Clinical Significance Of Differential Expression For ER,PR,HER-2 And Ki-67 Between Primary Tumor And Metastases In Breast Cancer

Objective:To compare and analyze the expression status of ER,PR,HER-2 and Ki-67 between primary and metastases in breast cancer patients who were received treatment in Cancer Hospital of Ningxia Medical University.We not only calculate the discordance in ER,PR,HER-2 and Ki-67 between primary and metastases,as well as analyze the possible reasons for the inconsistency between the two.Then,we also explore its clinical significance,so as to seek the best treatment strategy for patients with metastatic breast cancer.Method:A retrospective analysis was made on 208 patients with pathological diagnosed metastatic breast cancer admitted in the Cancer Hospital of Ningxia Medical University from January 2016 to February 2018.Immunohistochemical analysis was used to evaluate the expression of ER,PR,HER-2 and Ki-67 in primary tumor and metastases.Statistical methods were used to analyze the expression differences of biological markers above between primary and metastases.Result: 1.Discordance in ER,PR,HER-2 and Ki-67 between primary and metastatic lesions.(1)Among the 208 patients with metastatic breast cancer,74.0% of them(154/208)were found ER positive in primary lesions,62.5% of them(130/208)were found ER positive in metastatic lesions,44 patients were that ER converted from primarylesions positive to metastatic lesions negative,20 patients were changed to positive status,the discordance rate for ER was 30.77%,with a statistical significance in differential expression of ER in both primary lesions and metastatic lesions according to chi-square test(P<0.05).(2)34.62% of 208 patients appeared in the discordance of PR status.Among 136 patients,there were sixty in which primary tumor was positive,but metastatic lesions was negative.Among 72 patients,there were12(16.7 %)in which primary tumor was negative,but metastatic lesions was positive.With a statistical significance in differential expression of PR between primary lesions and metastatic lesions according to chi-square test(P<0.05).(3)Among those patients,33.2% of them(69/208)were found HER-2 positive in primary lesions,32.7% of them(68/208)were found Her-2 positive in metastatic lesions,16 patients were that Her2 converted from primary lesions positive to metastatic lesions negative,15 patients were changed to positive status,the discordance rate for Her2 was14.9%,with no statistical significance in differential expression of Her-2 between primary lesions and metastatic lesions according to chi-square test(P>0.05).(4)Eighty-four(40.38 %)of 208 patients appeared in the discordance of Ki-67 status.Among 169 patients,there were ten in which primary tumor was positive,but metastatic lesions was negative.Among 124 patients,there were 74(59.67 %)in which primary tumor was negative,but metastatic lesions was positive.With a statistical significance in differential expression of Ki-67 between primary lesions and metastatic lesions according to chi-square test(P<0.05).2.The relationship between the differential expression of ER,PR,HER-2 and Ki-67 and metastasis sites:Among those 208 patients,cases for first transfer were 148(71.15%),for the rest of 60 were not.Proportion of the liver metastasis is the largest.The discrepancy of ER,PR,HER-2,Ki-67 between visceral metastases and non-visceral metastasis was(29.58%,31.39%),(30.99%,36.50%),(11.27%,16.79%),(39.44%,40.88%).The differentialexpression of PR has associated with different metastasis sites(P<0.05),but there is no relationship between the differential expression of ER,HER-2,Ki-67 and different metastasis sites(P>0.05).3.ER,PR,HER-2 and Ki-67 expression differences in primary tumors and metastases of breast cancer and the relationship with the clinical features.In our study,208 female patients with breast cancer were included,among which 161 were Han,42 were Hui,4cases were Man,and only one case is Mongolian.The age among those patients ranged from31 years old to 71 years old,the average age is 54 years.Cases for women over age 35 with primary tumors and metastases ER positive were 148,129 respectively,with PR positive were130,87 respectively,with HER-2 positive were 64,63 respectively,and with Ki-67 positive we-re 100,160 respectively.Cases for women less than 35 years old,with primary tumors and metastases ER positive were 6,1respectively,with PR positive were 6,1 respectively,with HER-2 positive were 5,5 respectively,and with Ki-67 positive were 5,9 respectively.Results show that there was no difference in the expression of ER,PR,HER-2 and ki-67 in primary and metastatic foci in different ethnic groups.These biological indicators were more consistent in primary and metastatic lesions in patients older than 35 years old.Discordance in ER between primary and metastatic lesions ER were associated with patients' age,the difference was statistically significant(P<0.05),but there is no relationship between the differential expression of PR,HER-2 and Ki-67 and patients' age.Conclusions:1.With a statistical significance in differential expression of ER,PR between primary lesions and metastatic lesions(P>0.05).Most patients with ER,PR positive primaries changed to negative status in metastatic lesions,and endocrine therapy is available for those who with ER,PR negative primaries changed to positive status in metastatic lesions.2.The expression of Her-2 is relatively stable in primary and metastatic lesions of breast cancer,the number of HER-2 positive get and the number of HER-2 positive loss is roughly equal,there is no statistical significance between primary lesions and metastatic,andtargeted therapy is selectable for those who with Her-2 negative primaries changed to positive status in metastatic lesions.3.There is statistical significance between primary lesions and metastatic on differential expression of Ki-67,suggesting that the metastatic lesion is more malignant than the primary lesion,and the prognosis is poorer,and intensive treatment is needed.4.The expression of ER,HER-2,Ki-67 between different metastasis sites is undifferentiated,thus there is no necessary to take multiple biopsies for breast cancer patients who suffered multiple metastatic,so we can take biopsies from accessible place.