The Study About The Discordance Of ER,PR And Her-2 Expression In The Primary Breast Cancer Between Brain Metastases And Its Clinical Significance

Background:Breast cancer has become a global problem that threatens women's life.The most difficult thing about treatment of breast cancer is brain metastasis,which seriously affects the survival of patients.Estrogen receptor(ER),Progesterone receptor(PR)and Human epidermal growth factor receptor 2(Her-2)of breast cancer are important biological markers,which can judge the prognosis of patients and also particularly important for treatment decisions.However,whether the ER,PR and Her-2 states of the primary breast cancer between brain metastases is consistent or not,there is no uniform conclusion now and its deserve to make research.Method:In this paper,we retrospectively analyzed the patients with brain metastases from breast cancer in our hospital from April 1997 to March 2017.The data were analyzed by SPSS 16.0 statistical software and multivariate analysis was performed.Result:Our research suggested that loss of receptor positivity was seen in brain metastases for ER and PR,respectively.In other words,ER and PR have discordance between primary and metastatic breast tumor.Highest concordance between primary and brain metastases was seen for Her-2 status in almost 80.9%.Changes in subtypes were seen in about 9.1%.However,no change of subtype was seen in the triple-negative cases.Change of ER status from primary to brain metastases was shown in 36.4%and in 50.0%of PR status,respectively.PR status showed a higher rate of change compared to ER status,with a higher rate of PR receptor positivity loss in brain metastases.The discordance of ER and PR status and the consistency of Her-2 state also have a certain effect on the survival of patients.Patients with positive ER and PR status of primary had a slightly longer median interval until the occurrence of brain metastases than patients with negative ER or PR status.Patients with Her-2 positive breast cancer had shortest time to appearance of brain metastases compared to Her-2 negative breast cancer patients and correlated with ER and PR status(23.0m vs.31.5m).Patients with receptor change of ER status showed shorter median interval until the occurrence of brain metastases compared to patients without ER receptor change(32.0m vs.52.0m).In contrast,patients with receptor change of PR showed similar median interval until the occurrence of brain metastases compared to patients without receptor change.Patients with change of Her-2 status showed shorter survival than patients without change.Conclusion:There is a clear discordance in the expression of ER and PR between brain metastases and primary lesions of breast cancer,however,Her-2 expression is consistent.As the the ER and PR-positive state loss at the brain metastases from primary breast cancer,alternative treatment methods are also reduced accordingly,only chemotherapy combined with targeted drug therapy are recommended.