| Objective To investigate the relationship between prognostic significance and expressions of estrogen receptor a (ERα) and progesterone receptor (PR) in patients with beast cancer, as well as the relation between prognosis and positive rate of ERα and PR; and to explore the relation between prognosis and expression level of PR in patients who are ER(+) and have received endocrine therapy; furthermore to analyze the influencing factors of ERα and PR expressions.Methods 662 specimens of breast cancer were included. Immunohistochemical staining was carried out to detect ERα and PR expressions, and the results could be classified into different groups according to the proportion of positive cells. Kaplan-Meier method was used to estimate patients’ prognosis.80 cases were immunostained with the two anti-ER antibodies (SP1 and 6F11) and the results were interpreted by a senior pathologist to investigate the influence of different clones. ERα (SP1) expressions of the 214 cases were evaluated by three pathologists with H score and Allred score methods to investigate the influence of interpretation system and pathologists’ experience. The consistency of the results was measured with Kappa test.Results(1) Immunohistochemical staining was carried out on 662 cases of breast cancer. In invasive carcinoma of no special type (NST), invasive lobular carcinoma (ILC) and ductal carcinoma in situ (DCIS) groups, positive rates of ERα were 59.5%,78.9% and 63.6% respectively (P=0.002). PR positive rates were 56.3%,68.9% and 59.1% (P=0.079). ERα and PR positive rates were associated with different histological grades in NST (P<0.001) and different nuclear grades in DCIS patients (P<0.05). The differences of ERα, PR expressions between classic and non-classic ILC was not statistically significant (P=0.065,0.799). Among all the 662 cases,349 patients were ER(+) and had received endocrine therapy, and the analysis showed that different level of PR was associated with patients’age, menopausal status, pTNM stages and Ki-67, with P<0.005.(2) Survival analysis on 297 patients with complete following-up data showed that ERα, PR expressions exhibit a positive correlation with disease-free survival (DFS) and overall survival (OS), that is, DFS and OS were better in both ERα and PR low expression groups than those in negative groups (DFS:P=0.021, P=0.003), (OS: P=0.019,0.003), and in high positive groups DFS and OS were better than those in low expression groups (DFS:P=0.011, P=0.002), (OS:P=0.012, P=0.005); In ERα moderate positive group, DFS and OS were better than those in low and negative group (P<0.05), while there were no statistical significance of DFS and OS in PR low and negative group compared with moderate positive group (P>0.05). There were 155 patients who were ER(+) and had received endocrine therapy, and the analysis showed DFS and OS were worse in PR low positive group than those in high positive group (P=0.008,P=0.015).(3) SP1 was a better antibody than 6F11; the repeatability of the H score system was better than that of Allred score system; and the repeatabilities of positive rate and staining intensity were better among senior pathologists (κ=0.850, κ=0.824); but not between the senior and junior pathologists (0.4<κ<0.75); the repeatability was not that good regarding to the estimation and count of the positive rates (κ=0.726).Conclusions(1) The different positive rates of ERα and PR are closely related to patients’ prognosis:Generally, the higher positive cell percentage of ERα and PR, the better prognosis of DFS and OS.(2) DFS and OS are worse in patients (ERα+ and received endocrine therapy) with low PR expression than in those with high PR expression.(3) The positive rates of ERα and PR can be influenced by many variables, including pathological types, histological grade, nuclear grade, furthermore, antibody selection, interpretation system and the experience of the pathologists are also related with the positive rate of ERα. |
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