[Expression discordances and clinical values of ER, PR, HER-2 and Ki-67 in primary and metastatic breast cancer].

Objective: To investigate the expression discordances of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor2 (HER-2) and Ki-67 in primary and metastatic breast cancer specimens and explore the clinical significances. Methods: Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and/or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER-2 and Ki-67 in primary and metastatic lesions, their relationships with prognosis were also analyzed. Results: Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER-2 and Ki-67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER-2 and Ki-67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P<0.001). The disease-free survival (DFS) of patients with ER, PR positive, HER-2 negative and low expression of Ki-67 in metastatic lesion was much longer (P<0.05). Conclusions: The expressions of ER, PR, HER-2 and Ki-67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.目的： 分析晚期乳腺癌患者原发灶和转移灶中雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2(HER-2)以及Ki-67的表达差异及其临床意义。 方法： 对203例体检和(或)影像学检查提示复发转移可能的乳腺癌患者，进行转移病灶活检，明确病理性质以及转移灶中ER、PR、HER-2和Ki-67的表达状态，分析其变化情况以及与患者预后的相关性。 结果： 203例患者中，3例穿刺失败，未能获得转移灶的病理和免疫组化结果；1例病理结果确诊为肺结核；1例确诊为原发性肺癌。198例乳腺癌原发灶和转移灶中，ER、PR、HER-2和Ki-67受体变化率分别为27.3%(54例)、34.3%(68例)、11.8%(19例)和15.1%(14例)。PR在转移灶中转为阴性更常见(P<0.001)。转移灶中ER和PR阳性、HER-2阴性以及Ki-67低表达的患者，术后的无病生存时间更长(均P<0.05)。转移灶ER的表达状态与患者的无病生存时间有关，转移灶ER阳性的患者较ER阴性患者的危险度降低了42.6%。 结论： 转移灶受体ER、PR、HER-2和Ki-67的表达与乳腺癌患者的预后有关，检测乳腺癌转移灶中各指标的表达对治疗方案的选择和预后判断有重要意义。.