激素受体与HER-2表达不一致对转移性乳腺癌患者的预后影响
The Prognostic Impact of Hormonal Receptor and HER-2 Expression Discordance in Metastatic Breast Cancer Patients.
作者信息
Yang Ziyan, Li Nani, Li Xiaolin, Lei Lei, Wang Xiaojia
机构信息
The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310022, People's Republic of China.
Department of Medical Oncology, Fujian Cancer Hospital, Fuzhou, Fujian 350014, People's Republic of China.
出版信息
Onco Targets Ther. 2020 Jan 28;13:853-863. doi: 10.2147/OTT.S231493. eCollection 2020.
BACKGROUND
Hormone receptor (HR) and human epidermal growth factor receptor (HER2) discordance between primary and metastatic breast cancer lesions is common. However, its impact on long-term survival remains unclear. We aimed to determine the prognostic value of this discordance in patients with metastaticf breast cancer (MBC).
METHODS
A total of 270 patients with MBC who were underwent re-biopsy of progressive metastases at Zhejiang Cancer Hospital from January 1, 2012 to December 31, 2015 with patients consent and then review their primary tumors pathological findings. The HR and HER2 status in both primary and progressive metastatic lesions was determined by immunohistochemistry and/or fluorescence in situ hybridization. The discordance rates were correlated with the clinicopathologic characteristics, metastatic lesions, salvage treatment, and survival analysis in this population.
RESULTS
A total of 142 (52.6%) MBC patients were diagnosed with discordant HR and HER2 status. Alterations in estrogen receptor (ER), progesterone receptor (PR), and HER2 status were observed in 20.70%, 37.78%, and 11.48% cases, respectively. Chemotherapy (P=0.0192) and endocrine therapy (P=0.048) significantly affected the conversion of HR status. Endocrine therapy was positively correlated with PR discordance (P=0.002), while ER discordance was associated with adjuvant chemotherapy (P=0.031). Survival analysis showed that ER status alterations between primary and metastatic lesions were associated with overall survival (P=0.002). The clinical prognosis was significantly worse with HR losses than with persistent HR positivity (P=0.023). In Cox multivariate analysis, the loss of HR expression and conversion to triple negative were independent prognostic indicators.
CONCLUSION
Discordance in HR status between primary and metastatic lesions may impact the prognosis of MBC, and HR conversion has independent prognostic value.
背景
原发性和转移性乳腺癌病灶之间的激素受体（HR）和人表皮生长因子受体（HER2）不一致情况很常见。然而，其对长期生存的影响仍不清楚。我们旨在确定这种不一致性在转移性乳腺癌（MBC）患者中的预后价值。
方法
2012年1月1日至2015年12月31日期间，共有270例MBC患者在浙江肿瘤医院经患者同意后对进展性转移灶进行了再次活检，然后回顾其原发性肿瘤的病理结果。原发性和进展性转移病灶中的HR和HER2状态通过免疫组织化学和/或荧光原位杂交确定。该人群中的不一致率与临床病理特征、转移病灶、挽救性治疗和生存分析相关。
结果
共有142例（52.6%）MBC患者被诊断为HR和HER2状态不一致。分别在20.70%、37.78%和11.48%的病例中观察到雌激素受体（ER）、孕激素受体（PR）和HER2状态的改变。化疗（P = 0.0192）和内分泌治疗（P = 0.048）显著影响HR状态的转变。内分泌治疗与PR不一致呈正相关（P = 0.002），而ER不一致与辅助化疗相关（P = 0.031）。生存分析表明，原发性和转移性病灶之间的ER状态改变与总生存相关（P = 0.002）。HR丢失时的临床预后明显比HR持续阳性时更差（P = 0.023）。在Cox多因素分析中，HR表达缺失和转变为三阴性是独立的预后指标。
结论
原发性和转移性病灶之间的HR状态不一致可能影响MBC的预后，且HR转变具有独立的预后价值。
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