乳腺癌ER、PR、HER-2在原发灶及复发转移灶中表达变化

目的：探讨ER、PR及Her-2在乳腺癌原发和复发转移灶中的表达变化及其相关性。方法：免疫组化法检测45例乳腺癌原发及复发转移灶中的ER、PR及HER-2表达。结果：ER在原发灶和复发转移灶之间的变化率为66.67%（30/45）,PR总的变化率为17.78%,cerbB2癌基因蛋白总的变化率13.33%。结论：ER在乳腺癌原发灶和复发转移灶之间的表达的差异具有统计学意义（P〈0.05）。PR及cerbB2癌基因蛋白的表达在原发灶和复发转移灶之间差异无显著性（P〉0.05）。     

乳腺癌ER、PR、HER-2在原发灶及复发转移灶中表达变化

目的:探讨ER、PR及Her-2在乳腺癌原发和复发转移灶中的表达变化及其相关性。方法:免疫组化法检测45例乳腺癌原发及复发转移灶中的ER、PR及HER-2表达。结果:ER在原发灶和复发转移灶之间的变化率为66.67%(30/45),PR总的变化率为17.78%,cerbB2癌基因蛋白总的变化率13.33%。结论:ER在乳腺癌原发灶和复发转移灶之间的表达的差异具有统计学意义(P<0.05)。PR及cerbB2癌基因蛋白的表达在原发灶和复发转移灶之间差异无显著性(P>0.05)。     

雌、孕激素受体及HER-2受体在乳腺癌原发灶及复发转移灶之间的表达差异

背景与目的：乳腺癌内分泌治疗及免疫靶向药物赫赛汀生物治疗的前提是相应的雌激素受体(estrogen receptor,ER)、孕激素受体(progestin receptor,PR)的阳性表达及HER-2受体的过表达。目前对复发转移的乳腺癌病例受体表达情况的判断主要依据原发灶,而忽略了原发灶和复发转移灶之间可能存在的差异。本文着重研究ER、PR及HER-2受体在乳腺癌原发灶和复发转移灶之间的表达差异,探讨其临床意义。方法：免疫组织化学方法检测65例复发转移的乳腺癌病例中ER、PR及HER-2受体在原发灶及复发转移灶之间的表达差异。结果：ER的阳性率在原发灶和复发转移灶之间的差异有显著性,PR及HER-2受体的阳性率在两者之间的差异无显著性;ER在原发灶和复发转移灶之间总的变化率为35．4％,PR总的变化率为29．2％,HER-2受体总的变化率为16．9％。结论：ER在乳腺癌原发灶和复发转移灶之间的表达存在显著性差异。PR及HER-2受体的表达在原发灶和复发转移灶之间存在差异,虽无统计学意义,但在对复发或转移乳腺癌进行临床治疗时,仍应考虑上述三种指标在复发、转移灶里的确切状况。     

Comparative study of the immunohistochemical detection of hormone receptor status and HER-2 expression in primary and paired recurrent/metastatic lesions of patients with breast cancer

Recent studies have shown some degrees of discordance in ER, PR and HER-2 immunohistochemical expression between primary and recurrent/metastatic lesions (RML). Analysis was made on 78 patients with MBC whose ER, PR and/or HER-2 status were known both on the tissue samples of primary and RML. Among the RML sites, 29.5% were locoregional, 70.5% were distant metastatic sites. Among 75 patients with known ER expression on both primary and RML, 36% (n = 27) showed discordance on ER expression. Among 72 patients with known PR expression on both primary and RML, 54.2% (n = 39) showed discordance on PR expression. Among 61 patients with known HER-2 expression on both primary and RML, 14.7% (n = 9) showed discordance on HER-2 expression. No differences were observed when we compared patients who have discordant ER and HER-2 status with patients who have concordant results between the primary tumor and paired RML with respect to site of biopsy (locoregional vs distant metastasis) and prior therapies (chemotherapy and endocrine therapy). As these discordant results make changes in treatment decision, a biopsy of the metastatic lesion could be recommended in patients with MBC when feasible. Larger series are needed to identify the potential effect of prior therapies and site of metastasis on discordant results.     

