Effect of Estrogen Receptor Expression Level and Hormonal Therapy on Prognosis of Early Breast Cancer

PURPOSE: Estrogen receptor (ER) expression in breast cancer plays an essential role in carcinogenesis and disease progression. Recently, tumors with low level (1%–10%) of ER expression have been separately defined as ER low positive (ER(low)). It is suggested that ER(low) tumors might be morphologically and behaviorally different from tumors with high ER expression (ER(high)). MATERIALS AND METHODS: Retrospective analysis of a prospective cohort database was performed. Patients who underwent curative surgery for early breast cancer and had available medical records were included for analysis. Difference in clinicopathological characteristics, endocrine responsiveness and five-year recurrence-free survival was evaluated between different ER subgroups (ER(high), ER(low), and ER-negative [ER(−)]). RESULTS: A total of 2,162 breast cancer patients were included in the analysis, Tis and T1 stage. Among them, 1,654 (76.5%) were ER(high), 54 (2.5%) were ER(low), and 454 (21.0%) were ER(−) patients. ER(low) cases were associated with smaller size, higher histologic grade, positive human epidermal growth factor receptor 2, negative progesterone receptor, and higher Ki-67 expression. Recurrence rate was highest in ER(−) tumors and was inversely proportional to ER expression. Recurrence-free survival was not affected by hormonal therapy in the ER(low) group (p=0.418). CONCLUSION: ER(low) breast cancer showed distinct clinicopathological features. ER(low) tumors seemed to have higher recurrence rates compared to ER(high) tumors, and they showed no significant benefit from hormonal therapy. Future large scale prospective studies are necessary to validate the treatment options for ER(low) breast cancer.