Kolberg-Liedtke Cornelia, Wuerstlein Rachel, Gluz Oleg, Heitz Florian, Freudenberger Muriel, Bensmann Elena, du Bois Andreas, Nitz Ulrike, Pelz Enrico, Warm Matthias, Ortmann Monika, Sultova Elena, Brucker Sara Y, Kates Ronald E, Fehm Tanja, Harbeck Nadia
Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany.
Breast Center, Department of Gynecology and Obstetrics, University of Munich and CCCLMU, Munich, Germany.
Breast Care (Basel). 2021 Oct;16(5):475-483. doi: 10.1159/000512416. Epub 2020 Dec 15.
Tumor biological factors of breast cancer (BC) such as hormone receptor (HR) status, HER2 status, and grade can differ in the metastatic cascade from primary to lymph node (LN) metastasis and to distant metastatic tissue. Systematic data regarding therapeutic consequences are yet limited.
We conducted a prospectively planned, retrospective cohort study comparing BC phenotype in tissue from primary tumors (PTs), locoregional LN metastases, and disease recurrence (DR). HR and HER2 as well as tumor grade in PTs and DR were obtained by a database search. No centralized biomarker testing was performed. The impact of changes in tumor biological factors on post-recurrence survival (PRS) and overall survival was analyzed.
PriMet comprises 635 patients (LN tissue in 142 patients). Discrepancies for HR or HER2 status between PT and DR were observed in 18.7 and 21.6% of cases, respectively. For HR status, positivity of PT and negativity of DR was seen more often (13.2%) than vice versa (5.5%). For HER2 status, negativity of the primary and positivity of DR was seen more often (14.9%) than vice versa (6.7%). Discordance was more often observed between PT and LN metastasis compared to LN versus DR. However, numbers were small. Compared to concordant non-triple-negative (TN) disease, concordant TN disease showed significantly inferior PRS.
We demonstrate receptor discordance to occur relatively frequently between PT, LN metastasis, and DR and to impact patient prognosis. However, clinical consequences of receptor discordance need to be drawn with caution considering clinical aspects as well as tumor biology.
乳腺癌（BC）的肿瘤生物学因素，如激素受体（HR）状态、HER2状态和分级，在从原发性肿瘤到淋巴结（LN）转移以及远处转移组织的转移级联过程中可能会有所不同。关于治疗后果的系统性数据仍然有限。
我们进行了一项前瞻性规划的回顾性队列研究，比较原发性肿瘤（PTs）、局部区域LN转移和疾病复发（DR）组织中的BC表型。通过数据库搜索获取PTs和DR中的HR、HER2以及肿瘤分级。未进行集中的生物标志物检测。分析肿瘤生物学因素变化对复发后生存（PRS）和总生存的影响。
PriMet研究纳入了635例患者（142例患者有LN组织）。分别在18.7%和21.6%的病例中观察到PT与DR之间HR或HER2状态的差异。对于HR状态，PT为阳性而DR为阴性的情况更为常见（13.2%），反之则较少（5.5%）。对于HER2状态，原发性为阴性而DR为阳性的情况更为常见（14.9%），反之则较少（6.7%）。与LN转移和DR之间相比，PT与LN转移之间的不一致情况更常出现。然而，数量较少。与一致的非三阴性（TN）疾病相比，一致的TN疾病显示出显著较差的PRS。
我们证明受体不一致在PT、LN转移和DR之间相对频繁地发生，并影响患者预后。然而，考虑到临床方面以及肿瘤生物学，受体不一致的临床后果需要谨慎得出。