同期腋窝转移淋巴结受体检测在激素受体阴性乳腺癌中的临床意义

  目的   探讨同期腋淋巴结转移病灶雌激素受体（estrogen receptor,ER）和孕激素受体（progesterone receptor,PR）补测在激素受体阴性浸润性乳腺癌中的临床意义。   方法   观察2012年7月至2013年1月,重庆医科大学附属第一医院内分泌乳腺外科门诊随访及住院患者中补测激素受体阴性乳腺癌同期腋淋巴结转移病灶ER和PR的表达情况,所有标本（包括原发癌病灶及同期腋淋巴结转移病灶）的免疫组织化学检测均由重庆医科大学病理检测中心进行,根据检测报告,原发病灶阴性而腋淋巴结转移病灶ER和/或PR阳性者补加内分泌治疗。   结果   56例激素受体阴性乳腺癌中,同期腋淋巴结转移病灶ER阳性8例（14.3%）,PR阳性2例（3.6 %）,ER和PR均阳性3例（5.4%）,共13例（23.3%）因补查腋淋巴结转移病灶ER和/或PR变阳性而在随访中加用内分泌治疗。肿瘤原发病灶与腋转移淋巴结ER和PR均阴性43例（76.7%）,即肿瘤原发癌病灶与腋转移淋巴结ER和PR均为阴性表达的总符合率为76.7%,不一致率为23.3%。   结论   受体阴性浸润性乳腺癌原发病灶与腋淋巴结转移病灶ER和PR表达具有一定的不一致性,对原发癌病灶激素受体阴性乳腺癌患者应检查其同期腋淋巴结转移病灶受体的表达,可能筛查出原发病灶受体阴性而复发转移病灶受体阳性患者,及时加用内分泌治疗,提高该类患者的疗效,亦可解释部分激素受体阴性而内分泌治疗也有一定疗效的原因。      

乳腺癌原发灶与腋淋巴结转移灶ER和PR及c-erbB-2表达的对照研究

目的:研究雌激素受体(ER)、孕激素受体(PR)和c-erbB-2在乳腺癌原发灶和同期腋淋巴结转移灶之间的表达差异。方法:免疫组织化学方法检测60例初治单侧乳腺癌同期腋窝淋巴结转移手术治疗患者ER、PR和c-erbB-2在原发灶及腋淋巴结转移灶的表达差异。结果:ER在乳腺癌原发灶中的阳性率为56.7%(34/60),腋淋巴结转移灶中为48.3%(29/60);PR在乳腺癌原发灶中的阳性率为55.0%(33/60),腋淋巴结转移灶为48.3%(29/60);c-erbB-2在乳腺癌原发灶中的阳性率为26.7%(16/60),腋淋巴结转移灶为28.3%(17/60);ER、PR和c-erbB-2的阳性率在两者之间的差异均无统计学意义。ER在原发灶和腋窝淋巴结转移灶之间总的变化率为21.7%(13/60),PR为16.7%(10/60),c-erbB-2为15.0%(9/60)。结论:ER、PR和c-erbB-2的表达在乳腺癌原发灶和腋窝淋巴结转移灶之间存在不一致现象,但无统计学意义。判断乳腺癌的预后要综合考虑其原发灶和转移灶的生物学特性。     

