Impact of shifting of hormonal receptor and human epidermal growth factor receptor 2 on survival of non-metastatic breast cancer

Objectives This study explores variations in hormone receptor (HR) status between biopsy and post-operative reports, as well as changes following neoadjuvant chemotherapy (NACT). The correlation between HR status alterations and patient survival outcomes is the key focus of this investigation. Material and Methods This retrospective study conducted at a tertiary care center in Kolkata, Eastern India, from 2013 to 2018. Results The parameters of 482 breast cancer patients meeting inclusion criteria were studied. The majority were >40 years (68.2%), with 300 receiving NACT. Clinical staging distribution was I (2.9%), IIA (10.4%), IIB (22.2%), IIIA (34.3%), IIIB (28.6%), and IIIC (1.6%). Preoperative and postoperative staging changes occurred in 47.7%, with 38.8% downstaging and 13.5% upstaging. Estrogen receptor (ER), progesterone receptor (PR), and Her2neu positivity at diagnosis were observed in 46.3%, 41.9%, and 36.9% of patients, respectively. Postoperative ER, PR, and Her2neu positivity were 46.1%, 40%, and 37.3%, respectively. Recurrence in 33.6% of patients correlated with factors like age, tumor grade, lymphovascular invasion (LVI), Perineural invasion (PNI), postoperative stage, ER, PR, and their changes. Multivariate analysis identified age, PNI, postoperative stage, stage change, ER, and PR changes as independent factors for recurrence. The correlation study demonstrated a significant association between NACT and changes in PR status (χ2 = 16.56; p = 0.001), while no significant associations were found for ER and Her2neu changes. Analysis of variance (ANOVA) revealed a substantial association between NACT and PR status changes (p = 0.001). Post Hoc tests indicated significant differences in PR status changes related to NACT. Kaplan-Meier survival analysis revealed a significant difference in disease-free survival (DFS) based on changes in ER and PR status, with ER-positive patients having a median DFS of 76 months and PR-positive patients showing a median DFS of 47 months. No significant DFS difference was observed for changes in Her2neu status. Conclusion Changes in hormone receptor status, particularly ER and PR, significantly impacted recurrence and DFS. The study highlights the importance of personalized management strategies, with age, tumor grade, lymphovascular invasion (LVI), and changes in ER and PR status identified as key factors influencing prognosis.