Clinical Features and Prognosis Analysis of Hormone Receptor-Positive, HER2-Negative Breast Cancer with Differential Expression Levels of Estrogen and Progesterone Receptors: A 10-Year Retrospective Study.

BACKGROUND: Estrogen and progesterone receptor status can predict breast cancer patient prognosis and treatment sensitivity, but research on low ER and PR levels and expression balance remains limited.

METHODS: From January 2010 to October 2016, 283 ER+/PR+/HER2-breast cancer patients who met the inclusion criteria were enrolled and divided into the H group (ER > 10%, N  = 261) and the L group (1% ≤ ER ≤ 10%, N  = 22). Groups were further divided into the HH group (ER > 10%/PR > 20%, N  = 201), the HL group (ER > 10%/ER 1% ≤ PR ≤ 20% PR, N  = 60), the LH group (1% ≤ ER ≤ 10%/PR > 20%, N  = 5), and the LL group (1% ≤ ER ≤ 10%/1% ≤ PR ≤ 20%, N  = 17). The LH group was excluded due to its small size, leaving the clinical and prognostic characteristics of 2 large groups and 3 subgroups to be analyzed.

RESULTS: L group patients had significantly more stage N 2 axillary lymph nodes than H group patients (31.8% vs. 9.2%, P  = 0.007). Age ( P  = 0.011), menopause status ( P  = 0.001), and tumor size ( P  = 0.024) were significantly different in the HL vs. HH and LL groups. Five-year DFS (94.6% vs. 77.0%, P  < 0.001) and 5-year OS (97.2% vs. 85.8%, P  = 0.001) rates significantly differed between HH and HL. No significant differences in 5-year DFS (77.0% vs. 81.9%, P  = 0.564) or 5-year OS (85.8% vs. 87.8%, P  = 0.729) rates were observed between HL and LL; the OS rates of HL and LL were similar.

CONCLUSION: In the group of ER+/PR+/HER2-patients, there was no significant prognostic difference between ER-low positive and ER-high positive groups, but low PR expression was significantly associated with a worse prognosis. The role of ER and PR balance in breast cancer progression and individualized treatment requires further investigation.