Ilgun Serkan, Sarsenov Dauren, Erdogan Zeynep, Ordu Cetin, Celebi Filiz, Nur Pilanci Kezban, Ozturk Alper, Selamoglu Derya, Alco Gul, Aktepe Fatma, Eralp Yesim, Tuzlali Sitki, Ozmen Vahit
Gaziosmanpasa Taksim Training & Research Hospital, Dept of General Surgery, Istanbul, Turkey.
J BUON. 2016 Nov-Dec;21(6):1425-1432.
The receptor status of breast cancer plays a critical role in clinical practice. During the metastatic process, a change in the biological characteristics of the tumor can be seen. This study aimed to investigate the hormone receptor and HER2 status changes between primary and recurrent breast cancers and their effect on survival.
Eighty-six breast cancer patients with biopsy- proven local recurrences or distant metastases during the follow-up period were included in the study. Patients with metastatic disease at the time of first diagnosis or with history of previous neoadjuvant chemotherapy were excluded.
Forty-three of the 86 patients (50%) had changes in at least one of the estrogen receptor (ER), progesterone receptor (PR), or HER2. ER, PR and HER2 discordance rates were 12.7, 38.3, and 15.1%, respectively, and PR discordance was significantly higher (p=0.000). Among all molecular subtypes, the triple negative breast cancer (TNBC) subtype showed the least change. When the effect of chemotherapy on receptor change was analyzed, PR discordance was significantly higher in the group who received chemotherapy (p=0.029). Analysis of the hormonotherapy effects on receptor discordance revealed results similar to those of chemotherapy. Only the PR discordance was significantly greater in the group that received hormonotherapy (p=0.000). None of the three receptor discordances or loss of any receptor were related to survival. Primary tumor TNBC subtype and disease-free-interval (DFI) shorter than 5 years were found as independent prognostic factors that negatively affected overall survival (OS).
This study showed that during recurrent disease there was 50% discordance in the expression of ER, PR, and HER2. The receptor showing the greatest discordance and influence from the systemic treatment was PR. A significant relationship between receptor discordance and survival could not be demonstrated in our study.
乳腺癌的受体状态在临床实践中起着关键作用。在转移过程中，可以观察到肿瘤生物学特性的变化。本研究旨在探讨原发性和复发性乳腺癌之间激素受体和HER2状态的变化及其对生存的影响。
本研究纳入了86例在随访期间经活检证实有局部复发或远处转移的乳腺癌患者。排除首次诊断时患有转移性疾病或有新辅助化疗史的患者。
86例患者中有43例（50%）至少在雌激素受体（ER）、孕激素受体（PR）或HER2中的一项出现变化。ER、PR和HER2的不一致率分别为12.7%、38.3%和15.1%，PR的不一致率显著更高（p = 0.000）。在所有分子亚型中，三阴性乳腺癌（TNBC）亚型变化最小。分析化疗对受体变化的影响时，接受化疗的组中PR不一致率显著更高（p = 0.029）。分析激素治疗对受体不一致的影响，结果与化疗相似。仅接受激素治疗的组中PR不一致显著更大（p = 0.000）。三种受体不一致或任何一种受体缺失均与生存无关。原发性肿瘤TNBC亚型和无病生存期（DFI）短于5年被发现是对总生存期（OS）有负面影响的独立预后因素。
本研究表明，在复发疾病期间，ER、PR和HER2的表达有50%不一致。显示出最大不一致且受全身治疗影响最大的受体是PR。在我们的研究中未能证明受体不一致与生存之间存在显著关系。
