Validity of 1% Hormonal Receptor Positivity Cutoff by the ASCO/College of American Pathologists Guidelines at the Georgia Cancer Center

Firas Kreidieh, Ramses F. Sadek, Li Fang Zhang, Aaron Gopal, Jean Pierre Blaize, David Yashar, Reena Patel, Hiral S. Patel, Shou Ching Tang, Houssein Abdul Sater

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE Treatment of breast cancer (BC) with borderline or low (1%-9%) estrogen and progesterone expression remains controversial, with recent data disputing ASCO/College of American Pathologists 2010 guidelines that lowered the threshold of receptor positivity from 10% to 1%. The objective of this retrospective study was to validate these guidelines at the Georgia Cancer Center with a high percentage of Black race. METHODS All female patients with invasive BC diagnosed between 2005 and 2010 at the Georgia Cancer Center were chart reviewed up to an 11-year follow-up with data cutoff at 2016. We used Cox regression to explore survival among three hormonal status (HS) groups (, 1%, 1%-9%, and ≥ 10%) adjusting for all known BC clinicopathologic variables. Fisher’s exact test was used to evaluate response to endocrine therapy (ET). RESULTS Among 431 patients with mean age 59 years, 24.75% had HS, 1%, 17.5% HS 1%-9%, and 57.75% HS ≥ 10%. Race was 43.75% Black and 54% White. Disease stages were early (I-IIIA) in 84.4% and advanced (IIIB-IV) in 15.56%. Mortality in HS, 1% was significantly higher than that in HS ≥ 10% (hazard ratio [HR]: 1.8; 95% CI, 1.07 to 3.02), whereas no significant mortality difference between HS 1%-9% and HS ≥ 10% (HR: 1.05; 95% CI, 0.48 to 2.30) was observed. ET was protective, and treated patients had higher predicted survival than untreated patients in the 1%-9% group (HR: 0.10; 95% CI, 0.01 to 0.85). There was no significant mortality difference between ET-treated HS 1%-9% and ≥ 10% groups. CONCLUSION One percent cutoff predicted superior survival on treatment with ET compared with the other groups, and HS as low as 1%-9% was equiprognostic to HS ≥ 10%. Whether other factors such as lymphovascular invasion, grade, and other parameters change the behavior of the 1%-9% HS group remains to be explored.

Original languageEnglish (US)
Article numbere2100201
JournalJCO Precision Oncology
Volume6
DOIs
StatePublished - 2022
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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