Original Research Article
Year: 2020 | Month: January-March | Volume: 5 | Issue: 1 | Pages: 140-146
ER & PR Status, Tumour Recurrence in Breast Carcinoma Patients- A Prospective Cohort Study
Praveen Jacob Ninan1, Mary James2
1Assistant Professor in Radiotherapy, 2Associate Professor in Pediatrics
Govt. T.D Medical College, Vandanam, Alappuzha, Kerala, India.
Corresponding Author: Mary James
ABSTRACT
Introduction: Breast cancer occurs in middle and elder age group people but this is the most common carcinoma in women (22%), which is more than twice the prevalence of cancers in women at any other site. Breast cancer patients with tumours that are estrogen receptor (ER) positive and/or progesterone receptor (PR) positive have lower risk of mortality compared to women with ER and/or PR negative disease. In breast cancer the average incidence of estrogen receptor and progesterone receptor positivity is 77% and 55% respectively as shown in the studies. However lower rates of positive estrogen and progesterone receptor breast cancers are found in Indian population from the western literature. Prognosis and management of breast cancer are influenced by the classic variables such as histological grade, tumour size, lymph node status, status of hormone receptors (ER and PR) of the tumour and Her-2 Neu status.
Objective: To study the Estrogen and Progesterone receptor status of carcinoma Breast patients in various age groups, stages of disease, Grades of disease and axillary lymph node status
Association between joint hormone receptor status and breast cancer disease free survival (DFS) risk within categories of diagnosis age, stage of disease, grade of disease, Axillary lymph node status.
Materials and Method: All patients with tissue biopsy proven carcinoma breast registered to the department of Radiotherapy at Govt. T.D medical college Alappuzha will be taken into cohort. The period of recruitment was 3 years after ethics clearance. The Estrogen and Progesterone receptors in the tumour cells of these patients will be assessed using Immunohistochemistry method.
The patients will be categorized into four groups according to their joint ER/PR status: ER+/PR+, ER+/PR-, ER-/PR+, and ER-/PR-.The association between the joint hormone receptor status and the variables in breast cancer viz age of patient, stage of disease, grade of disease, axillary lymph node status will be studied. Disease free survival among the various groups will be studied using the Cox Proportional hazard model.
Result: A total of 158 patients who fulfilled the inclusion criteria were enrolled in the study. Out of these patients 102 (64.56%) were ER+/PR+; 18 (11.39%) were ER+/PR-; 3 (1.9%) patients were ER-/PR+; and 35 patients (22.15%) were ER-/PR-. The majority of the patients were ER+/PR+.
Age group of the patients. The maximum number of patients (50 patients) come under 50-59 years age group and this age group had the maximum number of patients with ER+/PR+ (45 patients). It was also noted that ER-/PR+ was the least in all age groups whereas ER-/PR- was relatively high in patients less than 49 years of age.
Depending on stage of the disease it was found that the majority of patients presented with stage 3 disease (48.10%). The majority of patients with stage 3 disease were ER+/PR+. Of the 3 patients with ER-/PR+ disease 2 patients had stage 4 disease. ER-/PR- was most frequently seen in Stage 2 disease.
Grade of the tumour was classified as Grade 1, Grade 2 and Grade 3. Out of 158 patients there were 6 with Grade 1 disease, 105 with Grade 2 and 47 patients had Grade 3 disease. It was observed that maximum number of patients had Grade 2 disease and this group had the most number of ER+/PR+ and ER-/PR- patients 58 and 30 respectively. Whereas ER+/PR- and ER-/PR+ was mostly seen with Grade 2 disease 15 and 2 respectively.
Axillary lymph node status was categorized as 0 nodes, 1-3 nodes, and 4 or more nodes. 63 (39.87%) patients had 0 nodes. 68 (43.04%) patients had 1-3 nodes and 27 (17.09%) patients had >4 nodes positive. It could be observed that majority of patients had 1-3 lymph nodes and most of the patients in this group had ER+/PR+ disease. It was also observed that ER-/PR- was mostly seen in patients with more than 4 nodes positive.
The study period was 3 years post ethics clearance. 158 patients had average follow up period of 1.8 months. During this period it was observed that total of 24 patients had disease progression. Out of the 24 patients, 18 had local recurrence whereas 6 patients had systemic recurrence. The 18 patients with local recurrence 1 was ER+/PR+; 6 ER+/PR-; 10 ER-/PR+; and 1 ER-/PR-. Out of the 6 patients with systemic recurrence 0 were ER+/PR+; 2 ER+/PR-; 3 ER-/PR+; and 1 ER-/PR-.
Multivariable Cox proportional hazards regression analysis showed that patients with ER+/PR- (hazard ratio [HR], 1.55; 95% CI, 1.52-1.58) and ER-/PR+ (HR, 1.68; 95%CI, 1.62-1.74) tumors had worse Disease Free survival (DFS) than patients with the ER+/PR+ subtype. The DFS was statistically significantly worse in patients with ER-/PR+ tumors than in patients with ER+/PR- tumors (HR, 1.16; 95% CI, 1.12-1.21).
Keywords: Estrogen receptor, Progesterone Receptor, Carcinoma Breast, Tumour Recurrence, Immunohistochemistry.