首次和二次原发性乳腺癌之间亚型标志物的变化。
The changes of subtype markers between first and second primary breast cancers.
机构信息
Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
出版信息
Cancer Med. 2023 Jun;12(12):13649-13660. doi: 10.1002/cam4.5979. Epub 2023 Apr 25.
BACKGROUND
Previous studies investigated the changes of subtype markers [estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)] in several clinical settings, but not for second primary breast cancer (SPBC) after first primary breast cancer (FPBC).
METHODS
A total of 15,390 patients with SPBC were preliminarily selected from the Surveillance, Epidemiology, and End Results Program, and 3777 patients with complete information on three subtype markers in both FPBC and SPBC were included in the final analyses. The changes of subtype markers and their prognostic implications and potential influential factors were well investigated.
RESULTS
The overall change rates of ER, PR, and HER2 between FPBC and SPBC were 23.0% (867/3777), 35.0% (1322/3777), and 18.3% (691/3777), respectively. Gains of ER, PR, and HER2 after negative index markers were 48.7% (364/748), 37.9% (418/1103), and 11.5% (370/3211), while losses of markers after positive index markers were 16.6% (503/3029), 33.8%(904/2674), and 56.7%(321/566). Loss of ER was significantly associated with increased mortality (18.1% vs. 7.9%, p < 0.001), while gain of ER was significantly associated with decreased mortality (11.5% vs. 23.2%, p < 0.001). Similar results were observed for changes of PR status. However, loss of HER2 was significantly associated with decreased mortality (8.7% vs. 16.3%, p = 0.014), and no significant association was observed between the gain of HER2 and the prognosis of SPBC. Multivariate competing risk analyses showed similar results. HER2 status in FPBC, chemotherapy, and radiotherapy was significantly associated with changes of ER/PR (all p < 0.05), and no available therapies associated with HER2 change.
CONCLUSION
The changes of subtype markers are observed in a considerable proportion of patients and has statistically significant prognostic implications. Biopsies should be taken as a routine procedure for better therapy management.
背景
先前的研究调查了几种临床环境下亚型标志物（雌激素受体 [ER]、孕激素受体 [PR]和人表皮生长因子受体 2 [HER2]）的变化，但没有针对首次原发性乳腺癌（FPBC）后的第二原发性乳腺癌（SPBC）进行研究。
方法
从监测、流行病学和最终结果计划中初步筛选出 15390 例 SPBC 患者，最终分析纳入了 3777 例 FPBC 和 SPBC 中三种亚型标志物均具有完整信息的患者。深入研究了亚型标志物的变化及其预后意义和潜在的影响因素。
结果
FPBC 和 SPBC 之间 ER、PR 和 HER2 的总体变化率分别为 23.0%（867/3777）、35.0%（1322/3777）和 18.3%（691/3777）。阴性指数标志物后 ER、PR 和 HER2 的增益率分别为 48.7%（364/748）、37.9%（418/1103）和 11.5%（370/3211），而阳性指数标志物后标志物的损失率分别为 16.6%（503/3029）、33.8%（904/2674）和 56.7%（321/566）。ER 缺失与死亡率增加显著相关（18.1%比 7.9%，p<0.001），而 ER 获得与死亡率降低显著相关（11.5%比 23.2%，p<0.001）。PR 状态变化也观察到了类似的结果。然而，HER2 的缺失与死亡率降低显著相关（8.7%比 16.3%，p=0.014），而 HER2 的获得与 SPBC 的预后无关。多变量竞争风险分析得到了类似的结果。FPBC 中的 HER2 状态、化疗和放疗与 ER/PR 的变化显著相关（均 p<0.05），而没有任何可用的治疗方法与 HER2 变化相关。
结论
相当一部分患者的亚型标志物发生了变化，且具有统计学显著的预后意义。为了更好地进行治疗管理，应将活检作为常规程序。
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