Re-testing of predictive biomarkers on surgical breast cancer specimens is clinically relevant
Re-testing of predictive biomarkers on surgical breast cancer specimens is clinically relevant
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DOI：
10.1007/s10549-018-05119-2
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发表时间：
2019-04-01
影响因子：
3.8
通讯作者：
Hartman, Johan
中科院分区：
文献类型：
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作者：
Robertson, Stephanie;Ronnlund, Caroline;Hartman, Johan
目的乳腺癌预测和预后生物标志物评估的准确性至关重要，因为它们指导治疗决策。目的是研究生物标志物和基于免疫组化（IHC）的替代肿瘤亚型在核心针活检（CNB）和连续配对乳腺癌手术切除之间的一致性。方法本回顾性研究纳入了2016年至2017年诊断的两组原发性乳腺癌患者：一组接受原发性手术治疗（n=526），一组接受新辅助化疗（NAC） （n=216）。在两个队列中，评估了术前CNB和配对肿瘤标本在生物标志物和替代肿瘤亚型评估方面的一致性。结果原发性手术队列中，雌激素受体（ER）、孕激素受体（PR）和Ki67的符合率和kappa值分别为98.6%（=0.917）、89.3%（=0.725）和78.8%（=0.529）。重要的是，人表皮生长因子受体2 (HER2) IHC评估显示只有中等程度的一致性（=0.462）。在3.6%的病例中，结合IHC和原位杂交的HER2状态不一致，这可能影响HER2靶向治疗的适应症。基于ihc的替代肿瘤亚型的符合率仅为73.2% ~ 78.3%。在NAC队列中，ER、PR和HER2的符合率普遍较低。在这里，7.4%的人HER2状态不一致。结论原发性乳腺癌CNB与配对手术标本HER2、Ki67表达不一致。替代肿瘤亚型的有限一致性表明对手术标本进行生物标志物重新检测具有重要的临床价值。
PurposeThe accuracy of predictive and prognostic biomarker assessment in breast cancer is paramount since these guide therapy decisions. The aim was to investigate the concordance of biomarkers and immunohistochemical (IHC)-based surrogate tumor subtypes between core needle biopsies (CNB) and consecutive paired breast cancer surgical resections.MethodsThis retrospective study comprised two cohorts of patients with primary breast cancer diagnosed between 2016 and 2017: one treated with primary surgery (n=526) and one with neoadjuvant chemotherapy (NAC) (n=216). The agreement between preoperative CNB and paired tumor specimens regarding the assessment of biomarkers and surrogate tumor subtypes was evaluated in both cohorts.ResultsIn the primary surgery cohort, the concordance rates and kappa values for estrogen receptor (ER), progesterone receptor (PR) and Ki67 were 98.6% (=0.917), 89.3% (=0.725) and 78.8% (=0.529), respectively. Importantly, human epidermal growth factor receptor 2 (HER2) IHC assessment showed only moderate agreement (=0.462). HER2 status combining IHC and in situ hybridization was discordant in 3.6% of cases, potentially impacting on indications for HER2-targeted therapy. The concordance rate for IHC-based surrogate tumor subtypes was only 73.2-78.3%. Generally lower concordance rates for ER, PR and HER2 were observed in the NAC cohort. Here, HER2 status was discordant in 7.4%.ConclusionsThe agreement of HER2 and Ki67 between CNB and paired surgical specimen in primary breast cancer is insufficient. Limited agreement of surrogate tumor subtypes indicates a significant clinical value of biomarker re-testing on surgical specimens.