乳腺癌复发转移前后激素受体、HER-2表达的改变及其临床意义

Discordance in receptor status between primary and recurrent breast cancer and its clinical signif cance

  • 摘要: 目的 探讨乳腺癌原发灶与复发转移灶中激素受体及HER-2表达的改变及分子表型改变与临床特征的关系。 方法 本研究纳入解放军总医院1999年4月1日-2013年8月31日收治的175例术后出现复发转移并再次行病理活检的乳腺癌患者,所有病例均有完整病历资料及初诊与复发转移后的病理检测资料,全部175例均进行了雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)表达检测,其中128例患者具有复发转移前后的Her-2表达检测。 结果 乳腺癌出现复发转移后ER、PR、Her-2与初诊时不一致的比例分别为35.4%(McNemar检验P=0.003)、39.4%(P=0.030)、14.8%(P=0.001)。复发转移后ER、PR的阳转率分别为10.9%、14.3%,阴转率分别为24.6%、25.1%,阴转率均高于阳转率(PER=0.003,PPR=0.030)。Her-2的阳转率为13.3%,阴转率为1.6%,阳转率高于阴转率(P=0.001)。乳腺癌患者复发转移前后,ER、Her-2的表达是否发生改变与初诊时肿瘤大小相关(PER=0.010,PHer-2=0.042);复发转移前后不同分子表型组间DFS呈现一定的趋势。 结论 乳腺癌的异质性与肿瘤大小相关,复发转移后的分子表型会发生改变,分子表型的改变与无病生存时间可能有关。乳腺癌出现复发转移后,肿瘤的恶性程度有升高的趋势。

     

    Abstract: Objective Toinvestigate the discordance expression of estrogen receptor (ER), progesterone receptor (PR), and Her-2 between primary and recurrent tumors in patients with recurrent breast cancer and its effect on disease-free survival (DFS). Methods One hundredand seventy-five women with recurrent breast cancer whounderwent biopsy in Chinese PLA General Hospital fromApril 1, 1999 toAugust 31, 2013 were enrolledin this study, the expression of ER and PR were testedin 175 patients while the Her-2 status was ascertainedin 128 patients. Results Discordance in ER, PR, and Her-2 between the primary and the recurrent was 35.4% (McNemar's test P=0.003), 39.4% (P=0.030), and 14.8% (P=0.001), respectively. The positive conversion rate of ER and PR were 10.9% and 14.3%, and the negative conversion rate were 24.6% and 25.1% which were higher than the positive conversion rate (PER=0.003, PPR=0.030). The positive and negative conversion rate of Her-2 were 13.3% and 1.6%, the former was higher than the later (P=0.001). The discordance in ER and Her-2 between the primary and the recurrent was relevant totumor size (PER=0.010, PHer-2=0.042). A statistically tendency in DFS tointra individual HR status and Her-2 status in primary tumor and relapse was noted. Conclusion Breast cancer is a highly heterogeneous disease. Some patients with breast cancer experience alteredHR and Her-2 status throughout tumor progression. The molecular classification of breast cancer is associatedwith DFS possibly. The discordance in HR and Her-2 between the primary and the recurrent is relevant totumor size. Once breast cancer relapses, it may showhigher degree of malignant.

     

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