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Altundag: Comment to “Patients with Concordant Triple-Negative Phenotype between Primary Breast Cancers and Corresponding Metastases Have Poor Prognosis”
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 different cutoff values [23]. 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.

Notes

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.
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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.
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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.
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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.
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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 [34]. 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.

Notes

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.
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.
crossref
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.
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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.
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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.
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