雌孕激素受体与女性原发乳腺癌术后复发转移关系的临床研究

目的:分析乳腺癌患者雌激素受体(es-trogen receptor,ER)和孕激素受体(progesteronereceptor,PR)状态与术后复发、转移部位的关系。方法:1989~1994年经天津医科大学附属肿瘤医院收治乳腺癌病例且雌、孕激素受体明确、术后随访完整的病例1372例。根据ER和PR状态分组,总结ER和PR状态与首次治疗后发生复发、转移部位的关系。结果:ER /PR 组患者皮肤、骨骼转移率为10·91%,明显高于ER-/PR-组(5·56%),P=0·0053;ER-/PR-组内脏转移率为15·56%,高于ER /PR 组(3·64%),P=0·0000。激素依赖性组5年总生存率和无瘤生存率(82·31%,80·04%)高于非激素依赖性组(77·22%,73·89%),P<0·05。两组10年总生存率、无瘤生存率并无区别。结论:乳腺癌在晚期转移部位与ER、PR受体状态有关,ER /PR 组5年总生存率、无瘤生存率高于ER-/PR-组,进行综合治疗是提高总生存率、无瘤生存率的关键。     

Discordance in Hormone Receptor Status Among Primary,Metastatic, and Second Primary Breast Cancers: Biological Difference or Misclassification?

Introduction.

Discordance in hormone receptor status has been observed between two breast tumors of the same patients; however, the degree of heterogeneity is debatable with regard to whether it reflects true biological difference or the limited accuracy of receptor assays.

Methods.

A Bayesian misclassification correction method was applied to data on hormone receptor status of two primary breast cancers from the Surveillance, Epidemiology, and End Results database between 1990 and 2010 and to data on primary breast cancer and paired recurrent/metastatic disease assembled from a meta-analysis of the literature published between 1979 and 2014.

Results.

The sensitivity and specificity of the estrogen receptor (ER) assay were estimated to be 0.971 and 0.920, respectively. After correcting for misclassification, the discordance in ER between two primary breast cancers was estimated to be 1.2% for synchronous ipsilateral pairs, 5.0% for synchronous contralateral pairs, 14.6% for metachronous ipsilateral pairs, and 25.0% for metachronous contralateral pairs. Technical misclassification accounted for 53%–83% of the ER discordance between synchronous primary cancers and 11%–25% of the ER discordance between metachronous cancers. The corrected discordance in ER between primary tumors and recurrent or metastatic lesions was 12.4%, and there were more positive-to-negative changes (10.1%) than negative-to-positive changes (2.3%). Similar patterns were observed for progesterone receptor (PR), although the overall discordance in PR was higher.

Conclusion.

A considerable proportion of discordance in hormone receptor status can be attributed to misclassification in receptor assessment, although the accuracy of receptor assays was excellent. Biopsy of recurrent tumors for receptor retesting should be conducted after considering feasibility, cost, and previous ER/PR status.     

HER-2/<Emphasis Type="Italic">neu</Emphasis> expression in primary and metastatic breast cancer

Introduction Trastuzumab is a highly effective therapy for the treatment of HER-2/neu positive breast cancer. To maximize benefit and minimize unnecessary toxicity, patient selection is essential. Currently HER-2/neu analysis is routinely performed only for primary invasive breast cancers, and trastuzumab therapy is recommended based on primary analysis only. Methods Using immunohistochemistry, we performed a retrospective study comparing HER-2/neu expression in original primary to subsequent metastatic breast cancers. Results Tumors from 382 patients with metastatic breast cancer were studied. In 254 cases (66%) both primary and metastatic lesions were concordant. In 90 cases the primary lesion was HER-2/neu positive with the metastatic lesion negative; whereas, in 37 cases the primary lesion was HER-2/neu negative and the metastatic lesion positive. Primary HER-2/neu immunostaining was associated with a negative predictive value of 35.7%. Although all four groups were similar at diagnosis, survival differences were noted with the best survival experienced by patients with initial primary lesions HER-2/neu negative and subsequent metastatic lesions positive. Patients with hormone receptor and HER-2/neu positive primary lesions who received tamoxifen were more likely to have HER-2/neu positive metastasis. Conclusions The significant discordance between HER-2/neu expression in primary and metastatic tumors suggests that determination of HER-2/neu status in metastatic disease should be attempted.     

