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. 2009 Nov 3;101(9):1529-36.
doi: 10.1038/sj.bjc.6605360. Epub 2009 Oct 6.

Change in the hormone receptor status following administration of neoadjuvant chemotherapy and its impact on the long-term outcome in patients with primary breast cancer

T Hirata  1 , C Shimizu, K Yonemori, A Hirakawa, T Kouno, K Tamura, M Ando, N Katsumata, Y Fujiwara
Affiliations

Change in the hormone receptor status following administration of neoadjuvant chemotherapy and its impact on the long-term outcome in patients with primary breast cancer

T Hirata et al. Br J Cancer. .

Abstract

Background: To evaluate the impact of change in the hormone receptor (HR) status (HR status conversion) on the long-term outcomes of breast cancer patients treated with neoadjuvant chemotherapy (NAC).

Methods: We investigated 368 patients for the HR status of their lesions before and after NAC. On the basis of the HR status and the use/non-use of endocrine therapy (ET), the patients were categorised into four groups: Group A, 184 ET-administered patients with HR-positive both before and after NAC; Group B, 47 ET-administered patients with HR status conversion; Group C, 12 ET-naive patients with HR status conversion; Group D, 125 patients with HR-negative both before and after NAC.

Results: Disease-free survival in Group B was similar to that in Group A (hazard ratio, 1.16; P=0.652), but that in Group C was significantly lesser than that in Group A (hazard ratio, 6.88; P<0.001). A similar pattern of results was obtained for overall survival.

Conclusion: Our results indicate that the HR status of tumours is a predictive factor for disease-free and overall survival and that ET appears to be suitable for patients with HR status conversion. Therefore, both the CNB and surgical specimens should be monitored for HR status.

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Figures

Figure 1
Figure 1
Immunostaining for oestrogen receptor in core needle biopsy and surgery specimens after neoadjuvant chemotherapy. (A) Staining of tumour cells in core-needle biopsy sample (CNB) staining positively for oestrogen receptor (ER). (B) Staining of tumour cells in surgical samples with ER-negative status after neoadjuvant chemotherapy (NAC). (C) Staining of tumour cells in CNB specimens with ER-negative status. (D) Staining of tumour cells in surgical samples with ER-positive status after NAC.
Figure 2
Figure 2
The distribution of scores for oestrogen receptor and progesterone receptor staining before and after neoadjuvant chemotherapy in 30 patients whose lesions changed from hormone receptor (HR)-positive status to HR-negative status. The size of the circle indicates the number of patients and the number is below the circle. (A–C) Proportion score, intensity score and total score of ER before and after NAC. (D–F) Proportion score, intensity score and total score of PgR befoe and after NAC.
Figure 3
Figure 3
Scores of staining for oestrogen receptor and progesterone receptor before and after neoadjuvant chemotherapy in 29 patients whose lesions changed from being hormone receptor (HR)-negative to HR-positive. The size of the circle indicates the number of patients and the number is below the circle. (A–C) Proportion score, intensity score, total score of ER before and after NAC. (D–F) Proportion score, intensity score, total score of PgR before and after NAC.
Figure 4
Figure 4
Bubble plot for immunohistochemistry score for HER2 before and after neoadjuvant chemotherapy in 59 patients with hormone receptor status conversion. The figures added to the bubbles are the number of patients and each bubble's size is determined by the number of patients in the category: the more the patients, the larger the bubble. The symbols (+) and (−), respectively, indicate the positive and negative status by fluorescent in situ hybridisation (FISH).
Figure 5
Figure 5
Kaplan–Meier curves of disease-free survival in four groups. Short vertical lines indicate censored data points. Log-rank test was significant for disease-free survival (DFS) (P=0.008).
Figure 6
Figure 6
Kaplan–Meier curves of OS in four groups. Short vertical lines indicate censored data points. Log-rank test was significant for overall survival (OS) (P=0.035).
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