Kong Lingjun, Ren Chongxi
Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Qian Tong North Street NO.17, Cangzhou City, Hebei province, 061000, China.
Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Qian Tong North Street NO.17, Cangzhou City, Hebei province, 061000, China.
Breast. 2025 Jun;81:104471. doi: 10.1016/j.breast.2025.104471. Epub 2025 Apr 8.
It is unclear whether the expression of biomarkers such as estrogen receptor (ER), progesterone receptor(PR), human epidermal growth factor receptor-2(HER2), and Ki-67 proliferation index changes following chemotherapy-based systemic therapy(CST) in patients with de novo metastatic breast cancer(dnMBC). The study aimed to investigate the expression of the biomarkers before and after CST and its impact on the prognosis of dnMBC patients.
Using hospital-based database, we conducted a retrospective cohort study on dnMBC patients who received CST between February 2010 and December 2017. Based on clinicopathological data, changes in pathological findings(ER,PR,HER-2,Ki-67) following CST were examined. The effect of biomarker conversion on prognosis was evaluated. The primary outcome was overall survival(OS). Kaplan-Meier method and log-rank test was used for survival analyses.
The study included 192 female patients. The change rates of ER,PR,HER-2 and Ki-67 before and after CST were 9.9 %,17.2 %,6.2 % and 25.5 % respectively. Among them, the change in negative-to-positive expression of Ki-67 was the most common type of discordance observed. There was no statistical difference in OS between patients with changes in the four biomarkers and patients with no changes in the biomarkers(all p > 0.05). Interestingly, positive conversion of ER and PR, as well as persistent positive HER2 and Ki-67, were significantly associated with poor prognosis(p < 0.001,p < 0.001; p = 0.029,p < 0.001). Family history, initial metastatic site, and tumor grade were independent variables related to survival(p = 0.002,p < 0.001,p < 0.001).
Changes in ER, PR, HER2, and Ki-67 status were observed in patients following CST. Positive conversion of ER and PR, and persistent positive expression of HER2 and Ki-67 may indicate a poor prognosis. Further research is needed to determine whether biomarker expression investigations are needed following CST to optimize treatment options and improve survival.
对于初发性转移性乳腺癌（dnMBC）患者，在基于化疗的全身治疗（CST）后，雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER2）和Ki-67增殖指数等生物标志物的表达是否会发生变化尚不清楚。本研究旨在调查CST前后这些生物标志物的表达情况及其对dnMBC患者预后的影响。
利用医院数据库，我们对2010年2月至2017年12月期间接受CST的dnMBC患者进行了一项回顾性队列研究。根据临床病理数据，检查CST后病理结果（ER、PR、HER-2、Ki-67）的变化。评估生物标志物转换对预后的影响。主要结局是总生存期（OS）。采用Kaplan-Meier法和对数秩检验进行生存分析。
该研究纳入了192名女性患者。CST前后ER、PR、HER-2和Ki-67的变化率分别为9.9%、17.2%、6.2%和25.5%。其中，Ki-67从阴性转为阳性表达是观察到的最常见的不一致类型。四种生物标志物有变化的患者与生物标志物无变化的患者在OS方面无统计学差异（所有p>0.05）。有趣的是，ER和PR的阳性转换，以及HER2和Ki-67持续阳性与预后不良显著相关（p<0.001，p<0.001；p=0.029，p<0.001）。家族史、初始转移部位和肿瘤分级是与生存相关的独立变量（p=0.002，p<0.001，p<0.001）。
在接受CST的患者中观察到了ER、PR、HER2和Ki-67状态的变化。ER和PR的阳性转换以及HER2和Ki-67的持续阳性表达可能预示预后不良。需要进一步研究以确定CST后是否需要进行生物标志物表达检测，以优化治疗方案并提高生存率。
