A meta-analysis of oestrogen receptor,progesterone receptor and human epidermal growth factor receptor 2 discordance between primary breast cancer and metastases |
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| Affiliation: | 1. European Institute of Oncology, Medical Oncology, via Ripamonti 435, Milan, Italy;2. European Institute of Oncology, Division of Epidemiology and Biostatistics, via Ripamonti 435, Milan, Italy;3. European Institute of Oncology, Division of Pathology, via Ripamonti 435, Milan, Italy;4. University of Milan, School of Medicine, Milan, Italy;5. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, via Bicocca degli Arcimboldi 8, 20126 Milan, Italy;6. Second University of Naples, Medical Oncology, via Pansini 5, Naples, Italy;1. Department of Radiation Oncology, Catharina Hospital, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands;2. Department of Radiation Oncology, Institute Verbeeten, P.O. Box 90120, 5000 LA Tilburg, The Netherlands;3. Faculty of Health Medicine and Life sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;4. Department of Surgery, Elkerliek Hospital, The Netherlands;5. Department of Surgery, VieCuri Medical Centre, The Netherlands;6. Department of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands;7. Eindhoven Cancer Registry, Comprehensive Cancer Center South, P.O. Box 231, 5600 AE Eindhoven, The Netherlands;8. Department of Epidemiology, Maastricht University Medical Centre, Maastricht, The Netherlands;1. Institute of Cancer Sciences, University of Glasgow, Glasgow G11 6NT, UK;2. School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow G4 0SF, UK;3. School of Medicine, Department of Pathology, University of Glasgow, Southern General Hospital, Glasgow G51 4TF, UK;4. School of Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK;1. Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy;2. Medical Oncology 2, Istituto Oncologico Veneto IOV – IRCCS, Padova, Italy;3. Anatomy and Histology Unit, Padova Hospital, Padova, Italy;4. Pathology Unit, Ulss 5 Polesana, Rovigo, Italy;1. International Breast Cancer Center, Quiron Group, Barcelona, Spain;2. Medica Scientia Innovation Research, Barcelona, Spain;3. Medica Scientia Innovation Research, Ridgewood, NJ, USA;4. Institut Jules Bordet–Université Libre de Bruxelles, Brussels, Belgium;5. Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain;6. Institut Català d''Oncologia, L''Hospitalet de Llobregat, Barcelona, Spain;7. Hospital Clínico Universitario de Valencia, Valencia, Spain;8. Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, UK;9. Barts Hospital NHS Trust, London, UK;10. University Hospital Heidelberg, Medical Faculty Mannheim Heidelberg University, Heidelberg, Germany;11. Vall d''Hebron Institute of Oncology, Barcelona, Spain;12. Hospital Universitario A Coruña, UGC Oncología Intercentros, A Coruña, Spain;13. Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Malaga, Spain;14. Medical Oncology Service, Instituto de Investigaciones Biomédicas de Málaga, Malaga, Spain;15. Medical Oncology, University Hospital Ramón y Cajal, Madrid, Spain;p. Department of Medical Oncology, Hospital Universitari Sant Joan de Reus, Reus, Spain;q. Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain;r. Translational Genomics and Targeted Therapies Group, IDIBAPS, Barcelona, Spain;s. Department of Medicine, University of Barcelona, Barcelona, Spain;t. Institut Claudius Regaud, IUCT-Oncopole, Toulouse Cancer Research Centre, INSERM, Toulouse, France;u. APHP, Tenon Hospital IUC-UPMC, Nuclear Medicine and PET Center Department, Sorbonne University, Paris, France;v. IRCCS European Institute of Oncology, Division of Medical Senology, Milan, Italy;w. Centro Hospitalar Universitário do Porto, Porto, Portugal;x. Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy;y. Hospital Arnau de Vilanova, Universidad Catolica, Valencia, Spain |
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| Abstract: | BackgroundThe discordance in oestrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) status between primary and recurrent breast cancer is being intensively investigated and a large amount of data have been produced. However, results from different studies are heterogeneous and often conflicting. To highlight this issue, a meta-analysis of published data was performed.MethodsA literature search was performed using Medline, and all the studies published from 1983 to 2011 comparing changes in ER, PgR and/or HER2 status in patients with matched breast primary and recurrent tumours were included. We used random-effects models to estimate pooled discordance proportions.ResultsWe selected 48 articles, mostly reporting retrospective studies. Thirty-three, 24 and 31 articles were focused on ER, PgR and HER2 changes, respectively. A total of 4200, 2739 and 2987 tumours were evaluated for ER, PgR and HER2 discordance, respectively. The heterogeneity between study-specific discordance proportions was high for ER (I2 = 91%, p < 0.0001), PgR (I2 = 79%, p < 0.0001) and HER2 (I2 = 77%, p < 0.0001). Pooled discordance proportions were 20% (95% confidence interval (CI): 16–35%) for ER, 33% (95% CI: 29–38%) for PgR and 8% (95% CI: 6–10%) for HER2. Pooled proportions of tumours shifting from positive to negative and from negative to positive were 24% and 14% for ER (p = 0.0183), respectively. The same figures were 46% and 15% for PgR (p < 0.0001), and 13% and 5% for HER2 (p = 0.0004).ConclusionOur findings strengthen the concept that changes in receptor expression may occur during the natural history of breast cancer, suggesting clinical implications and a possible impact on treatment choice. |
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| Keywords: | Breast cancer HER2 Hormone receptors Concordance |
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