乳腺癌患者原发灶与复发转移灶中ER、PR、HER-2及Ki-67表达异质性的回顾性分析

目的:探讨ER、PR、HER-2及Ki-67在乳腺癌患者原发灶及复发转移灶中的表达差异，并分析其对乳腺癌患者预后的影响。方法:统计2012年01月01日2021年12月31日我院肿瘤科收治的复发转移性乳腺癌患者，除外病理及临床资料缺失的患者后，共计89例患者纳入本研究。采用回顾性队列研究方法，比较乳腺癌原发灶及复发转移灶中ER、PR、HER-2及Ki-67的表达差异。结果:本研究纳入患者的平均年龄为53.14岁(20~84岁)。其中有34例患者接受术前新辅助治疗，所有患者均行乳腺癌根治术或改良根治术，并进行了相应的术后辅助治疗。乳腺癌原发灶中ER及PR阳性表达率均高于转移灶；而HER-2阳性及Ki-67高表达的情况在转移灶中更常见。乳腺癌原发灶与复发转移灶中ER、PR、HER-2、Ki-67表达差异比例分别为:24.72%、42.70%、11.24%、13.48%。乳腺癌原发灶及转移灶中ER、PR表达的异质性与患者无病生存期相关。结论:乳腺癌患者的ER、PR、HER-2和Ki-67表达状态在原发灶与复发转移灶中存在一定的异质性，进而影响患者的治疗策略及预后。

Retrospective analysis of the discordance in ER,PR,HER-2 and Ki-67 expression between recurrent metastasis and primary sites in breast cancer patients

Objective:To investigate the differential expressions of ER,PR,HER-2 and Ki-67 in primary and recurrent metastasis breast cancer patients.Further,analyze their effects on disease-free survival of breast cancer patients.Methods:The medical records from January 01,2012 to December 31,2021 were collected by case retrieval system of our hospital.Excluding cases with missing pathological and clinical data,a total of 89 cases with recurrent metastasis breast cancer were included in this study.The clinical characteristics，including ER,PR,HER-2 and Ki-67 status of patients were recorded in detail,and the discordance between recurrent metastasis and primary sites were further studied by survival analysis.Results:The mean age of the enrolled patients was 53.14 years (20~84 years).All patients underwent radical mastectomy or modified radical mastectomy,and corresponding postoperative adjuvant therapy.Among them,34 patients received preoperative neoadjuvant therapy.The positive expression rates of ER and PR in the primary breast cancer were higher than those in metastasis sites.High expression of HER-2 and Ki-67 were more common in recurrent metastasis sites.The differences of ER，PR,HER-2 and Ki-67 expression in primary lesions and recurrent metastasis lesions were 24.72%，42.70%，11.24%and 13.48%，respectively.Biomarker discordance of ER and PR expression were correlated with disease-free survival.Conclusion:The inconsistent expression of ER,PR,HER-2 and Ki-67 in breast cancer patients between primary and recurrent metastasis lesions,may further affects the treatment strategy and survival of patients.