Annals of Oncology Advance Access originally published online on November 6, 2007
Annals of Oncology 2008 19(3):465-472; doi:10.1093/annonc/mdm509
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breast cancer |
Expression of ER, PgR, HER1, HER2, and response: a study of preoperative chemotherapy
1 Unit of Research in Medical Senology, Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Milan
2 Division of Pathology, European Institute of Oncology
3 School of Medicine, University of Milan, Milan, Italy
4 International Breast Cancer Study Group, Statistical Center, Dana-Farber Cancer Institute, and Frontier Science and Technology Research Foundation, Boston, MA, USA
5 Division of Senology, European Institute of Oncology, Milan
6 Department of Medicine, European Institute of Oncology, Milan, Italy
* Correspondence to: Dr M. Colleoni, Unit of Research in Medical Senology, Division of Medical Oncology, Department of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. Tel: +39-02-57489439; Fax: +39-02-57489212; E-mail: marco.colleoni{at}ieo.it
Purpose: To identify the role of estrogen (ER), progesterone (PgR), epidermal growth factor 1 (HER1), and HER2 receptors in predicting response to preoperative chemotherapy.
Materials and methods: We reviewed the pretreatment biopsies of 485 patients with locally advanced breast cancer (cT2-T4, N0-2, M0) treated with preoperative chemotherapy. The incidence of pathological complete remission (pCR) and outcome were assessed with respect to clinical and pathological findings including ER/PgR status (absent versus expressed), HER1 (absent versus expressed) and HER2 (overexpressed versus none) expression.
Results: Patients with ER/PgR-absent tumors were 12.0 times [95% confidence interval (CI) 4.93–29.28] more likely to achieve a pCR (P < 0.0001). Predictors of disease-free survival (DFS) at the univariate analysis included HER1 [hazards ratio (HR) 1.6, 95% CI 1.04–2.32, P = 0.03] and HER2 (HR 1.6, 95% CI 1.08–2.38, P = 0.02) expression. A statistically significant difference in DFS was confirmed at the multivariate analysis for patients with ER/PgR-absent disease (HR 2.1, 95% CI 1.41–2.99, P = 0.0002).
Conclusions: The pCR rate is higher and outcome worse for patients with ER/PgR-absent tumors. HER1 and HER2 expression may have a prognostic role in locally advanced breast cancer and warrant further studies.
Key words: breast cancer, predictive factors, prognostic factors, primary chemotherapy
Received for publication July 13, 2007. Revision received October 1, 2007. Accepted for publication October 2, 2007.
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