Weydandt Laura, Nel Ivonne, Kreklau Anne, Horn Lars-Christian, Aktas Bahriye
Department of Gynecology, Medical Center, University of Leipzig, 04103 Leipzig, Germany.
Department of Pathology, Medical Center, University of Leipzig, 04103 Leipzig, Germany.
Cancers (Basel). 2022 Apr 7;14(8):1863. doi: 10.3390/cancers14081863.
In breast cancer therapeutic decisions are based on the expression of estrogen (ER), progesterone (PR), the human epidermal growth factor 2 (HER2) receptors and the proliferation marker Ki67. However, only little is known concerning heterogeneity between the primary tumor and axillary lymph node metastases (LNM) in the primary site. We retrospectively analyzed receptor profiles of 215 early breast cancer patients with axillary synchronous LNM. Of our cohort, 69% were therapy naive and did not receive neoadjuvant treatment. Using immunohistochemistry, receptor status and Ki67 were compared between core needle biopsy of the tumor (t-CNB) and axillary LNM obtained during surgery. The discordance rates between t-CNB and axillary LNM were 12% for HER2, 6% for ER and 20% for PR. Receptor discordance appears to already occur at the primary site. Receptor losses might play a role concerning overtreatment concomitant with adverse drug effects, while receptor gains might be an option for additional targeted or endocrine therapy. Hence, not only receptor profiles of the tumor tissue but also of the synchronous axillary LNM should be considered in the choice of treatment.
在乳腺癌治疗中，治疗决策基于雌激素（ER）、孕激素（PR）、人表皮生长因子2（HER2）受体的表达以及增殖标志物Ki67。然而，关于原发部位的原发性肿瘤与腋窝淋巴结转移（LNM）之间的异质性，人们了解得很少。我们回顾性分析了215例伴有腋窝同步LNM的早期乳腺癌患者的受体谱。在我们的队列中，69%为初治患者，未接受新辅助治疗。采用免疫组织化学方法，比较了肿瘤粗针活检（t-CNB）与手术中获取的腋窝LNM之间的受体状态和Ki67。t-CNB与腋窝LNM之间的不一致率分别为：HER2为12%，ER为6%，PR为20%。受体不一致似乎在原发部位就已出现。受体丢失可能与伴随不良药物效应的过度治疗有关，而受体增加可能是额外进行靶向治疗或内分泌治疗的一个选择。因此，在选择治疗方案时，不仅应考虑肿瘤组织的受体谱，还应考虑同步腋窝LNM的受体谱。
