Deptartment of Pathology, Singapore General Hospital, Outram Road, Singapore.
Am J Clin Pathol. 2010 Mar;133(3):416-29. doi: 10.1309/AJCPJ57FLLJRXKPV.
Estrogen receptor (ER), progesterone receptor (PR), and c-ERBB2 (HER2/neu) are therapeutically and prognostically important markers in the management of breast carcinoma. They are not always analyzed in distant metastatic and locally recurrent breast cancers. We compared immunohistochemical expression in a series of primary breast carcinomas with their distant metastases (n = 72) and local recurrences (n = 45) and analyzed the impact of any changes on survival. Discordance rates between primary and metastatic and between primary and locally recurrent lesions, respectively, were 18% (13/72) and 13% (6/45) for ER, 42% (30/72) and 33% (15/45) for PR, and 7% (5/72) and 2% (1/45) for c-ERBB2. There was statistically significant discordance between primary and metastatic PR status (P = .017; kappa = 0.201). Among locally recurrent tumors, 15 (33%) of 45 revealed discordance for PR (P = .006; kappa = 0.366). We observed a trend for shorter survival among women with ER- metastatic and locally recurrent tumors regardless of the primary tumor ER status. Our findings suggest a benefit for routine evaluation of ER, PR, and c-ERBB2 status in distant metastatic and locally recurrent breast cancer for therapeutic and prognostic purposes.
雌激素受体 (ER)、孕激素受体 (PR) 和 c-ERBB2 (HER2/neu) 在乳腺癌的治疗和预后中具有重要的临床意义。在远处转移性和局部复发性乳腺癌中，这些指标并非总是进行分析。我们比较了一系列原发性乳腺癌及其远处转移灶 (n = 72) 和局部复发灶 (n = 45) 的免疫组化表达，并分析了任何变化对生存的影响。原发性与转移性肿瘤之间、原发性与局部复发性肿瘤之间的不相符率分别为 ER 为 18% (13/72)、PR 为 42% (30/72)，而 c-ERBB2 为 7% (5/72)。原发性与转移性 PR 状态之间存在统计学显著差异 (P =.017；kappa = 0.201)。在局部复发性肿瘤中，PR 不相符率为 33% (15/45) (P =.006；kappa = 0.366)。我们观察到 ER-转移性和局部复发性肿瘤患者的生存时间更短，而不论其原发性肿瘤 ER 状态如何。我们的研究结果表明，对于远处转移性和局部复发性乳腺癌，为了治疗和预后目的，常规评估 ER、PR 和 c-ERBB2 状态具有获益。
