Santinelli Alfredo, Pisa Eleonora, Stramazzotti Daniela, Fabris Guidalberto
Department of Neuroscience, Polytechnic University of Marche Region, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi, Via Conca 71, I-60020 Torrette di Ancona, Ancona, Italy.
Int J Cancer. 2008 Mar 1;122(5):999-1004. doi: 10.1002/ijc.23051.
In this prospective study, we determined HER-2 status in primary breast invasive carcinomas and in the paired lymph node metastases (synchronous and metachronous), local recurrence and metachronous distant metastases, to verify the percentage of discordant cases. HercepTest and Fluorescence in situ hybridization (FISH) were used to determine HER-2 status on 119 cases of primary infiltrating breast carcinoma and paired metastases (45 cases with synchronous lymph node metastases, 9 cases with metachronous lymph node metastases, 30 cases with local recurrence, and 35 cases with metachronous distant metastases). A therapeutically significant HER-2 status discordance was demonstrated between primary carcinoma and synchronous lymph node metastases (6.7%), local recurrence (13.3%) and metachronous distant metastases (28.6%). In the first comparison, there was a normal HER-2 status in primary tumours and HER-2 amplification in paired metastases, in the second the opposite phenomenon was present, and both types of discordance were evident in the third comparison. Considering the cases of local recurrences and metachronous distant metastases all together, 14 out of 65 cases (21.5%) showed a therapeutically significant discordance of HER-2 status between the primary tumour and the paired metachronous recurrence or metastasis (p < 0.001), the 15.4% of cases showing normal HER-2 status in the primary tumour and HER-2 amplification in the neoplastic relapse. For the treatment of metastatic patients, the evaluation of HER-2 status should be performed in neoplastic tissue from metastatic site, whenever possible. This procedure could be also suggested in the patients that are metastatic at the time of diagnosis.
在这项前瞻性研究中，我们测定了原发性乳腺浸润性癌及其配对的淋巴结转移灶（同时性和异时性）、局部复发灶和异时性远处转移灶中的HER-2状态，以核实不一致病例的比例。采用赫赛汀检测法（HercepTest）和荧光原位杂交技术（FISH）对119例原发性浸润性乳腺癌及其配对转移灶（45例同时性淋巴结转移、9例异时性淋巴结转移、30例局部复发、35例异时性远处转移）进行HER-2状态测定。结果显示，原发性癌与同时性淋巴结转移（6.7%）、局部复发（13.3%）和异时性远处转移（28.6%）之间存在具有治疗意义的HER-2状态不一致。在首次比较中，原发性肿瘤HER-2状态正常而配对转移灶HER-2扩增；在第二次比较中，出现相反现象；在第三次比较中，两种不一致情况均很明显。将局部复发和异时性远处转移病例合并考虑，65例中有14例（21.5%）原发性肿瘤与配对的异时性复发或转移灶之间存在具有治疗意义的HER-2状态不一致（p<0.001），其中15.4%的病例原发性肿瘤HER-2状态正常而肿瘤复发灶HER-2扩增。对于转移性患者的治疗，应尽可能在转移部位的肿瘤组织中评估HER-2状态。对于诊断时即已发生转移的患者，也可建议采用这一方法。
