Yang Yu-Feng, Liao Ying-Yang, Yang Mei, Peng Ning-Fu, Xie Shu-Rui, Xie Yan-Fang
Department of Pathology, The Third People's Hospital of Dongguan City, Dongguan, Guangdong Province, China.
Med Oncol. 2014 Oct;31(10):214. doi: 10.1007/s12032-014-0214-2. Epub 2014 Sep 13.
The aim of this study was to evaluate the frequency and prognostic impact of changes in the estrogen (ER), progesterone (PR) and human epidermal growth factor receptor 2 (HER2) status between primary and recurrent/metastatic lesions (RML). We investigated 133 breast cancer patients for ER, PR and HER2 status of primary and RML and their follow-up records. Among 133 patients with RML, discordance rate for ER, PR, and HER2 was 18.8, 33.8, and 6.8%, respectively. ER, PR and HER2 discordance were observed in 20.0, 38.1 and 6.7% of the patients with distant metastasis, and in 14.3, 17.9 and 7.1% of the patients with locoregional recurrence. The mean time between the primary diagnosis and last contact or death was 57 (range 22-78) months and between the recurrence biopsy and last contact or death was 17 (range 1-33) months. Among 133 patients with RML, the ER-discordant cases and ER-loss cases experienced a worse overall survival (OS) (p=0.001 and p=0.016, respectively) and post-recurrence survival (PRS) (p=0.001 and p=0.018, respectively), compared with the respective concordant cases. The HER2-discordant patients and HER2-loss patients had a poorer OS (p=0.008 and p=0.001, respectively) and PRS (p=0.004 and p=0.000, respectively) than the respective concordant cases. Among 105 patients with distant metastasis, ER discordance, ER loss, HER2 discordance and HER2 loss, compared with the respective concordant cases, resulted in a worse OS and PRS (p<0.05 for all). Our findings show an evident change in ER, PR and HER2 between breast primary tumors and relapsing tumors. The unstable status for ER or HER2 in breast cancer seems to be clinically significant and to correlate with a worse prognosis.
本研究的目的是评估原发性和复发/转移性病灶（RML）之间雌激素（ER）、孕激素（PR）和人表皮生长因子受体2（HER2）状态变化的频率及其预后影响。我们调查了133例乳腺癌患者原发性和RML的ER、PR和HER2状态以及他们的随访记录。在133例有RML的患者中，ER、PR和HER2的不一致率分别为18.8%、33.8%和6.8%。远处转移患者中ER、PR和HER2不一致的比例分别为20.0%、38.1%和6.7%，局部区域复发患者中分别为14.3%、17.9%和7.1%。从初次诊断到最后一次联系或死亡的平均时间为57（范围22 - 78）个月，从复发活检到最后一次联系或死亡的平均时间为17（范围1 - 33）个月。在133例有RML的患者中，与各自的一致病例相比，ER不一致病例和ER缺失病例的总生存期（OS）更差（分别为p = 0.001和p = 0.016），复发后生存期（PRS）也更差（分别为p = 0.001和p = 0.018）。HER2不一致患者和HER2缺失患者的OS（分别为p = 0.008和p = 0.001）和PRS（分别为p = 0.004和p = 0.000）比各自的一致病例更差。在105例远处转移患者中，与各自的一致病例相比，ER不一致、ER缺失、HER2不一致和HER2缺失导致更差的OS和PRS（所有p < 0.05）。我们的研究结果显示，乳腺原发性肿瘤和复发性肿瘤之间ER、PR和HER2有明显变化。乳腺癌中ER或HER2的不稳定状态似乎具有临床意义，且与更差的预后相关。
