Department of Breast & Endocrine Surgery, Kumamoto City Hospital, 1-1-60 Kotoh, Kumamoto City, Kumamoto 862-8505, Japan.
World J Surg Oncol. 2011 Oct 17;9:131. doi: 10.1186/1477-7819-9-131.
In breast cancer, ER/PgR, HER2, and Ki-67 are important biological markers for predicting prognosis and making effective treatment decisions. In addition, changes in markers due to relapse are also clinically experienced; however, the frequency and clinical significance are still not fully understood. Thus, changes in markers and their correlations with prognosis were investigated.
Out of the patients with relapse from 1997 to March 2011, there were 97 consecutive patients from whom the lesion was resected and evaluated by immunostaining. The biopsy sites were chest wall, lymph node, ipsilateral breast tumor recurrence, lungs, bones, ovaries and brain. The markers sought were ER, PgR, HER2, p53 and Ki-67.
The hormone receptor positive rate from the primary tumor to recurrence decreased from 63.9% to 57.7% and from 56.7% to 43.3% for ER and PgR, respectively. Changes in the positive/negative evaluation were seen at the rate of 10.3% and 25.8% for ER and PgR, respectively. The Ki-67 index increased significantly from a mean of 29.1% at primary tumor to 36.3% at relapse. When divided into 2 groups (< 50% and ≥50%), changes were seen in 24.7%. On the other hand, the rates of changes in HER2 and p53 positivity were 14.4% and 12.4%. The changes in subtypes were seen in 25%, however, the lowest rate of change was seen in the triple negative cases. Although there was no notable difference in the rate of change between disease-free interval (DFI) and PgR, Ki-67, p53 and HER2, there was a significant difference in the change rates in the ER. A multivariate analysis revealed that the status of distant metastasis and PgR level at relapse, and Ki-67 levels at primary tumor were all significant factors.
Estrogen receptor and PgR decreased while Ki-67 increased due to relapse; however, the rate of change was high for PgR and Ki-67. Change in the subtypes was seen in 25%. In addition, PgR at relapse and Ki-67 at primary tumor were significant factors for post-relapse prognosis while PgR becoming negative was a poor prognostic factor. These findings are important for making effective treatment decisions.
在乳腺癌中，ER/PgR、HER2 和 Ki-67 是预测预后和制定有效治疗决策的重要生物学标志物。此外，复发导致的标志物变化在临床上也有经验，但频率和临床意义仍不完全清楚。因此，研究了标志物的变化及其与预后的关系。
从 1997 年至 2011 年 3 月复发的患者中，连续有 97 例患者进行了病变切除和免疫染色评估。活检部位为胸壁、淋巴结、同侧乳房肿瘤复发、肺部、骨骼、卵巢和大脑。寻找的标志物为 ER、PgR、HER2、p53 和 Ki-67。
从原发肿瘤到复发，激素受体阳性率从 63.9%降至 57.7%，ER 和 PgR 分别从 56.7%降至 43.3%。ER 和 PgR 的阳性/阴性评估变化率分别为 10.3%和 25.8%。Ki-67 指数从原发肿瘤时的平均 29.1%显著升高至复发时的 36.3%。当分为<50%和≥50%两组时，变化率为 24.7%。另一方面，HER2 和 p53 阳性率的变化率分别为 14.4%和 12.4%。亚型变化率为 25%，但三阴性病例的变化率最低。尽管无病间隔（DFI）和 PgR、Ki-67、p53 和 HER2 的变化率之间无显著差异，但 ER 的变化率有显著差异。多变量分析显示，远处转移状态、复发时 PgR 水平以及原发肿瘤时 Ki-67 水平均为显著因素。
复发时 ER 和 PgR 降低，Ki-67 升高，但 PgR 和 Ki-67 的变化率较高。25%的患者出现亚型变化。此外，复发时的 PgR 和原发肿瘤时的 Ki-67 是复发后预后的重要因素，而 PgR 阴性是预后不良的因素。这些发现对制定有效的治疗决策很重要。
