【摘要】 目的:研究乳腺癌空芯针穿刺活检(core needle biopsy,CNB)对激素受体(hormone receptor,HR)、HER-2及Ki-67表达状况评价的可靠性,探讨新辅助化疗(neoadjuvant chemotherapy,NAC)对乳腺癌分子生物学信息表达的影响,分析上述生物学指标对NAC疗效的预测价值。方法:选择2012-03-01-2013-01-31山东省肿瘤医院外科收治的乳腺癌患者177例,其中行NAC者95例作为NAC组,未行NAC者82例作为对照组。免疫组织化学SP法检测两组患者CNB和治疗性手术切除标本中ER、PR、HER-2及Ki-67的表达状况,依据Miller-Payne分级系统评价化疗后病理反应,依据实体瘤反应评价标准(response evaluation criteria in solid tumors,RECIST)进行新辅助化疗的疗效评价。结果:对照组患者CNB和手术切除标本ER表达一致率为97.6%(80/82),PR为95.1%(78/82),HER-2为97.6%(80/82),Ki-67为92.7%(76/82),Spearman等级相关系数均>0.8,P均<0.05。NAC组和对照组CNB和手术切除标本比较,ER表达状况改变率分别为12.4%(10/79)和3.9%(2/82),差异有统计学意义,P=0.014;PR表达状况改变率分别为24.0%(19/79)和2.4%(4/82),差异有统计学意义,P=0.001;HER-2表达状况改变率分别为5.1%(4/79)和2.4%(2/82),差异无统计学意义,P=0.379;Ki-67表达状况改变率分别为38.0%(30/79)和7.3%(6/82),差异有统计学意义,P<0.001。NAC前后ER阳性率分别为64.6%和53.2%,差异无统计学意义,P=0.146;PR阳性率分别为63.3%和45.6%,差异有统计学意义,P=0.025;Ki-67高表达率分别为45.6%和15.2%,差异有统计学意义,P=0.017。化疗反应分级与ER、PR、HER-2表达变化无相关性,P均>0.05;与Ki-67表达变化明显相关,P=0.008。ER和PR表达状况与NAC疗效无相关性,P均>0.05;HER-2阳性的乳腺癌患者NAC有效率为81.8%,阴性者有效率为50.7%,差异有统计学意义,P=0.010;Ki-67高表达乳腺癌患者NAC有效率为70.2%,低表达者有效率为45.5%,差异有统计学意义,P=0.029。结论:CNB与手术切除标本在判断HR、HER-2和Ki-67表达状况上有很好的一致性;NAC能改变乳腺癌患者HR和Ki-67的表达状况,NAC使PR的阳性率降低,Ki-67的表达下降,ER阳性率有降低趋势,NAC对HER-2的表达无显著影响;HER-2阳性和Ki-67高表达的患者对化疗更敏感。更多还原

【Abstract】 OBJECTIVE:To study the reliability of core needle biopsy in evaluating the status of hormone receptor,HER-2and Ki-67in breast cancer,investigate the effects of chemotherapy on these biological factors and the predictive value of these biological factors in neoadjuvant chemotherapy.METHODS:Among the 177cases of breast cancer patients in our department from March 2012to January 2013,the expressions of ER,PR,HER-2and Ki-67were examined by immunohistochemical method between the core needle biopsies and surgical excision specimens in 95patients with NAC.As a control group,we analyzed sample pairs from 82patients without NAC.Pathological response of NAC was assessed using the Miller-Payer system and clinical response of NAC was evaluated by RECIST(response evaluation criteria in solid tumors).RESULTS:The expressions of ER 97.6%(80/82),PR 95.1%(78/82),HER-2 97.6%(80/82)and Ki-67 92.7%(76/82)had good coincidence between the core needle biopsies and surgical excision specimens.Ten(12.4%)of 79patients with NAC showed the ER status modulation in the surgically removed specimen as compared with 2(3.9%)of82patients without NAC,P=0.014.Nineteen(24.0%)of 79patients undergoing NAC appeared PR status alteration in the final surgical specimen,whereas only 4(2.4%)of 82patients without NAC did,P=0.001.The shift of HER-2status was found in 4(5.1%)of 79patients with NAC and in 2(2.4%)of 82patients without NAC,respectively,P=0.379.Thirty(38.0%)of 79patients with NAC and 6(7.3%)of 82patients without NAC showed the Ki-67status changed in the surgically removed specimen,P<0.001.The positive rates of ER before and after NAC were 64.6%and 53.2%,P=0.146.The positive rates of PR before and after NAC were 63.3%and 45.6%,P=0.025.The high expression rates of Ki-67before and after NAC were 45.6%and 15.2%,P=0.017.The status of ER,PR had no obvious relation with the efficiency of NAC(P>0.05).The efficiency of NAC between the patients with HER-2positive and the patients with HER-2negative was 81.8%and 50.7%,P=0.010.The efficiency of NAC between the patients with high expression of Ki-67and the patients with low expression of Ki-67was 70.2%and 45.5%,P=0.029.CONCLUSIONS:The core needle biopsies have good coincidence with surgical excision specimen in determining the status of ER,PR,HER-2and Ki-67.NAC can change the status of ER,PR and Ki-67.The expression of Ki-67and the positive rate of PR decreased after NAC,while the decrease of ER positive rate showed no statistically significant.NAC had no effect on the status of HER-2.HER-2positive and high expression of Ki-67are correlated to better response with chemotherapy.更多还原