Simmons C, Miller N, Geddie W, Gianfelice D, Oldfield M, Dranitsaris G, Clemons M J
Division of Hematology and Medical Oncology, Princess Margaret Hospital; Department of Medicine.
Division of Pathology, University Health Network.
Ann Oncol. 2009 Sep;20(9):1499-1504. doi: 10.1093/annonc/mdp028. Epub 2009 Mar 18.
Decisions about systemic treatment of women with metastatic breast cancer are often based on estrogen receptor (ER), progesterone receptor (PgR), and Her2 status of the primary tumor. This study prospectively investigated concordance in receptor status between primary tumor and distant metastases and assessed the impact of any discordance on patient management.
Biopsies of suspected metastatic lesions were obtained from patients and analyzed for ER/PgR and Her2. Receptor status was compared for metastases and primary tumors. Questionnaires were completed by the oncologist before and after biopsy to determine whether the biopsy results changed the treatment plan.
Forty women were enrolled; 35 of them underwent biopsy, yielding 29 samples sufficient for analysis; 3/29 biopsies (10%) showed benign disease. Changes in hormone receptor status were observed in 40% (P = 0.003) and in Her2 status in 8% of women. Biopsy results led to a change of management in 20% of patients (P = 0.002).
This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence.
对于转移性乳腺癌女性患者的全身治疗决策通常基于原发肿瘤的雌激素受体（ER）、孕激素受体（PgR）和人表皮生长因子受体2（Her2）状态。本研究前瞻性地调查了原发肿瘤与远处转移灶之间受体状态的一致性，并评估了任何不一致性对患者管理的影响。
从患者获取疑似转移病灶的活检样本，并分析其ER/PgR和Her2情况。比较转移灶与原发肿瘤的受体状态。肿瘤学家在活检前后完成问卷调查，以确定活检结果是否改变了治疗方案。
纳入40名女性；其中35名接受了活检，获得29份足以进行分析的样本；29份活检样本中有3份（10%）显示为良性病变。40%的女性观察到激素受体状态变化（P = 0.003），8%的女性观察到Her2状态变化。活检结果导致20%的患者管理方式改变（P = 0.002）。
这项前瞻性研究表明，原发肿瘤与转移灶之间的受体状态存在显著不一致，这导致20%的病例管理方式发生改变。对于临床或影像学怀疑有转移复发的患者，应考虑进行组织确诊。
