HER2转阴对一线治疗后无进展生存和总生存影响不显著。 因此,该单中心回顾研究结果表明,乳腺癌骨转移后受体表达水平变化真实存在,并提供了各种变化率供业界参考;同时,这可能直接导致预后改变或导致后续治疗改变,最终显著影响生存结局。尤其值得注意的是,对肿瘤原发灶HER2零表达患者骨转移灶进行再次活检,有可能使患者获得新药(例如德曲妥珠单抗等新型抗体缀合药物)治疗机会,故有必要进一步开展多中心大样本前瞻研究进行验证。 Int J Cancer. 2022 Nov 21. IF: 7.316 Incidence and prognostic significance of receptor discordance between primary breast cancer and paired bone metastases. Lin M, Jin Y, Lv H, Hu X, Zhang J. Fudan University Shanghai Cancer Center, China; Shanghai Medical College, Fudan University, Shanghai, China. ER, PgR, and HER-2 status are the cornerstones of choosing systemic therapy for breast cancer, but can change during the disease course. Guidelines recommended the biopsy of the metastatic tumor to reassess receptor status. Bone is the most frequent metastatic site of breast cancer but remained technically difficult to biopsy. Our study aimed to evaluate the incidence and prognostic significance of receptor discordance between primary breast cancer and paired bone metastases. 155 breast cancer patients were diagnosed with pathology-confirmed bone metastasis at Fudan University Shanghai Cancer Center. 93 patients with receptor status available on both primary tumor and bone metastases were included in our study. ER, PgR, and HER-2 status converted from positive to negative in 10.8% (10/93), 28.0% (26/93), and 8.6% (8/93) of the patients, while ER, PgR, and HER-2 status converted from negative to positive in 3.2% (3/93), 4.3% (4/93), and 1.1% (1/93) of the patients, respectively. 40.4% (17/42) of the HER2-0 tumors converted to HER2-low, which enabled them to receive the treatment of new antibody-drug conjugates (ADCs). Prior endocrine and anti-HER2 therapy were the independent risk factors for receptor conversion. Loss of HR expression in bone metastases was significantly associated with worse first-line PFS (adjusted hazard ratio=3.271, P-value=0.039) and OS (adjusted hazard ratio=6.09, P-value=0.011). In conclusion, our study confirmed that patients may experience receptor conversion between primary breast cancer and bone metastases, possibly influenced by prior treatments, which significantly influenced prognosis. The re-biopsy of bone metastases in patients with primary HER2-0 tumors may benefit from the new ADC drugs. PMID: 36408915 DOI: 10.1002/ijc.34365