Ma Mingwei, Chen Xing, Zhang Zhen, Zhao Dachun, Zhao Jialin, Sun Qiang, Mao Feng, Peng Li
Breast Disease Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, China.
Gland Surg. 2024 Nov 30;13(11):2107-2115. doi: 10.21037/gs-24-364. Epub 2024 Nov 26.
Breast cancer is a complex disease encompassing multiple phenotypic and genetic subtypes. The biomarker status of primary and recurrent lesions may be dissimilar, and changes in biomarker status may inform clinical decision-making. The expression of biomarkers between primary breast cancers and loco-regional recurrences lacked large sample studies. This study aimed to investigate the discordance in the status of specific biomarkers between primary breast cancers and loco-regional recurrences, while also exploring the associated clinical and pathological characteristics of the affected patients.
A retrospective review was conducted on the medical records of 112 female patients with a confirmed pathological diagnosis of breast cancer who experienced loco-regional recurrence between July 2005 and March 2018 at Peking Union Medical College Hospital. Comprehensive data regarding primary and recurrent tumor characteristics, surgical interventions, history of systemic therapy, presence and management of loco-regional recurrences, as well as disease-free survival (DFS) and overall survival (OS), were systematically recorded and subsequently subjected to comparative analysis.
The study revealed disparities in the expression of individual biomarkers between primary breast cancers and loco-regional recurrences, with discordance rates exhibiting variation across breast cancer subtypes. Specifically, the overall discordance rates were as follows: 9.8% for estrogen receptor (ER) expression, 15.2% for PR expression, 7.6% for human epidermal growth factor receptor-2 (HER2) expression, and 20.6% for the Ki-67 index (21 out of 102 cases). Luminal A tumors exhibited the highest discordance rate at 81.8%, while triple negative (TN) tumors displayed the lowest at 9.1%. Furthermore, a statistically significant association was identified between DFS and the subtype of primary breast cancer (P=0.002).
The study shows that there exists discordance in the expression of individual biomarkers between primary breast cancers and loco-regional recurrences. The discordance rate was found to be highest among luminal A tumors and lowest for TN tumors. Additionally, patients with HER2 and TN primary breast tumors exhibited the shortest DFS. Based on these findings, the study recommends the implementation of biomarker testing for recurrent breast cancers as a valuable strategy to inform and guide decisions regarding the selection of rescue chemotherapy, endocrine therapy, and targeted therapy.
乳腺癌是一种复杂的疾病，包含多种表型和基因亚型。原发性和复发性病变的生物标志物状态可能不同，生物标志物状态的变化可为临床决策提供依据。原发性乳腺癌与局部区域复发之间生物标志物的表达缺乏大样本研究。本研究旨在调查原发性乳腺癌与局部区域复发之间特定生物标志物状态的不一致性，同时探索受影响患者的相关临床和病理特征。
对2005年7月至2018年3月在北京协和医院发生局部区域复发的112例经病理确诊为乳腺癌的女性患者的病历进行回顾性研究。系统记录了关于原发性和复发性肿瘤特征、手术干预、全身治疗史、局部区域复发的存在及处理，以及无病生存期（DFS）和总生存期（OS）的综合数据，随后进行比较分析。
该研究揭示了原发性乳腺癌与局部区域复发之间个体生物标志物表达存在差异，不同乳腺癌亚型的不一致率有所不同。具体而言，总体不一致率如下：雌激素受体（ER）表达为9.8%，孕激素受体（PR）表达为15.2%，人表皮生长因子受体2（HER2）表达为7.6%，Ki-67指数为20.6%（102例中有21例）。Luminal A型肿瘤的不一致率最高，为81.8%，而三阴性（TN）肿瘤的不一致率最低，为9.1%。此外，DFS与原发性乳腺癌亚型之间存在统计学显著关联（P=0.002）。
该研究表明，原发性乳腺癌与局部区域复发之间个体生物标志物的表达存在不一致性。发现不一致率在Luminal A型肿瘤中最高，在TN肿瘤中最低。此外，HER2和TN原发性乳腺癌患者的DFS最短。基于这些发现，该研究建议对复发性乳腺癌进行生物标志物检测，作为为挽救性化疗、内分泌治疗和靶向治疗的选择提供信息和指导决策的有价值策略。
