Oncotarget

Research Papers:

Receptor conversion in metastatic breast cancer: a prognosticator of survival

Xiangying Meng, Santai Song, Ze-Fei Jiang, Bing Sun, Tao Wang, Shaohua Zhang and Shikai Wu _

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Oncotarget. 2016; 7:71887-71903. https://doi.org/10.18632/oncotarget.12114

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Abstract

Xiangying Meng1, Santai Song2, Ze-Fei Jiang2, Bing Sun1, Tao Wang2, Shaohua Zhang2, Shikai Wu1

1Radiotherapy Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China

2Breast Cancer Department, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China

Correspondence to:

Shikai Wu, email: skywu4923@sina.com

Keywords: breast cancer, estrogen receptor, progesterone receptor, metastases, survival

Received: June 09, 2016    Accepted: September 05, 2016    Published: September 19, 2016

ABSTRACT

Objective: This retrospective study investigated the association between hormone receptor (HR) conversion and survival in breast cancer patients.

Methods: Estrogen receptor (ER) and progesterone receptor (PR) status (positive or negative) of primary tumors and of paired metastatic sites in 627 breast cancer patients were analyzed by McNemar’s test for rates of receptor conversion. A survival analysis was performed using the Kaplan-Meier method, and prognostic factors were assessed using Cox’s proportional hazards regression model.

Results: Conversion of ER occurred in 165 (26.31%) patients, and conversion of PR in 213 (33.97%; P < 0.001, both). For 82 patients whose ER and PR were reassessed 2-4 times during metastatic progression, ER and PR re-conversion occurred in 22 (26.83%) and 29 (35.36%), respectively. The change of ER or PR from positive to negative was associated with worse overall survival and post-recurrent survival (log-rank; P < 0.001, both). A subgroup analysis of HR-positive patients (i.e., positive ER, PR, or both) in primary tumor and HR-negative in metastatic sites showed that patients who accepted both salvage endocrine therapy and chemotherapy had better post-recurrent survival than did those who accepted salvage chemotherapy only (log-rank; P = 0.003).

Conclusion: ER and PR status may change several times during metastatic tumor progression. A change of HR from positive to negative was associated with worse survival compared with consistent positivity. Repeated evaluations of HR status are necessary in metastatic breast cancer. Salvage hormonal therapy is still worth trying for patients whose HR status changes from positive to negative.


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