Study On Heterogeneity Of ER,PR And HER2 Expression In Patients With Advanced Breast Cancer

Background:Breast cancer is one of the most common malignancies in women.Epidemiological data indicate that the incidence rate increases year by year.Advanced metastatic breast cancer(metastatic breast cancer,MBC)treatment has not yet reached the desired level.The application of conventional treatment such as chemotherapy,radiotherapy,endocrine therapy and targeted therapy is still difficult to cure the disease.The average median survival time after treatment is 2-3 years,and only a small number of patients can be long-term survival.The principle of the treatment of breast cancer patients is mainly the comprehensive drug treatment.At present,the treatment of metastatic breast cancer needs to be based on the expression of ER,PR and HER-2 receptors on the surface of tumor cells,so as to further select the endocrine,chemotherapy,targeting and joint application of different treatment method.There have been several retrospective studies reported that the recurrence/metastases compared with the primary breast cancer have different levels in the expression of those three kinds of receptor inconsistencies;even between the different sites of recurrence/metastasis in the same breast cancer patient and between the bilateral breast cancer,there were heterogeneity of ER,PR and HER-2 receptors.The above phenomenon further affected the prognosis of patients and the choice of treatment options.Objective:To investigate the inconsistent expression of three receptors in the recurrence/metastasis and the primary lesion.Further investigation of the age of patients,time of the recurrence or metastasis,whether previous treatments such as endocrine,chemotherapy and targeted therapy were associated with the inconsistent expression of the three receptors.Methods:Retrospectively analysis the metastatic breast cancer patients who have treatment months in Run Run Shaw hospital affiliated to Zhejiang University between 2013.9 and 2016.12,and the expression level of the ER,PR and HER-2 receptors on the surface of tumor cells in the primary tumor resection specimens and recurrence or metastasis.Results:In this study,we analyzed the expression of three receptors in 96 patients with advanced breast cancer who underwent repeated or multiple biopsies.The mean age at 96 patients with advanced breast cancer was 49 years(from 33 years to 76 years).All patients with primary breast cancer underwent radical or modified radical mastectomy,and there were 96 patients who have adjuvant treatment such as radiotherapy,endocrine therapy and chemotherapy,and 6 patients had Herceptin targeted therapy.The ER,PR and HER2 were inconsistent in the primary breast tumor lesions and metastases,and the inconsistency rate was 20%,34%and 13%,respectively.The age of the patient,the recurrence/metastasis interval,the previous treatment such as endocrine therapy,chemotherapy and targeted therapy and other factors and three kinds of receptor expression is inconsistent Related.The potential adjustment rate of the treatment regimen in total patients was about 23%according to the changing expression of ER,PR and HER2.Conclusion:Research shows that there were a considerable amount of inconsistency in ER,PR and HER2 receptors between primary and recurrent/metastatic.The discordances of ER,PR and HER2 receptors between the primary and recurrence/metastatic lesions was found to be very likely to affect the patient’s follow-up treatment.Therefore,the study concluded that re-biopsy be recommended to metastatic breast cancer patients whenever possible.