The Case to Case Comparison of Hormone Receptors and HER2 Status between Primary Breast Cancer and Synchronous Axillary Lymph Node Metastasis

Background: Nowadays, the adjuvant treatment for breast cancer patients chosen depends on immunohistochemical pattern of Estrogen receptor(ER), Progesterone receptor(PR) and HER2 status of primary breast tumor. Several retrospective studies showed significant discordance in receptor expression between primary and metastatic tumors. The objective of this research was to determine discordant rate of ER, PR and HER2 status between primary breast cancer and synchronous axillary lymph node metastasis of individual breast cancer patients in Thammasat University Hospital. Methods: A prospective observational study of all breast cancer patients who have axillary metastasis and underwent surgery at Thammasat Hospital between January 2011 to December 2015. Tumor staging, ER, PR, and HER2 status on primary breast tumor were recorded. Synchronous axillary lymph node metastasis was evaluated with immunohistochemistry for ER, PR, and HER2. Results: The ER-positive rate from primary tumor to synchronous axillary lymph node metastasis decreased from 74.7% to 71.7%; the HER2 overexpression rate was decreased from 26% to 24%. In contrast, PR positive rate were 71% in both primary tumor and synchronous axillary lymph node metastasis. In case to case comparison, discordance rate of ER, PR and HER2 status between primary breast cancer and synchronous axillary lymph node metastasis were 11.1%, 20.2% and 10.1%, respectively. Furthermore, the tumor staging was not significant associated with discordance of ER, PR and HER2. Conclusion: ER, PR and HER 2 biomarkers showed significant concordance between primary tumor and synchronous axillary lymph node metastasis. Hence, if we cannot assess the ER, PR and HER2 status in primary tumor, then synchronous axillary lymph node metastasis can be studied instead. However, the repeat of biomarker testing in node-positive breast cancer patients may be beneficial for tailored adjuvant therapy, especially for patients with negative hormone receptor and/or HER2 profile on primary tumor.     

Discordance in ERα, PR and HER2 receptor status across different distant breast cancer metastases within the same patient

BackgroundWe studied discordance in estrogen receptor alpha (ERα), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status between multiple distant metastases from the same breast cancer patient.Material and methodsMultiple distant metastases from 55 female patients were stained for ERα, PR and HER2 by immunohistochemistry and in situ hybridization for confirmation of the HER2 status.ResultsDifferent metastatic sites within the same patient showed discordance in ERα receptor status in 7.3% or 10.9% of patients (using a 10% or 1% threshold for positivity, respectively). For PR, 29.1% or 30.9% of patients showed discordance. Taking ERα and PR together, 36.4% of cases (both thresholds) showed discrepancy between metastases. In 10.9% (10% threshold) or 14.5% of patients (1% threshold), such discordance could have clinical consequences with regard to hormonal treatment. For HER2, there was 3.6% discordance on the immunohistochemical level but 0% on the gene level.ConclusionIn a significant proportion of metastatic breast cancer patients, discordance in ERα and PR receptor status between different metastatic sites was observed. This implies that multiple metastases may need to be biopsied to optimally reassess receptors.     

乳腺癌孕酮受体对预后的影响

Estrogen and progesterone receptors (ER and PR) were detected in 400 women with primary breast cancer from 1979 to 1986. Cytosols showing saturable binding of 10 fmol/mg protein or more were taken as positive for ER and PR. The positive rate was 55.5% and 42.8%, respectively in this series. PR negative patients had higher risk of early recurrence than PR positive patients according to the highly significant difference between the two disease-free survival curves (P less than 0.01). The relative risk of recurrence in the PR negative group was 3.2 times higher than PR positive group (P less than 0.01). Simple ER positive or ER negative did not provide any relevant information for predicting the disease-free survival in this present series. Thirty months after mastectomy, 32.2% of the patients with PR negative tumors had recurrent disease as compared with the PR positive group (10.2%) (p less than 0.01). The recurrent rate was negatively correlated with tumor PR concentration. The prognostic value of PR status with respect to clinical stage, menopausal status and axillary node involvement is discussed. It is concluded that the PR content of breast cancer is an important predictor of prognosis and will help us to formulate treatment plan for the patients.     

