title: Receptor conversion in metastatic breast cancer: a prognosticator of survival.
abstract: This retrospective study investigated the association between hormone receptor (HR) conversion and survival in breast cancer patients.
  
  
  
  Estrogen receptor (ER) and progesterone receptor (PR) status (positive or negative) of primary tumors and of paired metastatic sites in 627 breast cancer patients were analyzed by McNemar's test for rates of receptor conversion. A survival analysis was performed using the Kaplan-Meier method, and prognostic factors were assessed using Cox's proportional hazards regression model.
  
  
  
  Conversion of ER occurred in 165 (26.31%) patients, and conversion of PR in 213 (33.97%; P < 0.001, both). For 82 patients whose ER and PR were reassessed 2-4 times during metastatic progression, ER and PR re-conversion occurred in 22 (26.83%) and 29 (35.36%), respectively. The change of ER or PR from positive to negative was associated with worse overall survival and post-recurrent survival (log-rank; P < 0.001, both). A subgroup analysis of HR-positive patients (i.e., positive ER, PR, or both) in primary tumor and HR-negative in metastatic sites showed that patients who accepted both salvage endocrine therapy and chemotherapy had better post-recurrent survival than did those who accepted salvage chemotherapy only (log-rank; P = 0.003).
  
  
  
  ER and PR status may change several times during metastatic tumor progression. A change of HR from positive to negative was associated with worse survival compared with consistent positivity. Repeated evaluations of HR status are necessary in metastatic breast cancer. Salvage hormonal therapy is still worth trying for patients whose HR status changes from positive to negative.
authors.affiliation: Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
authors.forename: Xiangying
authors.initials: X
authors.lastname: Meng
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
authors.forename: Santai
authors.initials: S
authors.lastname: Song
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
authors.forename: Ze-fei
authors.initials: ZF
authors.lastname: Jiang
authors.affiliation: Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Sun
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
authors.forename: Shaohua
authors.initials: Sh
authors.lastname: Zhang
authors.affiliation: Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
authors.forename: Shikai
authors.initials: Sh
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D012189:Retrospective Studies
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: breast cancer; estrogen receptor; metastases; progesterone receptor; survival