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Breast cancer during follow-up and progression - A population based cohort on new cancers and changed biology
Karolinska Inst, Canc Ctr Karolinska, Radiumhemmet, Dept Oncol Pathol, Stockholm, Sweden.;St Gorans Univ Hosp, S-11281 Stockholm, Sweden.;Cent Hosp Karlstad, Dept Oncol, S-65230 Karlstad, Sweden..
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School. Karlstad Univ, Dept Econ & Stat, Karlstad, Sweden..ORCID iD: 0000-0002-9356-8767
Cent Hosp Karlstad, Dept Pathol, S-65230 Karlstad, Sweden..
Cent Hosp Karlstad, Dept Surg, S-65230 Karlstad, Sweden..
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2014 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no 17, 2916-2924 p.Article in journal (Refereed) PublishedText
Abstract [en]

Background: Emerging data indicate an important role for biopsies of clinically/radiologically defined breast cancer 'recurrences'. The present study investigates tumour related events (relapses, other malignancies, benign conditions) after a primary breast cancer diagnosis. Patients and methods: The cohort includes 2102 women, representing all patients, with primary invasive breast cancer during 2000-2011 in the county of Varmland, Sweden. A comparative analysis of oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and proliferation (Ki67) between the primary tumour and the relapse was performed and related to outcome. Results: With a mean follow-up time of 4.8 years, 1060 out of 2102 patients have had a biopsy taken after the initial breast cancer diagnosis demonstrating 177 recurrences, 93 other malignancies (colorectal, lung, skin), 40 cancer in situ (skin, breast) and 857 benign lesions. Approximately 70% (177 out of 245) of all cases of relapsed breast cancer underwent a biopsy during this time period. For patients with recurrences, ER (n = 127), PR (n = 101), HER2 (n = 73) and Ki67 (n = 55) status in both primary tumour and the corresponding relapse were determined. The discordance of receptor status was 14.2%, 39.6%, 9.6% and 36.3%, respectively. Loss of ER or PR in the relapse resulted in a significant increased risk of death (hazard ratio (HR) 3.62; 95% confidence interval (CI), 1.65-7.94) and (HR 2.34; 95% CI, 1.01-5.47) compared with patients with stable ER or PR positive tumours. The proportion of patients losing ER was bigger in the group treated with endocrine therapy alone or in combination with chemotherapy, 16.7% and 13.3%, respectively, compared with the group treated with chemotherapy alone or that which received no treatment 4.3% and 7.7%, respectively. Conclusion: Discordance of biomarkers between the primary tumour and the corresponding relapse was seen in 10-40% of the patients, adjuvant therapies seem to drive clonal selections. Patients with tumours losing ER or PR during progression have worse survival compared with patients with retained receptor expression. (C) 2014 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2014. Vol. 50, no 17, 2916-2924 p.
Keyword [en]
Breast cancer, Oestrogen receptor, Progesterone receptor, Human epidermal growth factor receptor 2, Biomarker
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:kau:diva-41493DOI: 10.1016/j.ejca.2014.08.014ISI: 000344628300004PubMedID: 25241230OAI: oai:DiVA.org:kau-41493DiVA: diva2:923169
Available from: 2016-04-25 Created: 2016-04-11 Last updated: 2016-07-07Bibliographically approved

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Appelgren, Jari
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