细针穿刺检测乳腺癌原发灶和转移灶ER、PR及C-erbB-2受体表达差异的意义

目的 探讨细针穿刺检测乳腺癌原发灶和转移灶雌激素受体(ER)、孕激素受体(PR)及C-erbB-2受体表达差异的意义.方法用细针穿刺检测60例乳腺癌原发灶和转移灶ER、PR及C-erbB-2受体表达情况,同时对其中28例乳腺癌原发灶ER、PR及CerbB-2受体表达的术后检测结果进行了对照分析.结果28例乳腺癌原发灶的...     

The effect of estrogen usage on the subsequent hormone receptor status of primary breast cancer

In order to determine if prior use of exogenous estrogens was related to the estrogen receptor (ER) content of primary breast cancers, a retrospective analysis was performed from 536 patients with invasive breast cancer. The patient's age, menopausal status, oral contraceptive or estrogen replacement therapy usage, and the ER and progesterone receptor (PR) content of the breast cancer were recorded for all patients. Hormone usage in premenopausal and postmenopausal patients was compared to ER and PR levels in primary breast cancers using nonparametric testing. Complete information was available from 508 (193 premenopausal and 315 postmenopausal) patients. Breast cancers were ER positive in 72% of postmenopausal patients and 57% of premenopausal patients. The majority of patients received 'Some' form of hormone therapy (111 of 193 premenopausal patients and 233 of 315 postmenopausal patients). Significantly more estrogen receptors were detected in tumors from patients receiving 'some' estrogen therapy compared to 'never' users. Postmenopausal patients 'never receiving estrogen therapy had a lower rate of ER positive tumors (62%) compared to 'some' users (75% ²=4.99, p<0.05). The same relationship was seen for PR ('never' users 44% positive, 'some' users 58% positive, ²=5.19, p<0.05). We conclude that postmenopausal patients who received 'some' estrogen therapy are more likely to have breast cancers that are estrogen receptor and progesterone receptor positive.     

Discordances in Estrogen Receptor Status,Progesterone Receptor Status,and HER2 Status Between Primary Breast Cancer and Metastasis

Background.

The primary aim of this retrospective study was to investigate intraindividual correlation of estrogen receptor (ER) status, progesterone receptor (PR) status, and HER2 status between primary breast cancer and metastatic breast cancer (mBC). Secondary aims included patients'' characteristics, overall survival, feasibility of histopathological evaluation in the metastatic setting, and predictive factors associated with receptors status discordance.

Methods.

Patients with either biopsy of metastatic relapse or surgery of metastasis were identified. Demographics, tumor characteristics, treatment characteristics, and ER, PR, and HER2 statuses were retrospectively obtained in patients'' reports. Receptors statuses were assessed by immunohistochemistry with a positivity cutoff of more than 10% for ER and PR. HER2 was considered as positive if overexpression was scored at 3+ in immunohistochemistry or if amplification ratio was >2 in fluorescent in situ hybridization.

Results.

From a cohort of 489 patients with mBC, 269 patients had histopathological samples of metastatic relapse. Histopathological analysis of the specimen confirmed the diagnosis of mBC in 235 patients. Discordance in one or more receptors between primary breast cancer and mBC was found in 99 patients (42%). A switch in receptor status was identified for ER in 17% of tumors (p = 4 × 10⁻³), PR in 29% of cancers (p < 4 × 10⁻⁴), and HER2 in 4% of lesions (p = .16). Exposure to chemotherapy and to anthracycline-based chemotherapy was statistically associated with switches in ER status. Seven (2%) second malignancies and three benign diseases (1%) were diagnosed.

Conclusions.

This study confirms that discordance in ER and PR receptor expression between the primary breast tumor and the corresponding metastatic lesions is high, whereas HER2 status remains relatively constant. Chemotherapy, and specifically anthracycline-based chemotherapy, was associated with switch in ER status. These results were obtained in a selected population of patients; further studies are warranted to confirm these data and to determine the interest of systematic rebiopsy in the metastatic setting.     

