ArticleAnnals of oncology : official journal of the European Society for Medical Oncology2017
Revisiting the definition of estrogen receptor positivity in HER2-negative primary breast cancer.
Article in Annals of oncology : official journal of the European Society for Medical Oncology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 91 papers, 3 of them syntheses that pooled it.
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Who cites it
91 citing papers in PubMed, 3 syntheses or guidelines pooled it, 156 citations in OpenAlex.
- Association between endocrine therapy and survival outcomes in estrogen receptor-low breast cancer: a systematic review and meta-analysis.The oncologist · 2026Pooled it
- The prognostic and predictive impact of low estrogen receptor expression in early breast cancer: a systematic review and meta-analysis.ESMO open · 2021Pooled it
- Prognostic Value of Ki-67 in Patients With Resected Triple-Negative Breast Cancer: A Meta-Analysis.Frontiers in oncology · 2019Pooled it
- Neoadjuvant camrelizumab plus nab-paclitaxel and epirubicin in early triple-negative breast cancer: a single-arm phase II trial.Nature communications · 2023Trial
- Independent validation of stromal uPA in ABCSG-08: Level 1b evidence for the prognostic value of uPA immunohistochemistry.Breast (Edinburgh, Scotland) · 2022Trial
- A dual-tower multimodal framework with feature quality enhancement for predicting pathological complete response after neoadjuvant chemotherapy in breast cancer: a multicenter study.Translational oncology · 2026Article
- Patterns of positron emission mammography uptake by benign and malignant breast lesions: radiopathological correlation with malignant histopathological subtypes, histological grades, and molecular subtypes.Annals of nuclear medicine · 2026Article
- PRR11 expression in early ER+/HER2-low breast cancer: Association with estrogen receptor positivity and exploratory analysis of prognostic significance.Oncology letters · 2026Article
- Prognostic value of post-neoadjuvant pathological response and residual disease in early breast cancer: a real-world cohort study.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Article
- Evolution of ER-cut-off definition in clinical trials for triple negative breast cancer: trends and patterns over 15 years.Breast (Edinburgh, Scotland) · 2026Review
- New perspectives on endocrine therapy suitability for hormone receptor-positive metastatic breast cancer in clinical practice.Breast (Edinburgh, Scotland) · 2026Review
- Characteristics and outcomes of patients with HER2-negative metastatic breast cancers with low expression of estrogen and progesterone receptors in the multicenter ESME cohort.Breast (Edinburgh, Scotland) · 2026Article
- Estrogen Receptor-Low Positive (ER-Low) Breast Cancer: A Unique Clinical and Pathological Entity.Current oncology (Toronto, Ont.) · 2026Review
- Impact of estrogen receptor expression levels on chemo-responsiveness and prognosis of breast cancer patients treated with neoadjuvant chemotherapy.NPJ breast cancer · 2026Article
- Dual cutoffs of estrogen receptor positivity define prognostic and predictive subgroups in breast cancer.iScience · 2026Article
- Reconsidering the definition of triple-negative breast cancer in the immune checkpoint inhibitor era: an optimal cut-off value for hormone receptor percentage of HER2-negative invasive breast cancer.British journal of cancer · 2026Review
- Adjuvant endocrine therapy in estrogen-low breast cancer in the era of CDKI: are we at another uncertain crossroads?Frontiers in oncology · 2026Review
- Prediction of neoadjuvant therapy response in breast cancer based on interpretable artificial intelligence.International journal of surgery (London, England) · 2026Article
- Prognosis and Biological Characteristics of ER-Low Metastatic Breast Cancer: Results from a Multicenter Cohort and the TONIC Trial.Clinical cancer research : an official journal of the American Association for Cancer Research · 2025Article
- Breast tumors with intermediate ER expression differ biologically from ER-low tumors and exhibit a more favorable prognosis.Breast cancer (Tokyo, Japan) · 2025Article
31 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundAlthough 1% has been used as cut-off for estrogen receptor (ER) positivity, several studies have reported that tumors with ER < 1% have characteristics similar to those with 1% ≤ ER < 10%. We hypothesized that in patients with human epidermal growth factor 2 (HER2)-negative breast cancer, a cut-off of 10% is more useful than one of 1% in discriminating for both a better pathological complete response (pCR) rate to neoadjuvant chemotherapy and a better long-term outcome with adjuvant hormonal therapy. Our objectives were to identify a percentage of ER expression below which pCR was likely and to determine whether this cut-off value can identify patients who would benefit from adjuvant hormonal therapy. PATIENTS AND
methodsPatients with stage II or III HER2-negative primary breast cancer who received neoadjuvant chemotherapy followed by definitive surgery between June 1982 and June 2013 were included. Logistic regression models were used to assess the association between each variable and pCR. Cox models were used to analyze time to recurrence and overall survival. The recursive partitioning and regression trees method was used to calculate the cut-off value of ER expression.
resultsA total of 3055 patients were analyzed. Low percentage of ER was significantly associated with high pCR rate (OR = 0.99, 95% CI = 0.986-0.994, P < 0.001). The recommended cut-off of ER expression below which pCR was likely was 9.5%. Among patients with ER ≥ 10% tumors, but not those with 1%≤ER < 10% tumors, adjuvant hormonal therapy was significantly associated with long time to recurrence (HR = 0.24, 95% CI = 0.16-0.36, P < 0.001) and overall survival (HR = 0.32, 95% CI = 0.2-0.5, P < 0.001).
conclusionStage II or III HER2-negative primary breast cancer with ER < 10% behaves clinically like triple-negative breast cancer in terms of pCR and survival outcomes and patients with such tumors may have a limited benefit from adjuvant hormonal therapy. It may be more clinically relevant to define triple-negative breast cancer as HER2-negative breast cancer with <10%, rather than <1%, of ER and/or progesterone receptor expression.
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