Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA.
Cancer Biomark. 2012;12(6):219-30. doi: 10.3233/CBM-130317.
Although the analysis of hormone receptors and HER-2/neu has usually been performed on primary tumors only, a growing body of evidence suggests that substantial discordance exists between primary and metastatic disease for estrogen receptors (30-40%) and HER-2/neu (10-30%). This discordance may reflect alterations in pathologic assessment techniques, changes between primary and metastatic breast cancer, differences within a heterogenous tumor, or the effect of treatment. The etiology of discordance is poorly understood and frequently may reflect tumor heterogeneity along with lack of standardized preanalytic and analytic variables. Standardization of diagnostic variables can improve diagnostic reproducibility. Because of the emergence of targeted hormonal and HER-2/neu therapies, tumor biomarkers assume a pivotal role in treatment decisions. The loss of sensitivity to hormones or HER-2/neu may suggest tumor resistance; whereas, the acquisition of hormone receptors and HER-2/neu provides potential new treatment targets which can improve overall patient outcomes.
虽然激素受体和 HER-2/neu 的分析通常仅在原发性肿瘤上进行，但越来越多的证据表明，雌激素受体（30-40%）和 HER-2/neu（10-30%）在原发性和转移性疾病之间存在实质性的不一致。这种不一致可能反映了病理评估技术的改变、原发性和转移性乳腺癌之间的变化、异质性肿瘤内的差异，或治疗的影响。不一致的病因尚不清楚，通常可能反映肿瘤异质性以及缺乏标准化的分析前和分析变量。诊断变量的标准化可以提高诊断的可重复性。由于靶向激素和 HER-2/neu 治疗的出现，肿瘤生物标志物在治疗决策中起着关键作用。对激素或 HER-2/neu 的敏感性丧失可能表明肿瘤耐药性；而激素受体和 HER-2/neu 的获得则提供了潜在的新的治疗靶点，可以改善患者的整体预后。