Prognostic impact of discordance between triple-receptor measurements in primary and recurrent breast cancer

BackgroundWe evaluated discordance in expression measurements for estrogen receptor (ER), progesterone receptor (PR), and HER2 between primary and recurrent tumors in patients with recurrent breast cancer and its effect on prognosis.MethodsA total of 789 patients with recurrent breast cancer were studied. ER, PR, and HER2 status were determined by immunohistochemistry (IHC) and/or FISH. Repeat markers for ER, PR, and HER2 were available in 28.9%, 27.6%, and 70.0%, respectively. Primary and recurrent tumors were classified as triple receptor-negative breast cancer (TNBC) or receptor-positive breast cancer (RPBC, i.e. expressing at least one receptor). Discordance was correlated with clinical/pathological parameters.ResultsDiscordance for ER, PR, and HER2 was 18.4%, 40.3%, and 13.6%, respectively. Patients with concordant RPBC had significantly better post-recurrence survival (PRS) than discordant cases; patients with discordant receptor status had similarly unfavorable survival as patients with concordant TNBC. IHC scores for ER and PR showed weak concordance between primary and recurrent tumors. Concordance of HER2–FISH scores was higher.ConclusionsConcordance of quantitative hormone receptor measurements between primary and recurrent tumors is modest consistent with suboptimal reproducibility of measurement methods, particularly for IHC. Discordant cases have poor survival probably due to inappropriate use of targeted therapies. However, biological change in clinical phenotype cannot be completely excluded.     

Stability of estrogen receptor status in breast carcinoma: a comparison between primary and metastatic tumors with regard to disease course and intervening systemic therapy

BACKGROUND:

The purposes of this study were to address a persistent controversy as to whether the ER status of a primary tumor remains stable during progression to metastasis and to evaluate the influence of disease course and prior systemic therapy on ER status.

METHODS:

Breast carcinomas from 227 women with known ER status in both primary tumor and paired metastasis were retrospectively reviewed. ER status was compared between primary and metastatic tumors with respect to metastatic site, interval between two ER assays, and intervening chemotherapy and endocrine therapy. Semiquantitative comparison of ER values was performed for 92 tumor pairs.

RESULTS:

ER status agreed in 210 (92.5%) patients, including 147 positive and 63 negative. Of the 17 patients (7.5%) with discordant ER status, both negative to positive conversion (n = 7) and positive to negative conversion (n = 10) were observed. ER discordance was not significantly associated with metastatic site (locoregional vs distant), time interval between assays (<5 years vs. ≥5 years), or intervening chemotherapy and endocrine therapy. Semiquantitative levels of ER expression were similar between primary and metastatic tumors. In discordant cases, variations in testing methods and marginal scores were common.

CONCLUSIONS:

ER status in breast carcinoma is generally stable during progression to metastasis. Preanalytical and analytical variability may contribute to discordance in some cases. Given the importance of ER status for clinical management, ER testing in metastatic breast carcinoma should be repeated, especially for patients whose clinical courses are not compatible with stated ER status. Cancer 2011. © 2010 American Cancer Society.     

Incidence and prognostic significance of receptor discordance between primary breast cancer and paired bone metastases

