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Annals of Oncology Advance Access originally published online on July 12, 2009
Annals of Oncology 2009 20(12):1953-1958; doi:10.1093/annonc/mdp263
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

breast cancer

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

C. Liedtke1,2, K. Broglio3, S. Moulder1, L. Hsu1, S.-W. Kau1, W. F. Symmans4, C. Albarracin4, F. Meric-Bernstam5, W. Woodward6, R. L. Theriault1, L. Kiesel2, G. N. Hortobagyi1, L. Pusztai1 and A. M. Gonzalez-Angulo1,7,*

1 Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
2 Department of Gynecology and Obstetrics, University of Muenster, Medical Center, Muenster, Germany
3 Division of Quantitative Sciences
4 Department of Pathology
5 Department of Surgical Oncology
6 Department of Radiation Oncology
7 Department of Systems Biology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

* Correspondence to: Dr A. M. Gonzalez-Angulo, Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, TX 77039, USA. Tel: +1-713-792-2817; Fax: +1-713-794-4385; E-mail: agonzalez{at}mdanderson.org

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.

Key words: concordance, HER2, hormone receptors, survival, testing

Received for publication March 29, 2009. Accepted for publication March 31, 2009.


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