Biomarker conversion from primary breast cancer to synchronous axillary lymph node metastasis and neoadjuvant therapy response: a single-center analysis

Mao Ding ¹, Mengyuan Li ¹, Qian Liu ¹

⁰Department of Thyroid and Breast Surgery, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.

Journal of Cancer Research and Clinical Oncology +

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June 8, 2024

View abstract on PubMed

Summary

Biomarker profiles (ER, PR, HER2, Ki67) differ between primary breast cancer and lymph node metastases. This receptor discordance impacts neoadjuvant therapy response, particularly for hormone receptor-positive cases.

Area Of Science

Oncology
Breast Cancer Research
Biomarker Discovery

Background

Biomarker characteristics like estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki67 are crucial for predicting breast cancer treatment sensitivity.
Understanding receptor status in both primary tumors and metastatic sites is essential for tailoring neoadjuvant therapy.

Purpose Of The Study

To compare immunohistochemical profiles (ER, PR, HER2, Ki67) between primary breast tumors and synchronous axillary lymph node metastases.
To investigate the impact of receptor discordance on response to neoadjuvant therapy in breast cancer patients.

Main Methods

Retrospective study of 358 breast cancer patients with synchronous axillary lymph node metastasis treated with neoadjuvant therapy.
Analysis of clinicopathologic data, focusing on receptor status (ER, PR, HER2, Ki67) in primary and metastatic lesions.

Main Results

Discordance in ER, PR, HER2, and Ki67 expression was observed in 5.9%, 8.7%, 12.6%, and 17.3% of patients, respectively.
Hormone receptor (HR) discordance was more frequent with negative primary ER/PR status; HER2 discordance was more frequent with HER2-0/low primary status.
Loss of HR-positivity correlated with better neoadjuvant chemotherapy response, while unstable HER2 status decreased pCR rates.

Conclusions

Receptor discordance between primary breast tumors and axillary lymph node metastases exists before therapy.
Current receptor instability has limited impact on neoadjuvant therapy choices but warrants further study with new treatments like ADCs.

Keywords:

Breast cancer Discordance Lymph node metastasis Neoadjuvant therapy Receptor