A novel estrogen receptor expression stratification(low/moderate/high)based on Chinese population provides more accurate prognosis prediction for HR+/HER2-early breast cancer patients
10.16016/j.2097-0927.202510028
- VernacularTitle:基于中国人群的雌激素受体表达新分层(低/中/高)可更精准地预测HR+/HER2-早期乳腺癌患者的预后
- Author:
Chengfang WANG
1
;
Yuqin ZHOU
;
Yanling ZHANG
;
Xiaowei QI
;
Yi ZHANG
Author Information
1. 陆军军医大学(第三军医大学)第一附属医院乳腺甲状腺外科
- Keywords:
breast cancer;
estrogen receptor;
stratification by expression level;
endocrine therapy;
prognosis
- From:
Journal of Army Medical University
2025;47(22):2792-2804
- CountryChina
- Language:Chinese
-
Abstract:
Objective To stratify the estrogen receptor(ER)positive while human epidermal growth factor receptor 2(HER2)negative breast cancer patients by the expression level of ER,providing new evidence for prognostic prediction and guiding precision endocrine therapy(ET)for those with different ER expression levels.Methods A retrospective cohort study was conducted on 1 962 ER-positive/HER2-negative breast cancer patients treated in our department from January 1,2013 to December 31,2018.X-tile was used to calculate the optimal cutoff point of ER expression level,and then based on the results,they were divided into low(1%～10%),moderate(11%～30%),and high expression(31%～100%)groups.After propensity score matching(PSM)was performed to balance baseline characteristics,their prognostic outcomes were compared and the responses to ET were analyzed in the groups.Cox proportional risk regression model was applied to analyze the prognostic factors,and subgroup analysis was further performed.Results After PAM,129(11.5%)were assigned into a low ER expression group,151(13.5%)and 840(75%)into moderate and high ER expression groups,respectively.Statistical differences were observed in disease-free survival(DFS)and overall survival(OS)among the 3 groups(P=8e-6,P=8e-14).In the low ER expression group,the patients treated with selective estrogen receptor modulators(SERMs)showed no significant differences in DFS and OS than those treated with aromatase inhibitors(AIs)(P>0.05).However,the patients from the moderate and high ER expression groups demonstrated significantly better DFS when treated with AI than with SERM(P=0.02,P=0.03).Multivariate analysis showed that compared with the moderate ER expression group,the high ER expression group exhibited significantly lower risk of disease recurrence/metastasis(HR=0.62,95%CI:0.43～0.88,P=0.009)and risk of death(HR=0.49,95%CI:0.26～0.93,P=0.03).Subgroup analysis revealed that when compared with the high ER expression group,the moderate ER expression group exhibited notably worse DFS in the following subgroups:oral SERM,non-breast-conserving surgery,lymph node metastasis,TNM stage Ⅱ,and chemotherapy,and shorter OS in the subgroups of oral SERM,non-breast-conserving surgery,lymph node metastasis,TNM stage Ⅱ subgroup,and chemotherapy.Conclusion Taking ER expression of 11%～30%as an independent stratification criterion can guide more accurate prognostic assessment and more rational ET selection in ER-positive/HER2-negative breast cancer patients.
