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Receptor Conversion between Primary Tumors and Distant Metastases in 121 Cases of Metastatic Breast Cancer

Author(s): Chaoying Wang | Lijun Di1 | Kun Yan | Huiping Li | Guohong Song | Hanfang Jiang | Shanshan Yin | Xu Liang | Ying Yan | Bin Shao | Fengling Wan | Jun Ren

Journal: International Journal of Clinical Medicine
ISSN 2158-284X

Volume: 04;
Issue: 02;
Start page: 102;
Date: 2013;
Original page

Keywords: Breast Cancer | Receptor Conversion | Estrogen Receptor | Progesterone Receptor | HER2

Introduction: Systemic treatment for metastatic breast cancer has typically been determined by the immunohistochemistry (IHC) characteristics of the primary tumor. However, recent studies have shown that the immunophenotype of distant breast cancer metastases may be different from that of the primary tumor (receptor conversion). Methods: From August 5, 2010 to November 1, 2012 atotal of 121 metastatic breast cancer tissues from different sites, bone metastases excluded, (56 liver, 37 lymph node, 20 chest wall, 7 contralateral breast, 1 abdominal nodule) were IHC stained for estrogen receptorα (ERα), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). For the 108 cases with primary tissue slides, expression was compared to the reviewed IHC of the primary tumors. This comparison is our emphasis to avoid the difference between centers. For the other 13 cases whose primary tumors can not be acquired, the primary pathology reports were taken as reference. HER2 fluorescence in situ hybridization (FISH) was used in the case of HER2 2+ results. Results: At a 10% threshold, receptor conversion as determined by IHC for ERα and PR occurred in 25.0% and 25.9% of cases, respectively. Conversion from ER+ or PR+ to ER–/PR– occurred in 14.1% of cases, and from ER–/PR– to ER+ or PR+ in 7.7%. At a 1% threshold, receptor conversion by IHC for ERα and PR occurred in 23.2% and 27.7% of cases, respectively. Conversion from ER+ or PR+ to ER–/PR–occurred in 14.1% of cases and from ER–/PR– to ER+ or PR+ 9.0%. HER2 conversion occurred in 12.1% of patients, and was mainly from negative in he primary tumor to positive in metastases. Conclusion: In metastatic breast cancer conversion is relatively more frequent for PR, and then ER. HER2 conversion is relatively rare.
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