The Conversion And Their Clinical Significance Of The Relevant Receptors In Advanced Breast Cancer

Objective:To investigate the expression difference and its clinical significance of ER,PR,and HER2 between primary tumor and corresponding metastases of breast cancer.Methods:The study collected nearly more than 10,000 cases who were diagnosed by pathology as breast cancer in the 4th Hospital,Hebei Medical University from January 2010 to November 2014,and screened 149 cases with advanced breast cancer who had metastatic pathology,including ER,PR and HER2 status.ER,PR and HER2 discordance,the prognosis and treatment were assessed in the patients with receptors change.Results:The discordance proportions for ER,PR and HER2 in the study were respectively 20.6%, 39.6% and 12.3%.The proportions of tumours shifting from positive to negative and from negative to positive were 14.6% and 6% for ER respectively.The same figures were 31.7% and 7.9% for Pg R, 5.6% and 6.7% for HER2.Discordance rates between primary and distant metastases/locoregional recurrence, respectively were 26% and 18.4% for ER, 50% and 35% for PR,7.7% and 14.1% for HER2. Hormone receptor-positive cases of 105 cases,the ER,PR,and HER2 inconsistent rate in no endocrine treatment group respectively was 21.2%,48.1% and 21.2%,and in the endocrine treatment group was 21.9%,54.7% and 22.2%.All patients according to the presence of postoperative adjuvant chemotherapy or endocrine therapy were divided into four groups:postoperative adjuvant chemotherapy + endocrine therapy group(group A)and postoperative adjuvant chemotherapy group(group B),the postoperative adjuvant endocrine therapy group(group C),no postoperative adjuvant chemotherapy and endocrine treatment group(group D).In group A,ER,PR and HER2 inconsistent rate respectively was 23.9%,50.8% and 18.4%;18.5%,29.6% and 6.7% in group B; 21.4%,42.8% and 0% in group D.In the stable ER-positive group,64.6% of patients had stable HER2-negative status between primary tumor and relapse. In the group that gained ER at relapse,75% had stable HER2-negative status. In comparison,in the group that lost ER at relapse and in the stable ER-negative group,only 41.7% and 42.4% had stable HER2-negative disease. In the stable ER-positive group,the group that gained ER at relapse,the group that lost ER at relapse and the stable ER-negative group,the ratio of patients who had HER2-positive status in relapse were 22.9%,25%,41.7% and 57.7% respectively.In the stable PR-positive group,70.6% of patients had stable HER2-negative status between primary tumor and relapse;72.7% in the group that gained PR at relapse.In comparison,only 57.1% and 41.2% in the lost PR group and the stable PR-negative group.In the stable PR-positive group,the group that gained PR at relapse,the group that lost PR at relapse and the stable PR-negative group,the ratio of patients who had HER2-positive status in relapse were 23.5%,27.3%,32.1% and 55.9%,respectively.The expression difference of ER and HER2 in primary tumors and metastases was irrelevant to the age at diagnosis,age at the biopsy of metastases,TNM stage,neoadjuvant chemotherapy(CT)(including whether used anthracycline/taxanes-based chemotherapy drugs or not),postoperative adjuvant chemotherapy(including whether used anthracycline/taxanes-based chemotherapy drugs or not),postoperative adjuvant endocrine therapy(ET), postoperative adjuvant radiotherapy,the sites of metastases(distant or localregional),the expression difference of HER2 or HR,DFS,time to biopsy(TTB),ET before biopsy,anti-HER2 therapy before biopsy,and radiotherapy before biopsy,but the expression difference of ER was related to the expression difference of PR.The expression difference of PR in primary tumors and metastases was irrelevant to the age at diagnosis,age at the biopsy o f metastases,neoadjuvant CT(including whether used anthracycline/taxanes-based chemotherapy drugs or not),postoperative adjuvant CT(including whether used anthracycline/taxanes-based chemotherapy drugs or not), postoperative adjuvant radiotherapy,the sites of metastases(distant or localregional),the expression differences of ER and HER2,DFS,TTB,CT before biopsy,ET before biopsy and anti-HER2 therapy before biopsy,but related to postoperative adjuvant ET and radiotherapy before biopsy.The median OS in the ER(+/+), ER(-/-) and ER(+/-) groups were 3925 days,1924 days and 2133 days,respectively;but the median OS in the ER(-/+) group was not available;The median survival from the time of biopsy in metastases to death in groups including ER(+/+), ER(-/-) and ER(+/-) groups were 1026 days, 559 days and 584 days respectively,but the median survival from the time of biopsy in metastases to death in the ER(-/+) group also was not available.The median OS in the PR(+/+),PR(-/-) and PR(+/-) groups were 3576 days,1920 days and 2950 days respectively,but the median OS in the PR(-/+) group was not available;The median survival from the time of biopsy in metastases to death in groups including PR(+/+),PR(-/-),PR(+/-) and PR(-/+) groups were 877 days,538 days,800 days and 1076 days respectively.ET after biopsy had an effect on the survival after biospy in ER(+/+) group(P=0.002;OR :0.215,95%CI:0.083-0.561);CT after biopsy had an effect on the survival after biospy in ER(-/-) group(P=0.002;OR:0.166,95%CI: 0.052-0.527) and ER(+/-) group(P=0.011;OR:0.043,95%CI:0.004-0.484).ET after biopsy in PR(+/+) group and PR(+/-) group had influence on survival after biospy(P=0.048,P=0.016);CT after biopsy in PR(-/-) group had influence on survival after biospy(P=0.000;OR:0.169,95%CI:0.070-0.407).Treatment after biopsy,such as CT,ET,anti-HER2 therapy,radiotherapy and surgery,had no statistically significant to survival after-biopsy in groups including HER2(-/-) group, HER2(+/-)group and HER2(-/+)group; HT after biopsy in HER2(+/+) group had influence onsurvival after biospy(P=0.028;OR:0.170,95%CI:0.035-0.826).Conclusions:ER, PR and HER2 expression between primary tumors and metastases are different,which influenced by many factors;Receptor expression differences and different treatment strategies have an impact on the prognosis of patients,so clinicians should pay attention to the biopsy of metastases and formulate reasonable intervention measures.