Skip to main content

Semi-quantitative evaluation of estrogen receptor expression is a strong predictive factor of pathological complete response after anthracycline-based neo-adjuvant chemotherapy in hormonal-sensitive breast cancer

Breast Cancer Research and Treatment volume 124, pages 387–391 (2010)Cite this article

Abstract

Absence of hormonal receptors (HR) expression is a predictive factor of high pathologic complete response (pCR) rate after neo-adjuvant chemotherapy. However, HR-positive tumors are less chemosensitive. In the present study, we evaluated the predictive value of estrogen (ER) and progesterone (PgR) semi-quantitative expression in patients with HR-positive tumors treated uniformly with antracycline-based neoadjuvant chemotherapy without hormonal treatment. Value of HR expression as a predictive factor was then evaluated in a multivariate analysis with tumor grade, Ki67 index and HER2 expression. From January 2000 and December 2006, 177 patients with HR-positive breast ductal invasive carcinoma ≥2 cm in its largest diameter were treated with six cycles of an anthracycline-based neo-adjuvant chemotherapy. Tumor grade, ER, PgR, HER2 status and Ki67 index were determined on microbiopsy performed before chemotherapy. A semi-quantitative evaluation of ER and PgR expression by IHC was performed using the Barnes’score. pCR rate was significantly different (P < 0.001) according to the ER expression score. pCR rate was 28% for low score, 9% for medium score and 3% for high score. On the contrary, pCR rate was not significantly different (P = 0.49) according to the PgR expression score. In the multivariate analysis, ER expression score (P = 0.0002) and Ki67 index (P = 0.02) were the only predictive factors of response for HR-positive tumors. pCR after anthracycline-based chemotherapy is significantly correlated with the ER expression score.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Goldhirsch A, Wood WC, Gelber RD et al (2007) Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 18:1133–1144

    CAS  Article  PubMed  Google Scholar 

  2. Early Breast Cancer Trialists’Collaborative Group (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717

    Article  Google Scholar 

  3. Henry NL, Hayes DF (2007) Can biology trump anatomy? Do all node-positive patients with breast cancer need chemotherapy? J Clin Oncol 25:2501–2503

    CAS  Article  PubMed  Google Scholar 

  4. Berry DA, Cirrincione C, Henderson IC et al (2006) Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 295:1658–1667

    CAS  Article  PubMed  Google Scholar 

  5. Allred DC, Mohsin SK (2005) ER expression is not bimodal in breast cancer. Am J Clin Pathol 124:474–475

    PubMed  Google Scholar 

  6. International Breast Cancer Study Group (2002) Endocrine responsiveness and tailoring adjuvant therapy for postmenopausal lymph node-negative breast cancer: a randomized trial. J Natl Cancer Inst 94:1054–1065

    Google Scholar 

  7. Albain K, Barlow W, O’Malley F et al. (2004). Concurrent versus sequential chemohormonal therapy versus tamoxifen alone for postmenopausal, node-positive, estrogen and/or progesterone receptor-positive breast cancer: mature outcomes and new biologic correlates on phase III intergroup trial 0100. Breast Cancer Res Treat 88(suppl 1). Abstract 37

    Google Scholar 

  8. Petit T, Wilt M, Velten M et al (2004) Comparative value of tumour grade, hormonal receptors, Ki-67, HER-2 and topoisomerase II alpha status as predictive markers in breast cancer patients treated with neo-adjuvant anthracycline-based chemotherapy. Eur J Cancer 40:205–211

    CAS  Article  PubMed  Google Scholar 

  9. Kaufmann M, Hortobagyi GN, Goldhirsch A et al (2006) Recommendations from an international expert panel on the use of neoadjuvant systemic treatment of operable breast cancer: an update. J Clin Oncol 24:1940–1949

    Article  PubMed  Google Scholar 

  10. Guarneri V, Broglio K, Kau SW et al (2006) Prognostic value of pathologic complete response after primary chemotherapy in relation to hormone receptors status and other factors. J Clin Oncol 24:1037–1044

