Prospective Study Evaluating the Impact of Tissue Confirmation of Metastatic Disease in Patients With Breast Cancer
Prospective Study Evaluating the Impact of Tissue Confirmation of Metastatic Disease in Patients With Breast Cancer
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DOI：
10.1200/jco.2010.33.5232
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发表时间：
2012-02-20
影响因子：
45.3
通讯作者：
Clemons, Mark
中科院分区：
文献类型：
--
作者：
Amir, Eitan;Miller, Naomi;Clemons, Mark
转移性乳腺癌患者的治疗决定通常基于原发肿瘤的雌激素（ER）、孕激素（PgR）和人表皮生长因子受体2（HER 2）状态。回顾性数据表明，原发性和转移性病灶之间的不一致导致有害的结果。这项前瞻性研究调查受体状态的原发性肿瘤和转移在同一个病人，并评估不一致对患者的管理和survival.Patients和MethodsBiopsies怀疑转移的影响进行了分析ER，PgR，和HER 2。使用类似的方法分析原发性肿瘤和转移瘤。治疗肿瘤学家在活检前后指示治疗计划，以确定结果是否影响管理。患者进行了随访的进展或death.ResultsOf 121妇女接受活检，80%可以分析受体状态。原发灶和转移灶之间ER、PgR和HER 2的不一致性分别为16%、40%和10%。活检导致14%的女性报告了管理变更（95% CI，8.4%至21.5%）。细针抽吸和骨活检导致分析受体的能力降低。中位随访12个月后，受体不一致性和治疗失败或总生存率之间的关联没有任何趋势。临床医生根据活检结果改变7例患者中1例的立即治疗，不一致性不会对结果产生不利影响。乳腺癌和疑似转移复发的妇女应考虑组织确认。J Clin Oncol 30：587-592. (c)2011年美国临床肿瘤学会
PurposeDecisions about treatment for women with metastatic breast cancer are usually based on the estrogen (ER), progesterone (PgR), and human epidermal growth factor receptor 2 (HER2) status of the primary tumor. Retrospective data suggest that discordance between primary and metastatic lesions leads to detrimental outcome. This prospective study investigated receptor status of primary tumors and metastases in the same patient and assessed the impact of discordance on patient management and survival.Patients and MethodsBiopsies of suspected metastases were analyzed for ER, PgR, and HER2. Primary tumors and metastases were analyzed using similar methodology. The treating oncologist indicated a treatment plan before and after biopsy to determine whether the result influenced management. Patients were followed up for progression or death.ResultsOf 121 women undergoing biopsy, 80% could be analyzed for receptor status. Discordance in ER, PgR, and HER2 between the primary and the metastasis was 16%, 40%, and 10%, respectively. Biopsy led to a reported change of management in 14% of women (95% CI, 8.4% to 21.5%). Fine-needle aspiration and biopsy of bone led to reduced ability to analyze receptors. After a median follow-up of 12 months, there were no trends for an association between receptor discordance and either time to treatment failure or overall survival.ConclusionBiopsy of metastases is technically feasible. Clinicians alter immediate management in one of seven patients on the basis of results of the biopsy, and discordance is not then associated with detrimental effects on outcome. Tissue confirmation should be considered in women with breast cancer and suspected metastatic recurrence. J Clin Oncol 30:587-592. (c) 2011 by American Society of Clinical Oncology