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

Gaetano Aurilio, Davide Disalvatore, Giancarlo Pruneri, Vincenzo Bagnardi, Giuseppe Viale, Giuseppe Curigliano, Laura Adamoli, Elisabetta Munzone, Angela Sciandivasci, Fernando De Vita, Aron Goldhirsch, Franco Nolè

Research output: Contribution to journalArticlepeer-review

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

Keywords

  • Breast cancer
  • Concordance
  • HER2
  • Hormone receptors

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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