Division of Surgical Oncology, Department of Surgery, Grady Memorial Hospital, Emory University, Atlanta, GA, USA.
Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
Breast Cancer Res Treat. 2024 Sep;207(2):373-382. doi: 10.1007/s10549-024-07368-w. Epub 2024 May 23.
In metastatic breast cancer, differences in expression patterns of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) between the primary tumor (PT) and metastatic site (MET) have been reported. However, there is limited understanding of the relationship of tumor subtype discordance and overall survival (OS). We evaluated patterns of ER/PR/HER2 in PTs and corresponding METs and assessed the relationship between these patterns and OS.
Patients diagnosed at our center with metastatic breast cancer (2011-2020) were included. ER/PR were stratified as < 1%/1-10%/ > 10% by immunohistochemistry and HER2 as positive/negative by immunohistochemistry/FISH. Tumor subtypes were classified as ER or PR + /HER2-, HER2+ , or triple-negative. Biomarker discordance data from PTs to METs were analyzed for expression patterns. OS was assessed.
Of 254 patients, 41 (16.1%) had synchronous and 213 (83.9%) had metachronous METs. Category change of ER/PR/HER2 expression was observed in 56 (22.0%), 117 (40.5%), and 30 (11.8%) patients, respectively. Tumor subtype changed in 56 (22.0%) patients. We identified a difference between PT and MET from ER > 10% to ER < 1% (n = 28,16.2% p < 0.01); PR > 10% to PR < 1% (n = 54,48.2%, p < 0.001); PR > 10% to PR 1-10% (n = 18,16.1%, p < 0.001), and ER or PR+/HER2- to triple-negative (n = 19,13.0%, p = 0.03). In log-rank analysis, change from an ER or PR+/HER2- (5-year OS 88.6%) PT to a HER2+(67.5%) or triple-negative (54.6%) MET was associated with decreased survival (p < 0.01); however, in multivariate analysis, discordant biomarker expression was not associated with decreased survival (p > 0.05).
Tumor expression of ER/PR/HER2 can differ between the PT and MET. Loss of ER/PR expression is common and may be related to worse survival. Routine assessment of MET tumor markers could inform prognosis and therapeutic decision-making.
在转移性乳腺癌中，原发肿瘤（PT）和转移部位（MET）之间的雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体 2（HER2）表达模式存在差异。然而，对于肿瘤亚型不一致与总生存期（OS）之间的关系，我们的了解有限。我们评估了 PT 和相应 MET 中 ER/PR/HER2 的模式，并评估了这些模式与 OS 之间的关系。
纳入了在我们中心诊断为转移性乳腺癌的患者（2011-2020 年）。通过免疫组化将 ER/PR 分为<1%/1-10%/>10%，HER2 为阳性/阴性通过免疫组化/FISH。肿瘤亚型分为 ER 或 PR+/HER2-、HER2+或三阴性。分析了从 PT 到 MET 的生物标志物不一致数据的表达模式。评估了 OS。
在 254 例患者中，41 例（16.1%）为同步转移，213 例（83.9%）为异时转移。ER/PR/HER2 表达的类别变化分别在 56 例（22.0%）、117 例（40.5%）和 30 例（11.8%）患者中观察到。56 例（22.0%）患者的肿瘤亚型发生了变化。我们发现 ER>10%到 ER<1%（n=28，16.2%，p<0.01）、PR>10%到 PR<1%（n=54，48.2%，p<0.001）、PR>10%到 PR 1-10%（n=18，16.1%，p<0.001）和 ER 或 PR+/HER2-到三阴性（n=19，13.0%，p=0.03）之间的 PT 和 MET 之间存在差异。在对数秩分析中，从 ER 或 PR+/HER2-（5 年 OS 88.6%）PT 转变为 HER2+（67.5%）或三阴性（54.6%）MET 与生存降低相关（p<0.01）；然而，在多变量分析中，不一致的生物标志物表达与生存降低无关（p>0.05）。
PT 和 MET 之间 ER/PR/HER2 的肿瘤表达可能存在差异。ER/PR 表达的丧失很常见，可能与生存状况较差有关。常规评估 MET 肿瘤标志物可以提供预后和治疗决策信息。
