Absent progesterone receptor expression in the lymph node metastases of ER-positive, HER2-negative breast cancer is associated with relapse on tamoxifen

Snell, Cameron E., Gough, Madeline, Middleton, Kathryn, Hsieh, Michael, Furnas, Lauren, Seidl, Brenton, Gibbons, Kristen, Pyke, Christopher, Shannon, Catherine, Woodward, Natasha and Armes, Jane E. (2017) Absent progesterone receptor expression in the lymph node metastases of ER-positive, HER2-negative breast cancer is associated with relapse on tamoxifen. Journal of Clinical Pathology, . doi:10.1136/jclinpath-2016-204304


Author Snell, Cameron E.
Gough, Madeline
Middleton, Kathryn
Hsieh, Michael
Furnas, Lauren
Seidl, Brenton
Gibbons, Kristen
Pyke, Christopher
Shannon, Catherine
Woodward, Natasha
Armes, Jane E.
Title Absent progesterone receptor expression in the lymph node metastases of ER-positive, HER2-negative breast cancer is associated with relapse on tamoxifen
Journal name Journal of Clinical Pathology   Check publisher's open access policy
ISSN 0021-9746
1472-4146
Publication date 2017-04-17
Year available 2017
Sub-type Article (original research)
DOI 10.1136/jclinpath-2016-204304
Open Access Status Not yet assessed
Total pages 7
Place of publication London, United Kingdom
Publisher BMJ Group
Collection year 2018
Language eng
Formatted abstract
Aims Progesterone receptor (PR) expression is prognostic in early stage breast cancer. There are several reports of discordant expression between primary tumour and axillary lymph node (ALN) metastasis expression of oestrogen receptor (ER) and PR. We sought to determine whether expression of these biomarkers in the synchronous ALN metastases of ER positive (+), HER2 negative (−) breast cancer could provide more accurate prognostic information.

Methods The retrospective cohort included 229 patients from a single institution with ER+, HER2− breast cancer who had synchronous ALN metastatic disease (2005–2014). PR expression was correlated with relapse-free survival, and subset analysis was performed for patients who received adjuvant tamoxifen or an aromatase inhibitor.

Results One patient had an ER+ primary tumour, which was ER− in the ALN metastasis. 27 (11.3%) were PR− in the primary tumour and 56 (23.6%) in the ALN metastasis. The predominant change was from PR+ in the primary tumour to PR− in the lymph node. Absence of PR expression in the ALN was significantly associated with relapse; however, this was not the case in the primary tumour. In a subset analysis of patients taking adjuvant endocrine therapy, poorer prognosis was limited to those with PR− metastases on tamoxifen (HR=5.203, 95% CI 1.649 to 16.416, p=0.005). No significant prognostic effect of PR− metastases in patients taking aromatase inhibitors was seen (HR=1.519, 95% CI 0.675 to 3.418, p=0.312).

Conclusions Evaluation of PR expression in ALN metastasis may enable prediction of patients who are less likely to benefit from adjuvant tamoxifen. This study should be replicated in other cohorts.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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Created: Wed, 19 Apr 2017, 17:57:18 EST by Natasha Woodward on behalf of Mater Research Institute-UQ