–617, 1985PubMedGoogle Scholar
  19. 19.
    Caldarola GL, Volterrani P, Caldarola B, Lai M, Jayme A, Gaglia P: The influence of hormone receptors and hormonal adjuvant therapy on disease-free survival in breast cancer: a multifactorial analysis. Eur J Cancer Clin Oncol 22: 151–155, 1986PubMedGoogle Scholar
  20. 20.
    Thorpe SM, Rose C, Rasmussen B, King WJ, De Sombre ER, Blough RM, Mouridsen HT, Rossing N, Andersen KW: Steroid hormone receptors as prognostic indicators in primary breast cancer. Breast Cancer Res Treat 7 (Suppl): 91–99, 1986PubMedGoogle Scholar
  21. 21.
    Kinne DW, Ashikari R, Butler A, Menendez-Botet C, Rosen PP, Schwartz M: Estrogen receptor protein in breast cancer as a predictor of recurrence. Cancer 47: 2364–2367, 1981PubMedGoogle Scholar
  22. 22.
    von Maillot K, Horke W, Prestele H: Prognostic significance of the steroid receptor content in primary breast cancer. Arch Gynecol 231: 185–190, 1982PubMedGoogle Scholar
  23. 23.
    Kaufmann M, Klinga K: Mögliche prognostische Kriterien zur Therapie-Verbesserung beim primären Mammakarzinom. Geburtsh u Frauenheilk 42: 501–509, 1982Google Scholar
  24. 24.
    Stewart JF, Rubens RD, Millis RR, King RJB, Hayward JL: Steroid receptors and prognosis in operable (stage I and II) breast cancer. Eur J Cancer Clin Oncol 19: 1381–1387, 1983PubMedGoogle Scholar
  25. 25.
    Vollenweider-Zerargui L, Barrelet L, Wong Y, Lemarchand-Béraud T, Gomez F: The predictive value of estrogen and progesterone receptors' concentrations on the clinical behavior of breast cancer in women. Cancer 57: 1171–1180, 1986PubMedGoogle Scholar
  26. 26.
    Fisher B, Redmond CK, Wickerham DL, Rockette HE, and Brown A, with the contribution of Allegra J, Bowman D, Plotkin D, Wolter J and other NSABP investigators: Relation of estrogen and/or progesterone receptor content of breast cancer to patient outcome following adjuvant therapy. Breast Cancer Res Treat 3: 355–365, 1983PubMedGoogle Scholar
  27. 27.
    Howell A, George WD, Crowther D, Rubens RD, Bulbrook RD, Bush H, Howat JMT, Sellwood RA, Hayward JL, Fentiman IS, Chaudary M: Controlled trial of adjuvant chemotherapy with cyclophosphamide, methotrexate and fluorouracil for breast cancer. Lancet ii: 307–311, 1983Google Scholar
  28. 28.
    Pascual MR, Macias A, Moreno L, Lage A: Factors associated with prognosis in human breast cancer. V. The simultaneous use of estrogen and progesterone receptor measurements for prediction of short-term relapse. Neoplasma 32: 247–256, 1985PubMedGoogle Scholar
  29. 29.
    Bonadonna G, Valagussa R, Rossi A, Tancini G, Brambilla C, Zambetti M, Veronesi U: Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer. Breast Cancer Res Treat 5: 95–117, 1985PubMedGoogle Scholar
  30. 30.
    Padmanabhan N, Howell A, Rubens RD: Mechanism of action of adjuvant chemotherapy in early breast cancer. Lancet ii: 411–415, 1986Google Scholar

Copyright information

© Martinus Nijhoff Publishers 1987

Authors and Affiliations

  • J. M. M. Raemaekers
    • 1
  • L. V. A. M. Beex
    • 1
  • G. F. F. M. Pieters
    • 1
  • A. G. H. Smals
    • 1
  • Th. J. Benraad
    • 2
  • P. W. C. Kloppenborg
    • 1
  • Breast Cancer Study Group
  • T. Wobbes
    • 3
  • W. van Daal
    • 4
  • R. Holland
    • 5
  • J. Hendriks
    • 6
  • D. Wagener
    • 7
  1. 1.Department of Medicine, Division of EndocrinologyUniversity Hospital NijmegenNijmegenThe Netherlands
  2. 2.Department of Experimental and Chemical EndocrinologyUniversity Hospital NijmegenNijmegenThe Netherlands
  3. 3.Department of SurgeryUniversity Hospital NijmegenNijmegenThe Netherlands
  4. 4.Department of RadiotherapyUniversity Hospital NijmegenNijmegenThe Netherlands
  5. 5.Department of PathologyUniversity Hospital NijmegenNijmegenThe Netherlands
  6. 6.Department of RadiologyUniversity Hospital NijmegenNijmegenThe Netherlands
  7. 7.Department of Medical OncologyUniversity Hospital NijmegenNijmegenThe Netherlands

Personalised recommendations