乳腺癌原发灶和转移灶激素受体与HER2表达差异及其影响因素

目的 乳腺癌的治疗已经进入分子分型时代,雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和人类表皮生长因子受体-2(human epidermal growth factor receptor 2,HER2)的表达对指导制订乳腺癌治疗方案及评价患者预后等尤为重要.许多研究证实,部分乳腺癌患者原发灶及转移灶激素受体与HER2表达存在差异,影响术后辅助及解救治疗方案的制订,进而影响患者的治疗效果及预后.本研究探讨乳腺癌原发灶与腋窝及远处转移灶之间激素受体与HER2表达的差异及其临床意义,同时分析了造成差异的影响因素.方法 以乳腺癌、激素受体(ER和PR)、HER2、原发灶和转移灶为关键词,检索PubMed、CNKI数据库和万方数据库1995-01-2016-10的相关文献.共505篇文章被检索到.纳入标准:原发灶与腋窝转移灶激素受体及HER2表达差异情况,原发灶与远处转移灶激素受体及HER2表达差异情况,原发灶与转移灶激素受体及HER2表达差异情况的临床意义.根据纳入标准最终纳入分析38篇文献.结果 在部分乳腺癌患者中,原发灶与腋窝转移灶及远处转移灶激素受体及HER2表达情况存在差异,多数文献报道,乳腺癌原发灶与转移灶ER表达状况变化(阳性转阴性或阴性转阳性)比例约为20％,PR约为20％,HER2约为15％.“肿瘤异质性、抗肿瘤治疗和检测方法”等是影响其表达差异的影响因素.结论 推荐对于存在局部及远处转移的乳腺癌患者,同时检测并综合原发灶及转移灶的激素受体及HER2表达情况制订治疗方案.

Differential expression of hormone receptor and HER2 in primary and metastatic breast cancer and its influencing factors

OBJECTIVE The treatment of breast cancer has entered the era of molecular typing.The expression of estrogen receptor,progesterone receptor and HER2/neu are particularly important in guiding the development of breast cancer treatment protocols and evaluating the progress of patients.Many studies show that hormone receptor and HER2 expression status differences in primary breast cancer and metastatic cancer,which affecting the development of adjuvant and rescue plan,affecting the patient's therapeutic affect and prognosis.This article reviewed the difference of the expression of hormone receptor and HER2 between primary breast cancer and axillary with distant metastasis,and its clinical significance.At the same time,the factors that caused the differences were analyzed.METHODS Relevant articles were searched with "breast cancer,hormone receptor (ER,PR),HER2,primary tumor and metastasis" as key words in pubmed,CNKI,Wanfang database from 1995 to 2016,a total of 505 articles were retrieved.A totally of thirty-eight papers were slected according to the inclusion criteriaas follows:differences in the expression of hormone receptors and HER2 in primary and axillary metastases,differences in the expression of hormone receptors and HER2 in primary and distant metastases,the clinical significant of the expression of hormone receptors and HER2 in primary and metastatic lesions.RESULTS There are significant differences in the expression of hormone receptors and HER2 in the primary and axillary metastases and distant metastases in some breast cancer patients,Most literature reports that the change of ER expression in primary breast cancer and metastatic foci (positive negative or negative positive) is about 20％,PR is about 20％,HER2 is about 15 ％."Tumor heterogeneity","anti tumor therapy" and "detection method" are the factors that influence the expression difference.CONCLUSION It is recommended that breast cancer patients with local and distant metastasis also detect the expression of hormone receptors and HER2 in the primary and metastatic lesions,and formulate the treatment plan of the primary and metastatic foci.