| Objective: The purpose of this study was to investigate the differentical expression of ER, PR, Her-2 and Ki-67 in primary tumor and simultaneous axillary lymph node metastases of breast cancer patients and explore the clinical significance of changes in the biological characteristics in breast cancer.Methods: The data of 57 patients of breast cancer with axillary lymph node metastasis in the same period(52 cases of non special type of invasive breast cancer and5 cases of papillary carcinoma) admitted to The Second Hospital of Dalian Medical University from June 2013 to March 2015 was retrospectively analyzed. All patients were performed operation in our hospital(17 cases of breast-conserving surgery and 40 cases of modified radical mastectomy) and underwent neoadjuvant chemotherapy and radiotherapy before the surgery. Immunohistochemical analysis was used to evaluate the expression of ER, PR, Her-2 and Ki-67 in primary tumor and simultaneous axillary lymph node metastases. Statistical methods were used to analyze the expression differences and correlation of biological markers above in primary tumor and simultaneous axillary lymph node metastases.Results: Among the 57 breast cancer patients with axillary lymph node metastasis,80.7% of them(45/57) were found ER-positive in primary tumor, 13.3%(6/45) were found ER-positive in primary tumor and ER-negative in axillary lymph node metastases and 16.7%(2/12) were found negative to positive. The total rate of expressiondifference of ER was 14.0%(8/57). The ER-positive rate of simultaneous axillary lymph node metastasis was 71.9%(41/57). The PR-positive, Her-2-positive and Ki-67-positive rates of primary tumor were 57.9%(33/57), 19.3%(11/57) and 43.9%(25/57) respectively. The total rates of differential expression for biomarkers in primary breast tumor and simultaneous axillary lymph node metastases were 8.8% for PR(5/57,6.0%(2/33) from positive to negative and 12.5%(3/24) from negative to positive),10.5% for Her-2(6/57, 18.1%(2/11) from positive to negative and 8.7%(4/46) from negative to positive) and 35.1% for Ki-67(20/57, 44%(11/25) from positive to negative and 28.1%(9/32) from negative to positive) respectively. The positive expression rates of PR, Her-2 and Ki-67 in simultaneous axillary lymph node metastasis were 56.1%(32/57), 22.8%(13/57) and 38.6%(22/57) respectively. A differential expression of ER,PR, Her-2 and Ki-67 in primary tumor and simultaneous axillary lymph node metastases was found but with no statistically significant difference(all P>0.05).Among the 57 breast cancer patients with axillary lymph node metastasis, differential expression of ER, PR, Her-2 and Ki-67 in primary tumor and simultaneous axillary lymph node metastases accounted for 45.6%(26/57), while consistent expression accounted for 54.4%(31/57). Among the 26 breast cancer patients with differential expression of biomarkers, 84.6%(23/26) of them presented different molecular subtypes in primary tumor and simultaneous axillary lymph node metastases, while15.4%(3/26) of them presented consistent molecular subtypes.Age, menopausal status and the maximum diameter of primary tumor exerted no effect on the expression differences of ER, PR and Ki-67 in primary tumor and simultaneous axillary lymph node metastases, and with no statistically significant difference(P>0.05). Age and menopausal status exerted no effect on the expression difference of Her-2, and with no statistically significant difference(P>0.05). A statistically significant difference in the expression difference of Her-2 and the maximum diameter of primary tumor(P=0.046) was observed. And a higher expression consistency of Her-2 in primary tumor and simultaneous axillary lymph node metastases was observed when the maximum diameter of primary tumor was more than2 cm.A correlation in the expression differences of ER and Her-2 was found, which was the same as PR and Ki-67.Conclusion: A differential expression of ER, PR, Her-2 and Ki-67 in primary tumor and simultaneous axillary lymph node metastases was found. Although with no statistically significant difference, this differential expression could result in changes of molecular subtypes in axillary lymph node metastases. In the individualized clinical treatment of breast cancer patients with axillary lymph node metastasis, we recommend testing the expression of biological markers in metastatic axillary lymph nodes at the same time in order to develop more accurate and effective individualized therapeutic regimen. |
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