title: Patients with Concordant Triple-Negative Phenotype between Primary Breast Cancers and Corresponding Metastases Have Poor Prognosis.
abstract: OBJECTIVE
  We investigated the prognostic impact of discordance between the receptor status of primary breast cancers and corresponding metastases.
  
  
  METHODS
  A total 144 patients with breast cancer and distant metastasis were investigated. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status of primary tumor and corresponding metastases were assessed. Tumor phenotype according to receptor status was classified as triple-negative phenotype (TNP) or non-TNP. Concordance and discordance was determined by whether there was a change in receptor status or phenotype between primary and metastatic lesions.
  
  
  RESULTS
  The rates of discordance between primary breast cancer and metastatic lesions were 18.1%, 25.0%, and 10.3% for ER, PR, and HER2, respectively. The rates of concordant non-TNP, concordant TNP and discordant TNP were 65.9%, 20.9%, and 13.2%, respectively. Patients with concordant ER/PR-negative status had worse postrecurrence survival (PRS) than patients with concordant ER/PR-positive and discordant ER/PR status (p=0.001 andp=0.021, respectively). Patients who converted from HER2-positive to negative after distant metastasis had worst PRS (p=0.040). Multivariate analysis showed that concordant TNP was statistically significant factor for worse PRS (p<0.001).
  
  
  CONCLUSIONS
  Discordance in receptor status and tumor phenotype between primary breast cancer and corresponding metastatic lesions was observed. Patients with concordant TNP had worse long-term outcomes than patients with concordant non-TNP and discordant TNP between primary and metastatic breast cancer. Identifying the receptor status of metastatic lesions may lead to improvements in patient management and survival.
authors.affiliation: Department of Surgery, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Hee-Chul
authors.initials: HC
authors.lastname: Shin
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul, Korea.; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Wonshik
authors.initials: W
authors.lastname: Han
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul, Korea.; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyeong-Gon
authors.initials: HG
authors.lastname: Moon
authors.affiliation: Department of Pathology, Seoul National University Hospital, Seoul, Korea.
authors.forename: In-Ae
authors.initials: IA
authors.lastname: Park
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul, Korea.; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Dong-Young
authors.initials: DY
authors.lastname: Noh
keywords: Breast neoplasms; Estrogen receptor; Progesterone receptor; Survival; erbB-2