The effect of neoadjuvant chemotherapy on estrogen and progesterone
receptor expression and hormone receptor status in breast cancer
Susan H. Lee, M.D.
, Maureen A. Chung, M.D., Ph.D.
*, M. Ruhul Quddus, M.D.
Margaret M. Steinhoff, M.D.
, Blake Cady, M.D.
The Breast Health Center, Program in Women’s Oncology, Women and Infants Hospital, 101 Dudley St., Providence, RI 02905, USA
Department of Surgery, Brown University, Providence, RI, USA
Department of Pathology, Brown University, Providence, RI, USA
Manuscript received June 3, 2003; revised manuscript June 21, 2003
Presented at the Fourth Annual Meeting of the American Society of Breast Surgeons, Atlanta, Georgia, April 30–May 4, 2003
Background: Neoadjuvant chemotherapy may decrease tumor volume to allow breast conservation surgery. Its effect on estrogen and
progesterone receptor (ER/PR) expression and hormone receptor (HR) status is controversial.
Methods: From February 2001 to July 2002, 56 breast cancer patients treated with neoadjuvant chemotherapy and 56 non-neoadjuvant
therapy (control) patients with adequate tissue samples were identiﬁed. Quantitative ER/PR expression was analyzed in preneoadjuvant or
preoperative core biopsies and ﬁnal surgical specimens. Changes between the two groups were compared to determine if alterations were
due to neoadjuvant chemotherapy or tissue sampling.
Results: The ER/PR expression changed in 34 (61%) neoadjuvant chemotherapy patients and 27 (48%) control patients. These expression
changes resulted in HR status (positive/negative) alterations in 3 patients (5%) in both groups. Age, histology, chemotherapy regimen, and
neoadjuvant response did not predict change.
Conclusions: Hormone receptor status changed in 5% of neoadjuvant chemotherapy and control groups due to tissue sampling. As these
changes may impact treatment, HR expression reanalysis in ﬁnal surgical specimens is recommended. © 2003 Excerpta Medica, Inc. All
Keywords: Neoadjuvant chemotherapy; Hormone receptor status; Breast cancer
Women with locally advanced breast cancer who want
breast conservation may be treated with neoadjuvant che-
motherapy to decrease the tumor volume. The effect of
neoadjuvant chemotherapy on estrogen and progesterone
receptor (ER/PR) expression is controversial. Changes in
receptor expression may affect the hormone receptor (HR)
status (positive or negative) of a tumor. If HR status change
occurs with neoadjuvant chemotherapy, it may be important
to reevaluate receptor expression after treatment.
From February 2001 to July 2002, 56 women with lo-
cally advanced breast cancer treated with neoadjuvant che-
motherapy and with adequate tissue before and after treat-
ment were identiﬁed. Thirty-nine (70%) patients were
treated with Doxorubicin and Cyclophosphamide, 12 (21%)
with Taxane, and the rest 5 (9%) with other cytotoxic
chemotherapy combinations. Core needle biopsy samples
obtained before the initiation of chemotherapy were the
pretreatment specimens and surgical tissues obtained from
the deﬁnitive surgery were the posttreatment specimens.
A control group consisting of 56 breast cancer patients
not treated with neoadjuvant chemotherapy with adequate
core needle biopsy and ﬁnal surgical specimen was also
* Corresponding author. Department of Surgery, Rhode Island Hospi-
tal, 593 Eddy Street, APC 4, Providence, RI 02903. Tel.: ϩ1-401-444-
6158; fax: ϩ1-401-444-6681.
E-mail address: email@example.com
The American Journal of Surgery 186 (2003) 348–350
0002-9610/03/$ – see front matter © 2003 Excerpta Medica, Inc. All rights reserved.