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1Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey.
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Correspondence to: Kadri Altundag. Department of Medical Oncology, Hacettepe University Cancer Institute, Tria Residence, Block A No: 8, Yildizevler Mah, Cankaya, Ankara 06550, Turkey. Tel: +90-312-4382526, Fax: +90-312-3242009, altundag66@yahoo.com
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Corresponding author.
Received 2016 Oct 13; Accepted 2016 Nov 28; Issue date 2016 Dec.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
I read the article by Shin et al. [1] regarding the prognostic impact of discordance between the receptor status of primary breast cancers and corresponding metastases. They concluded that patients with concordant triple-negative phenotype (TNP) had worse long-term outcomes than patients with concordant non-TNP and discordant TNP in a comparison of primary and metastatic breast cancer. As described in the “Methods” section, the cutoff value for estrogen receptor and progesterone receptor positivity was ≥10% of tumor cells positive for nuclear staining. However, in the literature, many studies on TNP describe hormone receptor status with different cutoff values [2,3]. Furthermore, the American Society of Clinical Oncology and College of American Pathologists (ASCO/CAP) recommended that a cutoff of 1% positive cells be used to define estrogen receptor-positive status [4]. In conclusion, for better interpretation of studies related to TNP, as in the case of the definition of human epidermal growth factor receptor 2 status, internationally accepted defined cutoff values for hormone receptors are urgently needed.
Footnotes
CONFLICT OF INTEREST: The author declares that he has no competing interests.
References
1.Shin HC, Han W, Moon HG, Park IA, Noh DY. Patients with concordant triple-negative phenotype between primary breast cancers and corresponding metastases have poor prognosis. J Breast Cancer. 2016;19:268–274. doi: 10.4048/jbc.2016.19.3.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol. 2010;28:2784–2795. doi: 10.1200/JCO.2009.25.6529. [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Rakha EA, El-Sayed ME, Green AR, Lee AH, Robertson JF, Ellis IO. Prognostic markers in triple-negative breast cancer. Cancer. 2007;109:25–32. doi: 10.1002/cncr.22381. [DOI] [PubMed] [Google Scholar]
4.Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triplenegative phenotype: a population-based study from the California cancer Registry. Cancer. 2007;109:1721–1728. doi: 10.1002/cncr.22618. [DOI] [PubMed] [Google Scholar]
1Department of Surgery, Seoul National University Hospital, Seoul 03080, Korea.
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Correspondence to: Dong-Young Noh. Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-3673-4250, Fax: +82-2-766-3975, dynoh@snu.ac.kr
As noted in the commentary, the American Society of Clinical Oncology and College of American Pathologists (ASCO/CAP) guideline recommendations for estrogen receptor (ER) and progesterone receptor (PR) positivity were revised from 10% to 1% in 2010 [1]. Patients with breast cancer in this study underwent primary surgery and biopsy for distant metastasis from 2000 to 2010 and the cutoff value for ER and PR positivity was 10% [2]. Many studies on patients with breast cancer before 2010 defined ER and PR positivity as ≥10% of tumor cells positive for nuclear staining [3,4]. Furthermore, other studies reported that weakly ER/PR-positive breast cancer that had 1% to 10% positivity showed a survival rate intermediate between those of strongly ER-positive and ER-negative breast cancers [5]. Therefore, I agree that a cutoff value for ER and PR positivity should be 1% after a new guideline is established. However, as our study included patients before 2010, this cutoff value is acceptable for this study.
Footnotes
CONFLICT OF INTEREST: The author declares that he has no competing interests.
References
1.Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version) Arch Pathol Lab Med. 2010;134:e48–e72. doi: 10.5858/134.7.e48. [DOI] [PubMed] [Google Scholar]
2.Shin HC, Han W, Moon HG, Park IA, Noh DY. Patients with concordant triple-negative phenotype between primary breast cancers and corresponding metastases have poor prognosis. J Breast Cancer. 2016;19:268–274. doi: 10.4048/jbc.2016.19.3.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Regan MM, Francis PA, Pagani O, Fleming GF, Walley BA, Viale G, et al. Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer: TEXT and SOFT trials. J Clin Oncol. 2016;34:2221–2231. doi: 10.1200/JCO.2015.64.3171. [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Regan MM, Pagani O, Fleming GF, Walley BA, Price KN, Rabaglio M, et al. Adjuvant treatment of premenopausal women with endocrine-responsive early breast cancer: design of the TEXT and SOFT trials. Breast. 2013;22:1094–1100. doi: 10.1016/j.breast.2013.08.009. [DOI] [PMC free article] [PubMed] [Google Scholar]
5.Prabhu JS, Korlimarla A, Desai K, Alexander A, Raghavan R, Anupama C, et al. A majority of low (1-10%) ER positive breast cancers behave like hormone receptor negative tumors. J Cancer. 2014;5:156–165. doi: 10.7150/jca.7668. [DOI] [PMC free article] [PubMed] [Google Scholar]