ER, PgR and HER-2 status are the cornerstones of choosing systemic therapy for breast cancer, but can change during the disease course. Guidelines recommended the biopsy of the metastatic tumor to reassess receptor status. Bone is the most frequent metastatic site of breast cancer but remained technically difficult to biopsy. Our study aimed to evaluate the incidence and prognostic significance of receptor discordance between primary breast cancer and paired bone metastases. One hundred and fifty-five breast cancer patients were diagnosed with pathology-confirmed bone metastasis at Fudan University Shanghai Cancer Center. Ninety-three patients with receptor status available on both primary tumor and bone metastases were included in our study. ER, PgR and HER-2 status converted from positive to negative in 10.8% (10/93), 28.0% (26/93) and 8.6% (8/93) of the patients, while ER, PgR and HER-2 status converted from negative to positive in 3.2% (3/93), 4.3% (4/93) and 1.1% (1/93) of the patients, respectively. 40.4% (17/42) of the HER2-0 tumors converted to HER2-low, which enabled them to receive the treatment of new antibody-drug conjugates (ADCs). Prior endocrine and anti-HER2 therapy were the independent risk factors for receptor conversion. Loss of HR expression in bone metastases was significantly associated with worse first-line PFS (adjusted hazard ratio = 3.271, P-value = .039) and OS (adjusted hazard ratio = 6.09, P-value = .011). In conclusion, our study confirmed that patients may experience receptor conversion between primary breast cancer and bone metastases, possibly influenced by prior treatments, which significantly influenced prognosis. The rebiopsy of bone metastases in patients with primary HER2-0 tumors may benefit from the new ADC drugs.     

乳腺癌原发灶与转移灶内ER、PR、Her-2表达的差异及其对治疗的影响

目的:探索ER、PR、Her-2在乳腺癌原发灶及转移灶内表达的差异，及其对治疗的影响。方法:用IHC方法对44例有淋巴结或者远处转移灶或者局部复发的乳腺癌患者原发灶及转移灶标本配对进行ER、PR、Her-2检测，然后分别计算二者表型的表达率以及变化率，并根据原发灶及转移灶ER、PR、Her-2表达的情况调整治疗方案用于临床治疗。结果:44例乳腺癌组织的ER、PR、Her-2在原发灶的阳性表达率分别为68.2%、61.4%、18.2%，而在转移灶中的阳性表达率分别为65.9%、63.6%、9.1%，三者在原发灶及转移灶中的阳性表达率差异均无显著统计学意义。 ER、PR、Her-2在原发灶与转移灶间的总变化率分别为:25.0%（11例）、27.3%（12例）、9.1%（4例）。44例乳腺癌患者中，内分泌治疗增加12例，占比27.3%。结论:由于ER、PR、Her-2在乳腺癌原发灶与转移灶间的表达存在一定的差异，因此，对复发转移灶的受体再检查是必要的，并根据原发灶及转移灶的受体表达情况综合考虑治疗方案。     

Association between HER-2/neu and the progesterone receptor in oestrogen-dependent breast cancer is age-related

Summary In oestrogen receptor-positive (ER⁺) breast cancer, HER-2/neu and the progesterone receptor (PR) are inversely associated. This explains a lower response to anti-oestrogens if ER⁺ breast cancers are HER-2/neu positive. One randomized study however, showed that premenopausal women with an ER⁺ breast cancer respond to anti-oestrogens independent of HER-2/neu. We therefore hypothesized an age-related association between HER-2/neu and PR in ER⁺ breast cancers. Receptors for ER, PR and HER-2/neu were analysed by immunohistochemistry (IHC). A uni- and multivariate analyses was carried out to assess this relationship in 1104 women with an ER⁺ breast cancer. We observed an inverse association between HER-2/neu and PR only after age 45. There were 173 women of age 45 and 931 of age >45 years. In multivariate analysis, only tumour grade (p=0.005) but not PR status was associated with HER-2/neu in women age 45 years. However, in age >45 years group, both PR status (p=0.001) and tumour grade (p = 0.001) were independently associated with HER-2/neu. In ER⁺ breast cancers from women age >45, PR was positive in 76.9% if HER-2/neu negative but in 53.4% if HER-2/neu positive (p<0.001) and the median quantitative PR levels are 150 and 75 respectively in HER-2/neu negative and HER-2/neu positive tumours (p=0.002). This age effect of HER-2/neu on the PR status was not seen in women age 45 years and the median quantitative PR levels are 200 and 220 respectively in HER-2/neu negative and HER-2/neu positive tumours (p = 0.518). The study confirms an age-related inverse relationship between HER-2/neu and PR only in women age >45 years but not in women age 45 years.