雌激素受体低表达阳性乳腺癌：混杂的生物学与分歧的治疗论

　　激素受体检测主要用于指导乳腺癌治疗选择，雌激素受体阳性乳腺癌患者对内分泌治疗有显著效果。不过，定义雌激素受体状态和治疗指征的方法仍然存在争议。虽然最新指南考虑根据免疫组化将肿瘤细胞核染色≥1%定义为雌激素受体阳性，但是对于雌激素受体表达为1%～10%的雌激素受体低表达阳性乳腺癌，内分泌治疗的获益令人担忧。该亚组占全部患者的3%～9%，与雌激素受体高表达阳性乳腺癌相比，可能具有独特的分子特征和内分泌治疗效果。最新指南未对此类患者进行详细描述，造成治疗策略不统一。

　　2021年7月12日，中国抗癌协会旗下《癌症通讯》在线发表复旦大学附属肿瘤医院余科达、蔡毓文、吴松阳、水若鸿、邵志敏等学者的长篇综述，讨论了雌激素受体低表达或弱阳性乳腺癌的分子特征及其最近进展，突出了分子靶向治疗而非千篇一律的传统内分泌治疗，可为将来的基础研究和临床研究提供参考。全文共计13页，分为10个章节：背景、检测方法、生物学机制、复杂的临床病理学特征、分子本质、内分泌治疗效果和生存结局、治疗策略、新疗法与正在进行的临床试验、临床建议、结论，参考文献多达81篇。

Cancer Commun (Lond). 2021 Jul 12. Online ahead of print.

Estrogen receptor-low breast cancer: Biology chaos and treatment paradox.

Yu KD, Cai YW, Wu SY, Shui RH, Shao ZM.

Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Breast Cancer, Shanghai, China.

Hormone receptor testing mainly serves the purpose of guiding treatment choices for breast cancer patients. Patients with estrogen receptor (ER)-positive breast cancers show significant response to endocrine therapy. However, the methods to define ER status and eligibility for treatment remain controversial. Despite recent guidelines considering staining ≥1% of tumor nuclei by immunohistology as ER-positive, it has raised concerns on the benefit of endocrine therapy for tumors with ER 1%-10% expression, termed "ER-low positive". This subgroup accounts for 3% to 9% of all patients and is likely to have unique molecular features, and therefore distinct therapeutic response to endocrine therapy compared with ER-high positive tumors. The latest guidelines did not provide detailed descriptions for those patients, resulting in inconsistent treatment strategies. Consequently, we aimed to resolve this dilemma comprehensively. This review discusses molecular traits and recent ER-low positive breast cancer innovations, highlighting molecular-targeted treatment rather than traditional unified endocrine therapy for future basic and clinical research.

KEYWORDS: breast cancer; endocrine therapy; estrogen receptor-low; immunohistochemistry; intrinsic subtype

PMID: 34251757

DOI: 10.1002/cac2.12191