Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Int J Cancer. 2023 Apr 1;152(7):1476-1489. doi: 10.1002/ijc.34365. Epub 2022 Nov 30.
ER, PgR and HER-2 status are the cornerstones of choosing systemic therapy for breast cancer, but can change during the disease course. Guidelines recommended the biopsy of the metastatic tumor to reassess receptor status. Bone is the most frequent metastatic site of breast cancer but remained technically difficult to biopsy. Our study aimed to evaluate the incidence and prognostic significance of receptor discordance between primary breast cancer and paired bone metastases. One hundred and fifty-five breast cancer patients were diagnosed with pathology-confirmed bone metastasis at Fudan University Shanghai Cancer Center. Ninety-three patients with receptor status available on both primary tumor and bone metastases were included in our study. ER, PgR and HER-2 status converted from positive to negative in 10.8% (10/93), 28.0% (26/93) and 8.6% (8/93) of the patients, while ER, PgR and HER-2 status converted from negative to positive in 3.2% (3/93), 4.3% (4/93) and 1.1% (1/93) of the patients, respectively. 40.4% (17/42) of the HER2-0 tumors converted to HER2-low, which enabled them to receive the treatment of new antibody-drug conjugates (ADCs). Prior endocrine and anti-HER2 therapy were the independent risk factors for receptor conversion. Loss of HR expression in bone metastases was significantly associated with worse first-line PFS (adjusted hazard ratio = 3.271, P-value = .039) and OS (adjusted hazard ratio = 6.09, P-value = .011). In conclusion, our study confirmed that patients may experience receptor conversion between primary breast cancer and bone metastases, possibly influenced by prior treatments, which significantly influenced prognosis. The rebiopsy of bone metastases in patients with primary HER2-0 tumors may benefit from the new ADC drugs.
ER、PgR 和 HER-2 状态是选择乳腺癌系统治疗的基石，但在疾病过程中可能会发生变化。指南建议对转移性肿瘤进行活检，以重新评估受体状态。骨骼是乳腺癌最常见的转移部位，但在技术上仍然难以进行活检。我们的研究旨在评估原发性乳腺癌和配对骨转移灶之间受体不一致的发生率和预后意义。在复旦大学附属肿瘤医院诊断为病理学证实的骨转移的 155 例乳腺癌患者中，有 93 例患者的原发性肿瘤和骨转移灶均有受体状态数据。在这些患者中，10.8%（10/93）、28.0%（26/93）和 8.6%（8/93）的患者的 ER、PgR 和 HER-2 状态由阳性转为阴性，而 3.2%（3/93）、4.3%（4/93）和 1.1%（1/93）的患者的 ER、PgR 和 HER-2 状态由阴性转为阳性。40.4%（17/42）的 HER2-0 肿瘤转化为 HER2-低，使这些患者能够接受新型抗体药物偶联物（ADC）的治疗。内分泌治疗和抗 HER-2 治疗是受体转换的独立危险因素。骨转移中 HR 表达缺失与一线无进展生存期（调整后的危险比=3.271，P 值=0.039）和总生存期（调整后的危险比=6.09，P 值=0.011）显著相关。总之，我们的研究证实，患者可能在原发性乳腺癌和骨转移灶之间经历受体转换，这可能受先前治疗的影响，而这些治疗显著影响预后。对于原发性 HER2-0 肿瘤的患者，对骨转移灶进行再活检可能受益于新型 ADC 药物。
