The presence or absence of estrogen and progesterone steroid hormone receptor expression (ER, PR) is an essential feature of invasive breast cancer and determines prognosis and endocrine treatment decisions. Among the four ER/PR receptor phenotypes, the ER-/PR+ is infrequent, and its clinical relevance has been controversially discussed. Thus, we investigated its clinical significance and gene expression pattern in large datasets. In a retrospective clinical study of 15,747 breast cancer patients, we determined the ER/PR subtype survival probabilities using Kaplan-Meier and Cox regression analyses. From The Cancer Genome Atlas (TCGA) breast cancer dataset, PAM50 expression signature and pathway analyses were performed to test for distinct molecular features. In our cohort, the ER-/PR+ phenotype has been observed at a frequency of 4.1 % and was associated with an improved 10-year survival for stage I cancers compared to the ER+/PR+ reference subtype (median; 95 % CI 88.1 %; 83-93 vs. 84.3 %; 82-86 %, P = 0.024) as was confirmed by multivariate analysis over the entire follow-up (HR 0.59, 95 % CI 0.38-0.92, P = 0.021). This association lacked significance when including all stages. ER-/PR+ patients treated with antihormonal agents (34.5 %) had shorter survival compared to their non-treated counterparts (Log-rank P = 0.0001). PAM50 signatures suggest a distinct configuration for the ER-/PR+ phenotype. This specific phenotype has been further separated by a set of 59 uniquely expressed genes. Our study supports the notion of the existence of an ER-/PR+ phenotype with clinical and molecular features distinct from the large group of ER+/PR+ patients.
The homogeneity of the schemes for follow-up
care after curative surgical treatment of early breast cancer is
still a matter of debate in Germany. We investigated whether
symptom-oriented follow-up is equivalent in terms of survival
rates to conventional surveillance based on scheduled tests.
Patients and Methods: In a prospective, non-randomised,
multicentre cohort study carried out between 1995 and 2000,
244 patients underwent a conventional follow-up (scheduled
laboratory tests including CEA and CA 15-3, chest X-rays and
liver ultrasound). 426 patients were monitored in a symptomoriented
manner (additional tests only in the case of symptoms
indicating possible recurrence). Mammography, structured
histories and physical examinations were done regularly
in both branches. 1,108 patients did not participate in the project.
They represent ‘real world patients’, unaffected by the
implications of a study. Results: The symptom-oriented follow-
up group produced results not inferior to those of the intensive
one (p < 0.05) in terms of overall and relapse-free survival.
Furthermore, no difference was indicated in terms of
overall survival between study participants and the ‘real world
patients’ (p = 0.316). Conclusion: The results confirm that regular
imaging and laboratory tests have no relevant effect on
overall survival of patients after curative primary therapy of
early breast cancer and support the implementation of a
symptom-oriented routine follow-up.
Based on a "similar case" model we did not observe any differences in the overall survival (OS), recurrence-free survival (RFS), and quality of life data between breast cancer patients with standard treatment and those who in addition to standard treatment received ML-I treatment.
Background:
The study was undertaken to evaluate the prognosis and prognostic factors of women with breast cancer under routine conditions. One of the main questions was to show, how prognosis is influenced by the adjuvant systemic therapy (CMF chemotherapy or hormonal therapy) with or without adjuvant radiotherapy in patients with breast cancer and positive axillary nodes (≥4). Patients and Methods: All patients (n =2,802) with primary breast cancer treated at the Oncology Center of Stuttgart, between 1988 and mid 1994, were retrospectively evaluated. Results: Patients with 4 or more nodes involved receiving adjuvant systemic therapy had an equal prognosis, compared to patients with 1–3 axillary nodes. After further analysis, a benefit was observed only among patients with 4–9 nodes involved, but not among patients with 10 or more axillary nodes. Conclusions: In the retrospective evaluation of data of groups not well-matched, the results have to be interpreted carefully. Bearing this in mind, the data nevertheless indicate that the prognosis of patients with 4–9 nodes involved is not so bad as it has been published, when they are treated with adjuvant systemic therapy with radiotherapy. Furthermore, the data indicate that adjuvant systemic treatment helps to prolong survival time in patients aged 80 years or more.
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