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To the Editor,
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 differ- ent 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 con- clusion, 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.
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 concor- dant triple-negative phenotype between primary breast cancers and corresponding metastases have poor prognosis. J Breast Cancer 2016;19:268-74.
2. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College Of American Pa- thologists guideline recommendations for immunohistochemical test- ing of estrogen and progesterone receptors in breast cancer. J Clin On- col 2010;28:2784-95.
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.
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 triple- negative phenotype: a population-based study from the California can- cer Registry. Cancer 2007;109:1721-8.
Author’s Reply
As noted in the commentary, the American Society of Clin- ical 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 me- tastasis 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 can- cer that had 1% to 10% positivity showed a survival rate inter- mediate between those of strongly ER-positive and ER-nega- tive breast cancers [5]. Therefore, I agree that a cutoff value for ER and PR positivity should be 1% after a new guideline is es- tablished. However, as our study included patients before 2010, this cutoff value is acceptable for this study.
CONFLICT OF INTEREST
The author declares that he has no competing interests.
Comment to “Patients with Concordant Triple-Negative Phenotype between Primary Breast Cancers and Corresponding Metastases Have Poor Prognosis”
Kadri Altundag
Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey COMMENTARY
J Breast Cancer 2016 December; 19(4): 465-466 https://doi.org/10.4048/jbc.2016.19.4.465
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
E-mail: [email protected]
Received: October 13, 2016 Accepted: November 28, 2016
Journal of
Breast
Cancer
466 Kadri Altundag
http://ejbc.kr https://doi.org/10.4048/jbc.2016.19.4.465
REFERENCES
1. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pa- thologists guideline recommendations for immunohistochemical test- ing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med 2010;134:e48-72.
2. Shin HC, Han W, Moon HG, Park IA, Noh DY. Patients with concor- dant triple-negative phenotype between primary breast cancers and corresponding metastases have poor prognosis. J Breast Cancer 2016;
19:268-74.
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 fac- tor receptor 2-negative early breast cancer: TEXT and SOFT trials. J
Clin Oncol 2016;34:2221-31.
4. Regan MM, Pagani O, Fleming GF, Walley BA, Price KN, Rabaglio M, et al. Adjuvant treatment of premenopausal women with endocrine-re- sponsive early breast cancer: design of the TEXT and SOFT trials.
Breast 2013;22:1094-100.
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;5:156-65.
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 E-mail: [email protected]
