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

Discordance of Estrogen Receptor (ER), Progestin Receptor (PR), and HER-2 Rece ptor Statuses between Primary and Metastatic Focuses of Breast Cancer

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(estrogenreceptor,ER)、孕激素受体(progestinreceptor,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。

BACKGROUND &OBJECTIVE: Hormone and Herceptin therapy for metasta ti c breast cancer is commonly based on expression of estrogen receptor (ER)and p rogestin receptor (PR), and over-expression of HER-2 in primary breast cance r, but studies comparing receptor statuses in primary and metastatic focuses of the same patient are limited. This study was designed to investigate discordance of ER, PR,and HER-2 statuses between primary and metastatic focuses of breast cancer. METHODS: Immunohistochemistry assay was used to detect expression of ER, PR, and HER-2 receptor in primary and metastatic focuses of 65 cases of breast cancer. RESULTS: Positive rate of ER in primary focuses was 56.9%(37/65), sign ificantly higher than that in metastatic focuses (33.8%, 22/65)(P< 0.01); whi le positive rates of PR and HER-2 receptor have no significant difference betwe en primary and metastatic focuses. Total discordance rates of ER, PR, and HER-2 were 35.4%, 29.2%, and 16.9%, respectively. CONCLUSION: Difference in expres sion level of ER between primary and metastatic focuses of breast cancer was sig nificant, while differences of expression of PR, and HER-2 wasnt significant, but we still should think highly of the expression differences of ER,PR,and HER -2 in our clinical practices.