A meta-analysis of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 discordance between primary breast cancer and metastases

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Abstract

Background The discordance in oestrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) status between primary and recurrent breast cancer is being intensively investigated and a large amount of data have been produced. However, results from different studies are heterogeneous and often conflicting. To highlight this issue, a meta-analysis of published data was performed. Methods A literature search was performed using Medline, and all the studies published from 1983 to 2011 comparing changes in ER, PgR and/or HER2 status in patients with matched breast primary and recurrent tumours were included. We used random-effects models to estimate pooled discordance proportions. Results We selected 48 articles, mostly reporting retrospective studies. Thirty-three, 24 and 31 articles were focused on ER, PgR and HER2 changes, respectively. A total of 4200, 2739 and 2987 tumours were evaluated for ER, PgR and HER2 discordance, respectively. The heterogeneity between study-specific discordance proportions was high for ER (I2 = 91%, p <0.0001), PgR (I2 = 79%, p <0.0001) and HER2 (I2 = 77%, p <0.0001). Pooled discordance proportions were 20% (95% confidence interval (CI): 16-35%) for ER, 33% (95% CI: 29-38%) for PgR and 8% (95% CI: 6-10%) for HER2. Pooled proportions of tumours shifting from positive to negative and from negative to positive were 24% and 14% for ER (p = 0.0183), respectively. The same figures were 46% and 15% for PgR (p <0.0001), and 13% and 5% for HER2 (p = 0.0004). Conclusion Our findings strengthen the concept that changes in receptor expression may occur during the natural history of breast cancer, suggesting clinical implications and a possible impact on treatment choice.

Original languageEnglish
Pages (from-to)277-289
Number of pages13
JournalEuropean Journal of Cancer
Volume50
Issue number2
DOIs
Publication statusPublished - Jan 2014

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Progesterone Receptors
Estrogen Receptors
Meta-Analysis
Breast Neoplasms
Neoplasm Metastasis
Confidence Intervals
Neoplasms
human ERBB2 protein
Breast
Retrospective Studies

Keywords

  • Breast cancer
  • Concordance
  • HER2
  • Hormone receptors

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

@article{d0ab02fdcfe2427a95700e3ad6dac00f,
title = "A meta-analysis of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 discordance between primary breast cancer and metastases",
abstract = "Background The discordance in oestrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) status between primary and recurrent breast cancer is being intensively investigated and a large amount of data have been produced. However, results from different studies are heterogeneous and often conflicting. To highlight this issue, a meta-analysis of published data was performed. Methods A literature search was performed using Medline, and all the studies published from 1983 to 2011 comparing changes in ER, PgR and/or HER2 status in patients with matched breast primary and recurrent tumours were included. We used random-effects models to estimate pooled discordance proportions. Results We selected 48 articles, mostly reporting retrospective studies. Thirty-three, 24 and 31 articles were focused on ER, PgR and HER2 changes, respectively. A total of 4200, 2739 and 2987 tumours were evaluated for ER, PgR and HER2 discordance, respectively. The heterogeneity between study-specific discordance proportions was high for ER (I2 = 91{\%}, p <0.0001), PgR (I2 = 79{\%}, p <0.0001) and HER2 (I2 = 77{\%}, p <0.0001). Pooled discordance proportions were 20{\%} (95{\%} confidence interval (CI): 16-35{\%}) for ER, 33{\%} (95{\%} CI: 29-38{\%}) for PgR and 8{\%} (95{\%} CI: 6-10{\%}) for HER2. Pooled proportions of tumours shifting from positive to negative and from negative to positive were 24{\%} and 14{\%} for ER (p = 0.0183), respectively. The same figures were 46{\%} and 15{\%} for PgR (p <0.0001), and 13{\%} and 5{\%} for HER2 (p = 0.0004). Conclusion Our findings strengthen the concept that changes in receptor expression may occur during the natural history of breast cancer, suggesting clinical implications and a possible impact on treatment choice.",
keywords = "Breast cancer, Concordance, HER2, Hormone receptors",
author = "Gaetano Aurilio and Davide Disalvatore and Giancarlo Pruneri and Vincenzo Bagnardi and Giuseppe Viale and Giuseppe Curigliano and Laura Adamoli and Elisabetta Munzone and Angela Sciandivasci and {De Vita}, Fernando and Aron Goldhirsch and Franco Nol{\`e}",
year = "2014",
month = "1",
doi = "10.1016/j.ejca.2013.10.004",
language = "English",
volume = "50",
pages = "277--289",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Ltd",
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TY - JOUR

