Modificaciones En Ihq Recurreencia Vs Primario De Mama

original article

Annals of Oncology 20: 1953–1958, 2009 doi:10.1093/annonc/mdp263 Published online 12 July 2009

Prognostic impact of discordance between triple-receptor measurements in primary and recurrent breast cancer
C. Liedtke1,2, K. Broglio3, S. Moulder1, L. Hsu1, S.-W. Kau1, W. F. Symmans4, C. Albarracin4, F. Meric-Bernstam5, W. Woodward6, R. L. Theriault1, L. Kiesel2, G. N.Hortobagyi1, L. Pusztai1 & A. M. Gonzalez-Angulo1,7*
1 Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA; 2Department of Gynecology and Obstetrics, University of Muenster, Medical Center, Muenster, Germany; 3Division of Quantitative Sciences; Departments of 4Pathology; 5Surgical Oncology; 6Radiation Oncology and 7Systems Biology, The Universityof Texas M. D. Anderson Cancer Center, Houston, TX, USA

Received 29 March 2009; accepted 31 March 2009

Background: We evaluated discordance in expression measurements for estrogen receptor (ER), progesterone
receptor (PR), and HER2 between primary and recurrent tumors in patients with recurrent breast cancer and its effect on prognosis. Methods: A total of 789 patients with recurrentbreast cancer were studied. ER, PR, and HER2 status were determined by immunohistochemistry (IHC) and/or FISH. Repeat markers for ER, PR, and HER2 were available in 28.9%, 27.6%, and 70.0%, respectively. Primary and recurrent tumors were classified as triple receptor-negative breast cancer (TNBC) or receptor-positive breast cancer (RPBC, i.e. expressing at least one receptor). Discordance was correlatedwith clinical/pathological parameters. Results: Discordance for ER, PR, and HER2 was 18.4%, 40.3%, and 13.6%, respectively. Patients with concordant RPBC had significantly better post-recurrence survival (PRS) than discordant cases; patients with discordant receptor status had similarly unfavorable survival as patients with concordant TNBC. IHC scores for ER and PR showed weak concordance betweenprimary and recurrent tumors. Concordance of HER2–FISH scores was higher. Conclusions: Concordance of quantitative hormone receptor measurements between primary and recurrent tumors is modest consistent with suboptimal reproducibility of measurement methods, particularly for IHC. Discordant cases have poor survival probably due to inappropriate use of targeted therapies. However, biological changein clinical phenotype cannot be completely excluded. Key words: concordance, HER2, hormone receptors, survival, testing
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introduction
Expression of both hormone receptors [i.e. estrogen receptor (ER) and progesterone receptor (PR)] and HER2 is frequently used to clinically define the major breast cancer subtypes [1] thatshow differences in clinical outcome [2]. Breast cancers lacking expression of ER, PR, and HER2 are designated as triple-negative breast cancer (TNBC) and carry a particularly unfavorable prognosis [3, 4]. The latter is understood as a consequence of both worse prognostic features of these tumors (i.e. higher grade) and limited therapeutic options (i.e. lack of benefit from endocrine and trastuzumabtherapies).

*Correspondence to: Dr A. M. Gonzalez-Angulo, Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, TX 77039, USA. Tel: +1-713-792-2817; Fax: +1-713-794-4385; E-mail: agonzalez@mdanderson.org

Given the predictive importance of both hormone receptors and HER2, it is currently recommended that theyshould be determined as part of diagnostic routine on every primary invasive breast cancer [5]. However, changes in receptor status over the course of disease progression have been described. For instance, concordance rates between primary tumors and recurrence site of 71% and 56% have been reported for ER and PR expression, respectively [6]. For HER2, discrepancy rates for expression among...