title: The variation and clinical significance of hormone receptors and Her-2 status from primary to metastatic lesions in breast cancer patients.
abstract: The objective of this study is to investigate how the change of hormone receptor (HR) and human epidermal growth factor receptor-2 (Her-2) status is related to patients' clinical features. One hundred ninety-three cases of patients treated at general hospital of PLA from 2000 to 2015 with advanced breast cancer were included. All patients developed recurrence that were re-biopsied and had complete pathological profile both at initial diagnosis and at relapse. HR status before and after relapse were available for all patients, while only 143 cases had Her-2 status at the two stages. The changes of ER, PR, and Her-2 status and their association with clincopathological factors and DFS were analyzed. The discordant rates of ER, PR, and Her-2 status between primary breast cancer and recurrent tumor were 34.2, 38.3, and 16.8 %, respectively. At relapse, the rates of gain of ER and PR positivity were 10.9 and 13.5 %, respectively; the rates of loss of ER and PR positivity were 23.3 and 24.9 %. Loss of positivity was more frequent than gain of positivity (p ER < 0.000, p PR = 0.001). Among patients with Her-2 negative primary tumors, 15.4 % acquired Her-2 positivity at relapse; and among Her-2 positive patients at initial diagnosis, 1.4 % turned to Her-2 negative at relapse; gain of positivity was more frequent than loss of positivity (p < 0.000). Patients with tumor larger than 2 cm in diameter were more likely to experience change of Her-2 status (25.0 vs 5.8 %, p = 0.005). Yet, the change of ER/PR was not significantly associated with the size of primary tumor. Patients with ER positive recurrent disease and PR positive primary tumor had a DFS of more than 40 months. Compared to patients who maintained PR negative, patients who gained PR positivity at relapse had significantly longer DFS by 8.5 % (35.2 vs 26.7 months, p = 0.024). Patients losing ER positivity at relapse had shorter DFS by 7.8 months compared to those with stable ER positive tumors; patients gaining ER positivity experienced longer DFS by 8.3 months; but both differences were not statistically significant. Loss of Her-2 positivity was associated with longer DFS by 13.8 months as opposed to stable Her-2 status, without statistical significance. For patients with Her-2 negative primary tumor, the changes of Her-2 status were not associated with DFS. 34.2, 38.3, and 16.8 % of breast cancer patients had their ER, PR, and Her-2 status changed after recurrence, and these changes of receptor status were associated with DFS to some degree. Gain of PR positivity at relapse was significantly correlated with longer DFS.
authors.affiliation: Department of Medical Oncology I, General Hospital of the People's Liberation Army, 28 Fuxing Road of Haidian District, 100853, Beijing, China.
authors.forename: Yan-Yun
authors.initials: YY
authors.lastname: Zhu
authors.affiliation: Department of Medical Oncology I, General Hospital of the People's Liberation Army, 28 Fuxing Road of Haidian District, 100853, Beijing, China.|School of Medicine, Nankai University, 100853, Tianjin, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Si
authors.affiliation: Department of Medical Oncology I, General Hospital of the People's Liberation Army, 28 Fuxing Road of Haidian District, 100853, Beijing, China.
authors.forename: Tie-Feng
authors.initials: TF
authors.lastname: Ji
authors.affiliation: First Outpatient Division of Management Bureau, Headquarters of the General Logistics Department, 22 Fuxing Road of Haidian District, 100842, Beijing, China.
authors.forename: Xiao-Qin
authors.initials: XQ
authors.lastname: Guo
authors.affiliation: Department of Medical Oncology I, General Hospital of the People's Liberation Army, 28 Fuxing Road of Haidian District, 100853, Beijing, China. huyi0401@aliyun.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Medical Oncology I, General Hospital of the People's Liberation Army, 28 Fuxing Road of Haidian District, 100853, Beijing, China. yangjunlan301@sina.cn.
authors.forename: Jun-Lan
authors.initials: JL
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001706:Biopsy; D001943:Breast Neoplasms / Q000737:chemistry* / Q000473:pathology / Q000628:therapy; D002277:Carcinoma / Q000737:chemistry* / Q000473:pathology / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D019468:Disease Management; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008408:Mastectomy; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; D011960:Receptors, Estrogen / Q000032:analysis*; D011980:Receptors, Progesterone / Q000032:analysis*; D000068878:Trastuzumab / Q000627:therapeutic use; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: Breast cancer; Disease-free survival; Estrogen receptor; Her-2; Progesterone receptor