Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Cancer. 2021 Feb 1;148(3):692-701. doi: 10.1002/ijc.33227. Epub 2020 Aug 19.
Although receptor status including estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) of the primary breast tumors was related to the prognosis of breast cancer patients, little information is yet available on whether patient management and survival are impacted by receptor conversion in breast cancer metastases. Using data from the nation-wide multicenter clinical epidemiology study of advanced breast cancer in China (NCT03047889), we report the situation of retesting ER, PR and HER2 status for breast cancer metastases and evaluate the patient management and prognostic value of receptor conversion. In total, 3295 patients were analyzed and 1583 (48.0%) patients retesting receptor status for metastasis. Discordance in one or more receptors between the primary and the metastatic biopsy was found in 37.7% of women. Patients who remained hormone receptor (HR) positive in their metastases had similar progression-free survival of first-line and second-line treatment compared to patients with HR conversion (P > .05). In multivariate analysis, patients who showed ER conversion from negative to positive had longer disease-free survival (DFS) than patients who remained negative in their metastases (hazard ratio, 2.05; 95% confidence interval [CI], 1.45-2.90; P < .001). Patients with PR remained positive and had longer DFS than patients with PR conversion from negative to positive (hazard ratio, 0.56; 95% CI, 0.38-0.83; P = .004). Patients with PR conversion have shorter overall survival than patients with PR remained positive or negative (P = .016 and P = .041, respectively). Our findings showed that the receptors' conversions were common in metastatic breast cancer, and the conversion impacted the survival.
虽然原发性乳腺癌的受体状态（包括雌激素受体[ER]、孕激素受体[PR]和人表皮生长因子受体 2[HER2]）与乳腺癌患者的预后相关，但关于乳腺癌转移中受体转换是否影响患者管理和生存的信息有限。我们利用来自中国全国多中心临床流行病学研究晚期乳腺癌（NCT03047889）的数据，报告了乳腺癌转移时重新检测 ER、PR 和 HER2 状态的情况，并评估了受体转换的患者管理和预后价值。共分析了 3295 例患者，其中 1583 例（48.0%）患者对转移的受体状态进行了重新检测。在 37.7%的女性中，原发性和转移性活检之间的一个或多个受体存在不一致。在转移性肿瘤中仍为激素受体（HR）阳性的患者，与 HR 转换的患者相比，一线和二线治疗的无进展生存期（PFS）相似（P>.05）。多变量分析显示，转移性肿瘤中 ER 由阴性转为阳性的患者，无病生存期（DFS）长于转移性肿瘤中仍为阴性的患者（危险比，2.05；95%置信区间[CI]，1.45-2.90；P<.001）。PR 仍为阳性的患者 DFS 长于 PR 由阴性转为阳性的患者（危险比，0.56；95%CI，0.38-0.83；P=0.004）。PR 转换的患者总生存期短于 PR 仍为阳性或阴性的患者（P=0.016 和 P=0.041，分别）。我们的研究结果表明，转移性乳腺癌中受体转换很常见，且转换会影响生存。
