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Ann Oncol. 2013 Sep;24(9):2292-7. doi: 10.1093/annonc/mdt183. Epub 2013 May 24.

A simple and reproducible prognostic index in luminal ER-positive breast cancers.

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  • 1Department of Medical Sciences, University of Turin, Turin, Italy. isabella.castellano@unito.it



The group of estrogen receptor (ER)-positive breast cancers (both luminal-A and -B) behaves differently from the ER-negative group. At least in early follow-up, ER expression influences positively patients' prognosis. This low aggressive biology flattens out the differences of clinical management. Thus we aimed to produce a prognostic index specific for ER-positive (ERPI) cancers that could be of aid for clinical decision.


The test set comprised 495 consecutive ER-positive breast cancers. Tumor size, number of metastatic lymph nodes and androgen receptor expression were the only independent variables related to disease-specific survival. These variables were used to create the ERPI, which was applied to the entire test set and to selected subpopulations (grade 2 (G2)-tumors, luminal-A and -B breast cancers). A series of 581 ER-positive breast cancers, collected from another hospital, was used to validate ERPI.


In the test population, 96.9% of patients classified as ERPI-good showed a good prognosis compared with 79.6% classified as ERPI-poor (P < 0.001). ERPI effectively discriminated outcome in luminal-A and luminal-B and in G2-tumors. In the validation series, the ERPI maintained its value.


ERPI is a practical tool in refining the prediction of outcome of patients with ER-positive breast cancer.


AR expression; ER expression; breast cancer; lymph nodal status; prognostic index; tumor size

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