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Estrogen receptor quantitative measures and breast cancer survival

  • Epidemiology
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Abstract

Purpose

While the estrogen receptor (ER) is the single most widely used biomarker to evaluate breast cancer outcomes, aspects of ER marker biology remain poorly understood. We sought to determine whether quantitative measures of ER, such as protein expression and intensity, were associated with survival, or with survival disparities experienced by Hispanic women.

Methods

A case-cohort study included a 15% random sample of invasive breast cancer cases diagnosed from 1997 to 2009 in six New Mexico counties and all deaths due to breast cancer-related causes. Pathology reports and tissue microarrays served as sources of ER information. Analyses were restricted to women with ≥1% ER immunohistochemical staining. Hazard ratios (HR) and 95% confidence intervals (CI) for breast cancer death were estimated using Cox proportional hazards models.

Results

Included women represented 4336 ER+ breast cancer cases and 448 deaths. Median follow-up was 93 months. ER percent expression was not associated with breast cancer survival after adjustment for standard prognostic factors (p trend = 0.76). ER intensity remained a strong and independent risk factor for breast cancer survival in multivariate analyses: Women whose tumors expressed ER at intensity = 2 (HR 0.6; 95% CI 0.4–1.0) or 3 (HR 0.5; 95% CI 0.2–0.9) had a reduced risk of breast cancer mortality, compared to ER intensity = 1 (p trend = 0.02). Neither ER protein expression nor intensity influenced Hispanic survival disparities.

Conclusions

Estrogen receptor percent positive staining is not independently related to breast cancer survival after adjustment for other survival-related factors. ER intensity, in contrast, demonstrates promise for prognostic utility.

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Acknowledgements

This study was supported by Grants R01CA 132877 and 2P30CA11810 from the National Cancer Institute (NCI), and NCI contract HSN26120130010I-Task Order HHSN26100005 to the Surveillance Epidemiology End Results (SEER) program.

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Authors and Affiliations

  1. Internal Medicine Department and Comprehensive Cancer Center, 1 University of New Mexico, MSC 10 5550, Albuquerque, NM, 87131-0001, USA

    Deirdre A. Hill, Charles Wiggins, Andrea Nibbe & Melanie Royce

  2. Department of Pathology, University of New Mexico, Albuquerque, NM, USA

    Marc Barry & Lesley Lomo

  3. Department of Molecular Medicine, University of New Mexico, Albuquerque, NM, USA

    Eric Prossnitz

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  1. Deirdre A. Hill
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Correspondence to Deirdre A. Hill.

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Hill, D.A., Barry, M., Wiggins, C. et al. Estrogen receptor quantitative measures and breast cancer survival. Breast Cancer Res Treat 166, 855–864 (2017). https://doi.org/10.1007/s10549-017-4439-6

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  • DOI: https://doi.org/10.1007/s10549-017-4439-6

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