Shin Hee-Chul, Han Wonshik, Moon Hyeong-Gon, Park In-Ae, Noh Dong-Young
Department of Surgery, Chung-Ang University Hospital, Seoul, Korea.
Department of Surgery, Seoul National University Hospital, Seoul, Korea.; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
J Breast Cancer. 2016 Sep;19(3):268-274. doi: 10.4048/jbc.2016.19.3.268. Epub 2016 Sep 23.
We investigated the prognostic impact of discordance between the receptor status of primary breast cancers and corresponding metastases.
A total 144 patients with breast cancer and distant metastasis were investigated. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status of primary tumor and corresponding metastases were assessed. Tumor phenotype according to receptor status was classified as triple-negative phenotype (TNP) or non-TNP. Concordance and discordance was determined by whether there was a change in receptor status or phenotype between primary and metastatic lesions.
The rates of discordance between primary breast cancer and metastatic lesions were 18.1%, 25.0%, and 10.3% for ER, PR, and HER2, respectively. The rates of concordant non-TNP, concordant TNP and discordant TNP were 65.9%, 20.9%, and 13.2%, respectively. Patients with concordant ER/PR-negative status had worse postrecurrence survival (PRS) than patients with concordant ER/PR-positive and discordant ER/PR status (=0.001 and =0.021, respectively). Patients who converted from HER2-positive to negative after distant metastasis had worst PRS (=0.040). Multivariate analysis showed that concordant TNP was statistically significant factor for worse PRS (<0.001).
Discordance in receptor status and tumor phenotype between primary breast cancer and corresponding metastatic lesions was observed. Patients with concordant TNP had worse long-term outcomes than patients with concordant non-TNP and discordant TNP between primary and metastatic breast cancer. Identifying the receptor status of metastatic lesions may lead to improvements in patient management and survival.
我们研究了原发性乳腺癌与相应转移灶受体状态不一致对预后的影响。
共调查了144例伴有远处转移的乳腺癌患者。评估原发性肿瘤及相应转移灶的雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER2）状态。根据受体状态将肿瘤表型分为三阴性表型（TNP）或非三阴性表型。通过原发性和转移性病变之间受体状态或表型是否改变来确定一致性和不一致性。
原发性乳腺癌与转移性病变之间ER、PR和HER2的不一致率分别为18.1%、25.0%和10.3%。一致性非三阴性表型、一致性三阴性表型和不一致性三阴性表型的发生率分别为65.9%、20.9%和13.2%。ER/PR一致性阴性状态的患者复发后生存率（PRS）低于ER/PR一致性阳性和不一致性ER/PR状态的患者（分别为P=0.001和P=0.021）。远处转移后HER2从阳性转为阴性的患者PRS最差（P=0.040）。多因素分析显示，一致性三阴性表型是PRS较差的统计学显著因素（P<0.001）。
观察到原发性乳腺癌与相应转移性病变之间受体状态和肿瘤表型存在不一致。原发性和转移性乳腺癌之间，一致性三阴性表型的患者比一致性非三阴性表型和不一致性三阴性表型的患者长期预后更差。确定转移性病变的受体状态可能会改善患者管理和生存情况。
