转移病灶再活检对乳腺癌患者的临床意义

目的 比较雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER-2）在乳腺癌原发灶及转移灶中的表达差异，探讨这种差异对乳腺癌患者预后的影响。方法 回顾性分析2012年1月—2018年12月就诊于徐州医科大学附属医院的188例乳腺癌转移灶再活检患者的病历资料。分别分析ER、PR和HER-2在原发灶及对应转移灶中的表达情况、转移部位的变化分布及其表达差异对预后的影响。结果 ER、PR和HER-2表达在原发灶和转移灶中的变化率分别为21.8%、33.5%和24.5%，其中PR和HER-2表达的差异均有统计学意义（P<0.05），ER表达的差异无统计学意义（P=0.117）。原发灶和转移灶中ER、PR表达不一致患者与表达一致患者的无进展生存期（PFS）比较，差异均有统计学意义（P<0.05），原发灶和转移灶中HER-2表达不一致患者与表达一致患者的PFS比较，差异无统计学意义（P=0.236）。结论 乳腺癌患者原发灶和转移灶中ER、PR和HER-2表达存在差异，且激素受体的表达变化能够影响患者的预后。检测乳腺癌转移灶中ER、PR和HER-2的表达，对个体化治疗策略的制定以及预后判断有重要的临床意义。

Clinical significance of biopsy of metastatic lesions in patients with breast cancer

Objective To compare the differences in expressions of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) in primary and metastatic lesions of breast cancer patients, and to explore the effects of such differences on prognosis of patients.Methods A retrospective analysis was made on the medical records of 188 breast cancer patients with metastasis who were confirmed by the Affiliated Hospital of Xuzhou Medical University between January 2012 and December 2018. Respectively analyze the expressions of ER, PR and HER-2 in primary lesions and corresponding metastatic sites, the distribution of their expression changes in metastatic sites, as well as the impact of expression differences on the prognosis of patients.Results The changing rate of ER, PR and HER-2 expression in primary and metastatic lesions was respectively 21.8%, 33.5% and 24.5%. The expression of PR was statistically different in primary and metastatic lesions, so was HER-2 expression (P<0.05), but the difference of ER expression in primary and metastatic lesions was not statistically significant (P=0.117). There was a statistical difference in the progression-free survival (PFS) between patients with concordant and discordant expression of ER and PR in the primary and metastatic lesions (P<0.05). But no statistical difference was found in PFS between patients with concordant HER-2 expression in primary and metastatic lesions and those without (P=0.236).Conclusion This study confirmed that the expressions of ER, PR and HER-2 in primary lesions were different with those in metastatic lesions of patients with breast cancer, and that such expression changes of hormone receptors can affect the prognosis of patients. Therefore, detecting the expressions of ER, PR and HER-2 in the metastatic lesions of breast cancer is of important clinical significance in making individual treatment strategies and evaluating prognosis.