T1 - A meta-analysis of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 discordance between primary breast cancer and metastases

AU - Aurilio, Gaetano

AU - Disalvatore, Davide

AU - Pruneri, Giancarlo

AU - Bagnardi, Vincenzo

AU - Viale, Giuseppe

AU - Curigliano, Giuseppe

AU - Adamoli, Laura

AU - Munzone, Elisabetta

AU - Sciandivasci, Angela

AU - De Vita, Fernando

AU - Goldhirsch, Aron

AU - Nolè, Franco

PY - 2014/1

Y1 - 2014/1

N2 - Background The discordance in oestrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) status between primary and recurrent breast cancer is being intensively investigated and a large amount of data have been produced. However, results from different studies are heterogeneous and often conflicting. To highlight this issue, a meta-analysis of published data was performed. Methods A literature search was performed using Medline, and all the studies published from 1983 to 2011 comparing changes in ER, PgR and/or HER2 status in patients with matched breast primary and recurrent tumours were included. We used random-effects models to estimate pooled discordance proportions. Results We selected 48 articles, mostly reporting retrospective studies. Thirty-three, 24 and 31 articles were focused on ER, PgR and HER2 changes, respectively. A total of 4200, 2739 and 2987 tumours were evaluated for ER, PgR and HER2 discordance, respectively. The heterogeneity between study-specific discordance proportions was high for ER (I2 = 91%, p <0.0001), PgR (I2 = 79%, p <0.0001) and HER2 (I2 = 77%, p <0.0001). Pooled discordance proportions were 20% (95% confidence interval (CI): 16-35%) for ER, 33% (95% CI: 29-38%) for PgR and 8% (95% CI: 6-10%) for HER2. Pooled proportions of tumours shifting from positive to negative and from negative to positive were 24% and 14% for ER (p = 0.0183), respectively. The same figures were 46% and 15% for PgR (p <0.0001), and 13% and 5% for HER2 (p = 0.0004). Conclusion Our findings strengthen the concept that changes in receptor expression may occur during the natural history of breast cancer, suggesting clinical implications and a possible impact on treatment choice.

AB - Background The discordance in oestrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) status between primary and recurrent breast cancer is being intensively investigated and a large amount of data have been produced. However, results from different studies are heterogeneous and often conflicting. To highlight this issue, a meta-analysis of published data was performed. Methods A literature search was performed using Medline, and all the studies published from 1983 to 2011 comparing changes in ER, PgR and/or HER2 status in patients with matched breast primary and recurrent tumours were included. We used random-effects models to estimate pooled discordance proportions. Results We selected 48 articles, mostly reporting retrospective studies. Thirty-three, 24 and 31 articles were focused on ER, PgR and HER2 changes, respectively. A total of 4200, 2739 and 2987 tumours were evaluated for ER, PgR and HER2 discordance, respectively. The heterogeneity between study-specific discordance proportions was high for ER (I2 = 91%, p <0.0001), PgR (I2 = 79%, p <0.0001) and HER2 (I2 = 77%, p <0.0001). Pooled discordance proportions were 20% (95% confidence interval (CI): 16-35%) for ER, 33% (95% CI: 29-38%) for PgR and 8% (95% CI: 6-10%) for HER2. Pooled proportions of tumours shifting from positive to negative and from negative to positive were 24% and 14% for ER (p = 0.0183), respectively. The same figures were 46% and 15% for PgR (p <0.0001), and 13% and 5% for HER2 (p = 0.0004). Conclusion Our findings strengthen the concept that changes in receptor expression may occur during the natural history of breast cancer, suggesting clinical implications and a possible impact on treatment choice.

KW - Breast cancer

KW - Concordance

KW - HER2

KW - Hormone receptors

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