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Ding M, Li M, Liu Q, Xu L. Biomarker conversion from primary breast cancer to synchronous axillary lymph node metastasis and neoadjuvant therapy response: a single-center analysis. J Cancer Res Clin Oncol 2024; 150:297. [PMID: 38850362 PMCID: PMC11162378 DOI: 10.1007/s00432-024-05834-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE The biomarker characteristics of breast cancer plays an important role in predicting treatment sensitivity. The aim of the present study was to compare immunohistochemical profiles (ER, PR, HER2, and Ki67) between the primary tumor and synchronous axillary lymph node metastasis and investigate the subsequent effects on neoadjuvant therapy response. METHODS A total of 358 patients with pathologically confirmed synchronous axillary lymph node metastasis at first diagnosis and treated by neoadjuvant therapy at Peking University First Hospital from January 1, 2013 to December 31, 2022 were included in this retrospective study. Clinicopathologic data, especially receptor status in primary and metastatic foci, was collected for each case. RESULTS Change of ER, PR, HER2, and Ki67 expression was observed in 5.9%, 8.7%, 12.6%, and 17.3% of patients, respectively. HR discordance was observed more frequently when the ER status (p = 0.023) or PR status (p = 0.010) of primary tumor was negative, while HER2 discordance seemed to be more frequent when the HER2 status of primary tumor was HER2-0 or HER2-low (p < 0.001). Patients with loss of HR-positivity (positive to negative) responded to neoadjuvant chemotherapy better compared to those with stable positive HR expression (50% vs. 11.1%, p = 0.0017). A significantly decrease in pCR rate was observed in patients with unstable HER2 status, but not in the HER2-0/HER2-low subgroup. CONCLUSION Receptor discordance between primary tumor and synchronous axillary LNM appears to already exist before any anti-tumor therapy. This instability has limited clinical impact on the choice of neoadjuvant therapy at current stage, but further investigation is warranted with the incremental application of endocrine drugs and ADCs in neoadjuvant therapy.
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Affiliation(s)
- Mao Ding
- Department of Thyroid and Breast Surgery, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China
| | - Mengyuan Li
- Department of Thyroid and Breast Surgery, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China
| | - Qian Liu
- Department of Thyroid and Breast Surgery, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China
| | - Ling Xu
- Department of Thyroid and Breast Surgery, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.
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Marletta S, Giorlandino A, Cavallo E, Dello Spedale Venti M, Leone G, Tranchina MG, Gullotti L, Bonanno CL, Spoto G, Falzone G, Tornabene I, Trovato C, Baron MM, Di Mauro G, Falsaperna L, Angelico G, Pafumi S, Rizzo A. Discordance of Biomarker Expression Profile between Primary Breast Cancer and Synchronous Axillary Lymph Node Metastasis in Preoperative Core Needle Biopsy. Diagnostics (Basel) 2024; 14:259. [PMID: 38337775 PMCID: PMC10854870 DOI: 10.3390/diagnostics14030259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/12/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Breast cancer (BC) is a heterogeneous disease made up of clones with different metastatic potential. Intratumoral heterogeneity may cause metastases to show divergent biomarker expression, potentially affecting chemotherapy response. Methods: We investigated the immunohistochemical (IHC) and FISH profile of estrogen receptors (ER), progesterone (PR) receptors, Ki67, and HER2 in a series of BC-matched primary tumors (PTs) and axillary lymph node (ALN) metastases in pre-operative core needle biopsies (CNBs). Phenotypical findings were correlated to morphological features and their clinical implications. Results: Divergent expression between PTs and ALNs was found in 10% of the tumors, often involving multiple biomarkers (12/31, 39%). Most (52%) displayed significant differences in ER and PR staining. HER2 divergences were observed in almost three-quarters of the cases (23/31, 74%), with five (16%) switching from negativity to overexpression/amplification in ALNs. Roughly 90% of disparities reflected significant morphological differences between PTs and ALN metastases. Less than half of the discrepancies (12/31, 39%) modified pre/post-operative treatment options. Conclusions: We observed relevant discrepancies in biomarker expression between PTs and metastatic ALNs in a noteworthy proportion (10%) of preoperative BC CNBs, which were often able to influence therapies. Hence, our data suggest routine preoperative assessment of biomarkers in both PTs and ALNs in cases showing significant morphological differences.
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Affiliation(s)
- Stefano Marletta
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy
| | | | - Enrico Cavallo
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Michele Dello Spedale Venti
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giorgia Leone
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Maria Grazia Tranchina
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Lucia Gullotti
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Claudia Lucia Bonanno
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Graziana Spoto
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giusi Falzone
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Irene Tornabene
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Carmelina Trovato
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Marco Maria Baron
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giuseppe Di Mauro
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Lucia Falsaperna
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giuseppe Angelico
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Anatomic Pathology, University of Catania, 95125 Catania, Italy;
| | - Sarah Pafumi
- Medical Oncology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy;
- Section of Oncology, Department of Medicine, University of Verona, Verona University Hospital Trust (AUOI), 37124 Verona, Italy
| | - Antonio Rizzo
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
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