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虽然乳腺原发肿瘤三大受体（雌激素受体、孕激素受体、人类表皮生长因子受体HER2）与乳腺癌患者预后密切相关，但是乳腺癌转移后三大受体转阴或转阳是否影响患者治疗和生存结局尚不明确。 2020年7月23日，国际抗癌联盟《国际癌症杂志》在线发表中国医学科学院肿瘤医院易宗毕、于佩、张粟、王文娜、韩逸群、王佳玉、范金虎、乔友林、徐兵河、中南大学湘雅医学院湖南省肿瘤医院欧阳取长、郑州大学河南省肿瘤医院闫敏、中国科学院大学浙江省肿瘤医院王晓稼、复旦大学附属肿瘤医院胡夕春、解放军总医院第五医学中心江泽飞、华中科技大学同济医学院附属协和医院黄韬、天津医科大学天津市肿瘤医院佟仲生、中山大学肿瘤防治中心中山大学肿瘤医院王树森、南京医科大学第一附属医院江苏省人民医院殷咏梅、四川省肿瘤医院李卉、昆明医科大学云南省肿瘤医院杨润祥、广西医科大学广西壮族自治区肿瘤医院杨华伟、中国医科大学附属第一医院滕月娥、中国医科大学辽宁省肿瘤医院孙涛、哈尔滨医科大学黑龙江省肿瘤医院蔡莉、重庆医科大学附属第一医院厉红元、解放军联勤保障部队第九〇〇医院陈曦、西安交通大学第一附属医院何建军、宁夏医科大学总医院刘新兰、新疆医科大学新疆维吾尔自治区肿瘤医院杨顺娥的中国晚期乳腺癌女性全国多中心临床流行病学研究报告，分析了乳腺癌转移后雌激素受体、孕激素受体、HER2状态再次检测的结果，以及受体转变对患者治疗和预后的临床意义。 NCT03047889: A Nation-wide Multicenter Clinical Epidemiologic Study of Chinese Females With Advanced Breast 该全国多中心回顾研究对2012年1月1日～2014年12月31日中国21家医院3295例晚期乳腺癌患者进行回顾分析，其中1583例（48.0%）再次检测了转移灶的受体状态。 原发灶与转移灶相比，受体状态不一致的女性占37.7%。 转移灶激素受体保持阳性与状态转变相比，一线和二线治疗的无进展生存结局相似（P>0.05）。 根据多因素分析，对诊断时年龄、初诊时肿瘤分期等影响因素进行校正后：
因此，该研究结果表明，乳腺癌转移灶受体转变比例高达37.7%，激素受体状态转变可能显著影响生存结局，故原发乳腺癌发生转移后，建议对转移灶重新进行受体检测，并有针对地加强治疗。 相关链接 Int J Cancer. 2020 Jul 23. Online ahead of print. Profile and outcome of receptor conversion in breast cancer metastases: a nation-wide multicenter epidemiological study. Yi ZB, Yu P, Zhang S, Wang WN, Han YQ, Ouyang QC, Yan M, Wang XJ, Hu XC, Jiang ZF, Huang T, Tong ZS, Wang SS, Yin YM, Li H, Yang RX, Yang HW, Teng YE, Sun T, Cai L, Li HY, Chen X, He JJ, Liu XL, Yang SE, Wang JY, Fan JH, Qiao YL, Xu BH. National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Hunan Cancer Hospital, Changsha, China; The affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China; Zhejiang Cancer Hospital, Hangzhou, China; Fudan University Shanghai Cancer Center, Shanghai, China; The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Tianjin Medical University Cancer Institute and Hospital, Tianjin, China; Sun Yat-sen University Cancer Center, Guangzhou, China; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Sichuan Province Tumor Hospital, Chengdu, Sichuan, China; Yunnan Cancer Hospital, Kunming Medical University, Kunming, China; Cancer Hospital, Guangxi Medical University, Guangxi, China; The First Hospital of China Medical University, Shenyang, China; Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China; Harbin Medical University Cancer Hospital, Harbin, China; The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China; 900 Hospital of the Joint Logistics Team, Fuzhou, China; The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China; Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China. Although receptor status included estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) of the primary breast tumors was related to the prognosis of breast cancer patients, little information is yet available on whether patient management and survival are impacted by receptor conversion in breast cancer metastases. Using data from the nation-wide multicenter clinical epidemiology study of advanced breast cancer in China (NCT03047889), we report the situation of retesting ER, PR and HER2 status for breast cancer metastases and evaluate the patient management and prognostic value of receptor conversion. In total, 3295 patients were analyzed and 1583 (48.0%) patients retesting receptor status for metastasis. Discordance in one or more receptors between the primary and the metastatic biopsy was found in 37.7% of women. Patients who remained hormone receptor (HR) positive in their metastases had similar progression free survival of first-line and second-line treatment compared to patients with HR conversion (P > 0.05). In multivariate analysis, patients who showed ER conversion from negative to positive had longer disease-free survival (DFS) than patients who remained negative in their metastases (hazard ratio, 2.05; 95% CI, 1.45-2.90; P < 0.001). Patients with PR remained positive had longer DFS than patients with PR conversion from negative to positive (hazard ratio, 0.56; 95% CI, 0.38-0.83; P = 0.004). Patients with PR conversion have shorter overall survival than patients with PR remained positive or negative (P = 0.016 and P = 0.041, respectively). Our finding showed that the receptors' conversions were common in metastatic breast cancer, and the conversion impacted the survival. KEYWORDS: Breast neoplasm; metastases; prognostic value; receptor conversion PMID: 32700765 DOI: 10.1002/ijc.33227 |
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