    Article  PubMed  Google Scholar 

  11. McShane LM, Altman DG, Sauerbrei W et al (2006) Reporting recommendations for tumor marker prognostic studies (REMARK). Breast Cancer Res Treat 100:229–235

    Article  PubMed  Google Scholar 

  12. Harris L, Fritsche H, Mennel R et al (2007) American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 25:5287–5312

    CAS  Article  PubMed  Google Scholar 

  13. Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer: the value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19:403–410

    CAS  Article  PubMed  Google Scholar 

  14. Allred DC, Harvey JM, Berardo M et al (1998) Prognostic and predictive factors in breast cancer by immunohistochemical analysis. Modern Pathol 11:155–168

    CAS  Google Scholar 

  15. Penault-Llorca F, André F, Sagan C et al (2009) Ki67 expression and docetaxel efficacy in patients with estrogen receptor-positive breast cancer. J Clin Oncol 27:2809–2815

    CAS  Article  PubMed  Google Scholar 

  16. Barnes DM, Millis RR, Beex LV et al (1998) Increased use of immunochemistry for oestrogen receptor measurement in mammary carcinoma: the need for quality assurance. Eur J Cancer 34:1677–1682

    CAS  Article  PubMed  Google Scholar 

  17. Trihia H, Murray S, Price K et al (2003) Ki-67 expression in breast carcinoma: its association with grading systems, clinical parameters, and other prognostic factors—a surrogate marker? Cancer 97:1321–1331

    CAS  Article  PubMed  Google Scholar 

  18. Allred DC, Swanson PE (2000) Testing for erbB-2 by immunohistochemistry in breast cancer. Am J Clin Pathol 113:171–175

    CAS  Article  PubMed  Google Scholar 

  19. Hammond MEH, Hayes DF, Dowsett M et al (2010) American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancers. J Clin Oncol 28:2784–2795

    Article  PubMed  Google Scholar 

  20. Yerushalmi R, Woods R, Ravdin PM et al (2010) Ki67 in breast cancer: prognostic and predictive potential. Lancet Oncol 11:174–183

    CAS  Article  PubMed  Google Scholar 

  21. Sorlie T, Tibshirani R, Parker J et al (2003) Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 100:8418–8423

    CAS  Article  PubMed  Google Scholar 

  22. Fan C, Oh DS, Wessels L et al (2006) Concordance among gene-expression-based predictors for breast cancer. N Engl J Med 355:560–569

    CAS  Article  PubMed  Google Scholar 

  23. Cheang MCU, Chia SK, Voduc C et al (2009) Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst 101:736–750

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgment

We thank Mrs Joy Fest for helping in editing the manuscript.

Author information

Affiliations

  1. Medical Oncology Department, CLCC Paul Strauss, 3 rue de la Porte de l’Hôpital BP42, 67065, Strasbourg Cedex, France

    Thierry Petit, Jean-Pierre Fricker & Patrick Dufour

  2. Pathology Department, CLCC Paul Strauss, Strasbourg, France

    Marc Wilt & Jean-Pierre Ghnassia

  3. Biostatistics Department, CLCC Paul Strauss, Strasbourg, France

    Michel Velten

  4. Surgery Department, CLCC Paul Strauss, Strasbourg, France

    Jean-François Rodier

Authors
  1. Thierry Petit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc Wilt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michel Velten
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-François Rodier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-Pierre Fricker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick Dufour
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Pierre Ghnassia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thierry Petit.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Petit, T., Wilt, M., Velten, M. et al. Semi-quantitative evaluation of estrogen receptor expression is a strong predictive factor of pathological complete response after anthracycline-based neo-adjuvant chemotherapy in hormonal-sensitive breast cancer. Breast Cancer Res Treat 124, 387–391 (2010). https://doi.org/10.1007/s10549-010-1142-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-010-1142-2

Keywords

  • Breast cancer
  • Neoadjuvant chemotherapy
  • Estrogen receptor
  • Predictive factors