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Estrogen receptor (ER) mRNA expression and molecular subtype distribution in ER-negative/progesterone receptor-positive breast cancers

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Abstract

We examined estrogen receptor (ER) mRNA expression and molecular subtypes in stage I–III breast cancers that are progesterone receptor (PR) positive but ER and HER2 negative by immunohistochemistry (IHC) or fluorescent in situ hybridization. The ER, PR, and HER2 status was determined by IHC as part of routine clinical assessment (N = 501). Gene expression profiling was done with the Affymetrix U133A gene chip. We compared expressions of ESR1 and MKI67 mRNA, distribution of molecular subtypes by the PAM50 classifier, the sensitivity to endocrine therapy index, and the DLDA30 chemotherapy response predictor signature among ER/PR-positive (n = 223), ER-positive/PR-negative (n = 73), ER-negative/PR-positive (n = 20), and triple-negative (n = 185) cancers. All patients received neoadjuvant chemotherapy with an anthracycline and taxane and had adjuvant endocrine therapy only if ER or PR > 10 % positive. ESR1 expression was high in 25 % of ER-negative/PR-positive, in 79 % of ER-positive/PR-negative, in 96 % of ER/PR-positive, and in 12 % of triple-negative cancers by IHC. The average MKI67 expression was significantly higher in the ER-negative/PR-positive and triple-negative cohorts. Among the ER-negative/PR-positive patients, 15 % were luminal A, 5 % were Luminal B, and 65 % were basal like. The relapse-free survival rate of ER-negative/PR-positive patients was equivalent to ER-positive cancers and better than the triple-negative cohort. Only 20–25 % of the ER-negative/PR-positive tumors show molecular features of ER-positive cancers. In this rare subset of patients (i) a second RNA-based assessment may help identifying the minority of ESR1 mRNA-positive, luminal-type cancers and (ii) the safest clinical approach may be to consider both adjuvant endocrine and chemotherapy.

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Fig. 1
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Abbreviations

ER:

Estrogens receptor

PR:

Progesterone receptor

IHC:

Immunohistochemistry

HR:

Hormone receptor

HER2:

Human epidermal growth factor receptor 2

DLDA:

Diagonal linear discriminant analysis

SET:

Sensitivity to endocrine therapy

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Acknowledgments

This work was supported by JSPS KAKENHI Grant Number: 25830101.

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Authors and Affiliations

  1. Okayama University, Okayama, Japan

    Mitsuya Itoh, Takayuki Iwamoto, Junji Matsuoka, Tomohiro Nogami, Takayuki Motoki, Tadahiko Shien, Naruto Taira, Toshiyoshi Fujiwara & Hiroyoshi Doihara

  2. Tokai University, Kanagawa, Japan

    Naoki Niikura

  3. St Luke’s International Hospital, Tokyo, Japan

    Naoki Hayashi

  4. Hiroshima City Hospital, Hiroshima, Japan

    Mitsuya Itoh, Shoichiro Ohtani & Kenji Higaki

  5. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    W. Fraser Symmans

  6. Yale University Cancer Center, New Haven, CT, USA

    Lajos Pusztai

Authors
  1. Mitsuya Itoh
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  2. Takayuki Iwamoto
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  3. Junji Matsuoka
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  14. W. Fraser Symmans
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  15. Lajos Pusztai
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Corresponding author

Correspondence to Takayuki Iwamoto.

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Itoh, M., Iwamoto, T., Matsuoka, J. et al. Estrogen receptor (ER) mRNA expression and molecular subtype distribution in ER-negative/progesterone receptor-positive breast cancers. Breast Cancer Res Treat 143, 403–409 (2014). https://doi.org/10.1007/s10549-013-2763-z

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  • DOI: https://doi.org/10.1007/s10549-013-2763-z

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