title: Hormonal receptor, human epidermal growth factor receptor-2, and Ki67 discordance between primary breast cancer and paired metastases: clinical impact.
abstract: OBJECTIVE
  As hormone receptor and human epidermal growth factor receptor-2 (HER-2) expression in primary breast tumors frequently differs from that of paired metastases, we first evaluated the discordance rate (DR) of estrogen receptor (ER), progesterone receptor (PgR), HER-2, and Ki67 in breast cancer patients and then assessed the discordance effect on prognosis.
  
  
  METHODS
  Of 145 cases reviewed, 120 with samples available from both primary tumors and paired metastases were included in the study. For each receptor, the DR was calculated as the proportion of discordant cases with respect to the total number of patients.
  
  
  RESULTS
  A change in ER status was observed in 19 cases (DR 16.4%), while PgR status was modified in 48 cases (DR 41.7%). HER-2 was altered in 21 cases (DR 17.5%), and Ki67 in 33 patients (DR 38.8%). Patients with Ki67 <20% had a significantly higher postrecurrence survival (PRS) compared to patients with Ki67 ≥20% (p = 0.0006). Patients with ER-positive tumors showed a trend towards higher PRS (p = 0.064) compared to ER-negative patients. No differences in PRS were seen among patients with altered PgR or HER2 status.
  
  
  CONCLUSIONS
  Changes in the cell biology of breast cancer metastasis would seem to occur and biopsy could potentially guide the choice of treatment and provide useful information on prognosis.
authors.affiliation: Osteoncology Center, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori I.R.S.T., IT-47014 Meldola, Italy. t.ibrahim@irst.emr.it
authors.forename: Toni
authors.initials: T
authors.lastname: Ibrahim
authors.forename: Alberto
authors.initials: A
authors.lastname: Farolfi
authors.forename: Emanuela
authors.initials: E
authors.lastname: Scarpi
authors.forename: Laura
authors.initials: L
authors.lastname: Mercatali
authors.forename: Laura
authors.initials: L
authors.lastname: Medri
authors.forename: Marianna
authors.initials: M
authors.lastname: Ricci
authors.forename: Oriana
authors.initials: O
authors.lastname: Nanni
authors.forename: Luigi
authors.initials: L
authors.lastname: Serra
authors.forename: Dino
authors.initials: D
authors.lastname: Amadori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D001943:Breast Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000378:metabolism / Q000401:mortality / Q000556:secondary; D018275:Carcinoma, Lobular / Q000378:metabolism / Q000401:mortality / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D019394:Ki-67 Antigen / Q000378:metabolism*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone