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Aim. To assess the prognostic significance of subtypes of expression levels of estrogen receptor (ER), progesterone receptor (PR), HER2/neu and Ki-67 in breast cancer (BC) patients within the high-resolution epidemiological analysis based on data from the Arkhangelsk Regional Cancer Registry (ARCR) over the period 2010-2020.
Materials and Methods. Data on expression levels of ER and PR, HER2/neu and Ki-67 from the pathology database of the Arkhangelsk Clinical Oncological Dispensary were combined with data on total BC samples from the ARCR database. Expression levels of immunohistochemical (IHC) markers were stratified into subgroups. Cancer-specific survival (CSS) was assessed using Kaplan-Meier and life table methods. The prognostic value of individual factors available in the ARCR database and IHC markers was evaluated using Cox regression.
Results. Information on ER, PR, HER2/neu and Ki-67 was available in 3 985, 3 985, 3 960 and 2 676 cases, respectively. Five-year CSS ranged from 66.9-86.3%, 70.8-90.1 %, 83.0-72.8 % and 88.1-68.5 % at ER levels of 0 % to 90-100 %, PR 0 % to 90-100 %, HER2/neu 0 to 3+ and Ki-67 0-4 % to 90-100 %, respectively, p < 0.001. In a multivariate model, ER expression levels of 10-29 % and 70 % or more and PR of 90 % or more were associated with a 30-54 % reduction in the risk of death from BC compared with cases without expression. The CSS hazard ratios for HER2/neu (3+) and Ki-67 above 30% were 0.78 and 2.2 compared to HER2/neu 0 and Ki-67 0-4 %, respectively.
Conclusion. High hormone receptor expression and HER2/neu overexpression are independent predictors of a favourable prognosis and Ki-67 expression above 30% of an unfavourable prognosis in the Russian population of BC patients. Further in-depth studies are required to explain the differences in survival between different molecular subtypes.
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