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. 2009 Dec;20(12):1953-8.
doi: 10.1093/annonc/mdp263. Epub 2009 Jul 12.

Prognostic impact of discordance between triple-receptor measurements in primary and recurrent breast cancer

C Liedtke  1 , K Broglio, S Moulder, L Hsu, S-W Kau, W F Symmans, C Albarracin, F Meric-Bernstam, W Woodward, R L Theriault, L Kiesel, G N Hortobagyi, L Pusztai, A M Gonzalez-Angulo
Affiliations

Prognostic impact of discordance between triple-receptor measurements in primary and recurrent breast cancer

C Liedtke et al. Ann Oncol. 2009 Dec.

Abstract

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 recurrent breast 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 correlated with 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 between primary 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 change in clinical phenotype cannot be completely excluded.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves for post-recurrence survival stratified for (A) triple-negative breast cancer (TNBC) concordance versus discordance and (B) all four combinations of TNBC expression in primary tumor and recurrence.
Figure 2.
Figure 2.
Percentages of positively stained nuclei for (A) estrogen receptor (ER) and (B) progesterone receptor (PR) and (C) FISH scores for both the primary and recurrent tumor are plotted. For each plot, the x-axis refers to the primary tumor and the y-axis to the recurrence site. The black lines represent the thresholds for clinical positivity (i.e. 10% staining for ER and PR immunohistochemistry and a FISH ratio of >2.0 for HER2).
See this image and copyright information in PMC

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