THE PROGNOSTIC-SIGNIFICANCE OF STEROID-RECEPTOR ACTIVITY IN TUMOR-TISSUES OF PATIENTS WITH PRIMARY BREAST-CANCER

The prognostic significance of steroid-receptor activity is still deba table. Discrepancies in results are probably attributable to few patie nts, heterogeneous patient populations, and short follow-up. We invest igated the prognostic significance of estrogen- and progesterone-recep tor (ER and PgR, respectively) activity as a continuous variable in a homogeneous patient population. The prognostic significance of steroid -receptor activity was examined in 329 node-negative and 320 node-posi tive unselected breast cancer patients. in node-negative patients, ER values of primary tumors between 100 and 300 fmol/mg protein appeal an d to be a significant predictor for low risk of recurrence, whereas hi gh ER (> 400) revealed an unfavorable prognosis. The classic cutoff le vel of ER (<10 fmol/mg proteins) had no prognostic significance, howev er. In patients receiving adjuvant chemotherapy-the node-positive brea st cancer patients-the classic cutoff value of ER (10 fmol/mg protein) predicts significantly distant metastases-free survival and overall s urvival only in the first 4 years of follow-up after diagnosis. Proges terone receptor is a time-dependent prognosticator in node-negative br east cancer patients (cutoff point for PgR, 80 fmol/mg). Ln node-posit ive breast cancer patients treated with chemotherapy or a combination of chemo-and hormonal therapy, PgR values lower than 60 fmol/mg had a worse prognosis. The results show the poor performance of standard cut off points for ER and PER positivity in predicting prognosis, Better p rognosis is related to higher receptor levels but this relation is pre dominantly time-dependent. Moreover, patients who have high ER levels have a prognosis that is worse when compared with intermediate ER leve ls. Standard cutoff points for steroid receptors should not be used to select patients for prognosis.