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The prognostic and predictive impact of low estrogen receptor expression in early breast cancer: a systematic review and meta-analysis
School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
Department of Oncology-Pathology, Karolinska Institutet Stockholm, Stockholm, Sweden.
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2021 (English)In: ESMO Open, E-ISSN 2059-7029, Vol. 6, no 6, article id 100289Article, review/survey (Refereed) Published
Abstract [en]

INTRODUCTION: Traditionally, estrogen receptor (ER)-positive breast cancer has been defined as tumors with ≥1% positive for ER. The updated American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines recommend that tumors with ER expression of 1%-10% should be classified as ER-low-positive, recognizing the limited clinical evidence on the prognostic and predictive role of low ER expression. We aimed to investigate the predictive role of ER-low expression to neoadjuvant chemotherapy (NeoCT) and the prognostic significance of ER-low expressing breast tumors compared with ER-positive or ER-negative breast tumors.

METHODS: A meta-analysis was conducted using the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines and eligible articles were identified on PubMed and ISI Web of Science databases. The primary outcome was pathologic complete response and secondary outcomes were disease-free survival (DFS) and overall survival (OS). Twelve retrospective cohort studies were included in the meta-analysis. NeoCT resulted in higher pathologic complete response among patients with ER-low expression compared with ER-positive and comparable to ER-negative. Patients with ER-low breast cancer had a statistically significant worse DFS and OS compared with patients with ER-positive breast cancer, whereas no difference in DFS or OS was observed between ER-low and ER-negative subgroups.

DISCUSSION: The current evidence suggests that ER-low breast cancer has a more similar outcome to ER-negative than to ER-positive breast cancer in terms of DFS and OS. ER-low expression seems also to have a predictive role regarding NeoCT. Considering the certainty of current evidence categorized as low to moderate, our results urge the need for well-designed prospective studies investigating the molecular background and the most appropriate treatment strategy for ER-low expressing breast cancer.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 6, no 6, article id 100289
Keywords [en]
ER-low, adjuvant, breast cancer, meta-analysis, neoadjuvant chemotherapy, prognosis
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-95187DOI: 10.1016/j.esmoop.2021.100289ISI: 000709851000006PubMedID: 34678571Scopus ID: 2-s2.0-85120354866OAI: oai:DiVA.org:oru-95187DiVA, id: diva2:1606323
Available from: 2021-10-27 Created: 2021-10-27 Last updated: 2023-12-08Bibliographically approved

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