Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
Hum Pathol. 2012 Mar;43(3):398-404. doi: 10.1016/j.humpath.2011.05.009. Epub 2011 Aug 12.
Prior studies have suggested that the type of breast cancer influences the location of distant metastases ("organotropism") and that there may be discordance of estrogen receptor and human epidermal growth factor receptor 2 (Her2) expression between primaries and metastases. Our aims were to investigate the relationship between tumor type and metastatic site and to compare biomarker expression between primary and metastatic tumors. We retrospectively reviewed 102 biopsy-proven cases of breast cancer metastatic to distant sites from 2000 to 2010 and 34 corresponding primaries for histologic subtype, grade, lymphovascular invasion, lymph node metastasis, and expression of estrogen receptor and Her2. Most metastases were of ductal (88) and lobular (11) histologic types. Available data on primaries indicated that the majority were grade III with positive lymph node metastasis and lymphovascular invasion. Biomarkers on 73 metastases showed 37 estrogen receptor positive/Her2-, 6 estrogen receptor positive/Her2+, 8 estrogen receptor negative/Her2+, and 22 estrogen receptor negative/Her2-. The most common metastatic sites were the lung (26%), bone (32%), and liver (21%). We found no association between estrogen receptor/Her2 profile and metastatic site (P = .16). When compared with ductal carcinoma, lobular carcinoma showed a unique metastatic pattern to gastrointestinal tract/gynecologic sites (P = .014). Of 34 cases with paired prognostic markers for primary and metastatic sites, 7 (20%) demonstrated discordance in estrogen receptor-positive/Her2 profile between the primary and the metastasis. Because the estrogen receptor-positive/Her2 profile of metastatic breast cancer did not always match that of the primary tumor, it is important to repeat the prognostic markers of metastasis.
先前的研究表明，乳腺癌的类型会影响远处转移的部位（“器官趋向性”），并且原发灶和转移灶之间的雌激素受体和人表皮生长因子受体 2（Her2）表达可能存在不一致。我们的目的是研究肿瘤类型与转移部位之间的关系，并比较原发灶和转移灶之间的生物标志物表达。我们回顾性分析了 2000 年至 2010 年期间 102 例经活检证实的远处转移乳腺癌病例和 34 例相应的原发灶的组织学亚型、分级、脉管侵犯、淋巴结转移以及雌激素受体和 Her2 的表达情况。大多数转移灶为导管（88）和小叶（11）组织学类型。原发灶的可用数据表明，大多数为 III 级，伴有阳性淋巴结转移和脉管侵犯。73 个转移灶的生物标志物显示 37 个雌激素受体阳性/Her2-、6 个雌激素受体阳性/Her2+、8 个雌激素受体阴性/Her2+和 22 个雌激素受体阴性/Her2-。最常见的转移部位是肺（26%）、骨（32%）和肝（21%）。我们未发现雌激素受体/Her2 谱与转移部位之间存在关联（P=.16）。与导管癌相比，小叶癌显示出向胃肠道/妇科部位转移的独特模式（P=.014）。在 34 例具有原发性和转移性部位预后标志物的病例中，有 7 例（20%）在原发性和转移性肿瘤之间雌激素受体阳性/Her2 谱存在不一致。由于转移性乳腺癌的雌激素受体阳性/Her2 谱并不总是与原发肿瘤相匹配，因此重复进行转移的预后标志物检测很重要。
